The ASAs 'other' website posts lies, insinuations and scare tactics .... again...

[ADMIN]

The ASA setup a website called "life line to modern medicine" which is little more than their own propaganda site veiled as some sortof public service.

On there is a new article about "anesthesia providers and your safety" found HERE (http://lifelinetomodernmedicine.com/ArticlePage.aspx?ID=ec7a7f12-ecfd-42f3-8907-3a82a449513e&LandingID=fc6eb1da-98e4-43c7-bb9f-09c17e2a005d) and pasted below.



Facts About Anesthesia Providers & Your Safety




Straight Facts About Anesthesia Providers and Your Safety

Some politicians and bureaucrats want to change the face of health care in the United States by replacing physicians with nurses. They claim it will “cut costs” and “increase access,” but no objective analysis supports such claims. Multiple polls conclude that citizens want a physician involved in their anesthesia care, but the government is ignoring those interests. Allowing nurses to administer anesthesia without supervision may put you and your family at risk. Here are the facts you need to know about opt out measures and changes that may affect you.

Anesthesia care is about patient safety.

It’s true. Physician anesthesiologists have significantly improved anesthesia safety and delivery for the benefit of their patients. They have designed safer anesthesiology medicines, monitoring devices and methods in efforts to decrease preventable mishaps. However, it’s the advanced skill and experience learned during eight or more years of medical training that enables the anesthesiologist or supervising physician to identify, diagnose and prevent anesthesia complications. These actions could save a patient’s life.

What does “Opt Out” mean?

Federal rules require that a physician supervise the administration of anesthesia. This long-standing federal requirement has successfully protected patients for 45 years and provided access to the highest standard of medical care available.

Some states are choosing to “opt out” of this requirement on the basis that it will “cut-costs” and “expand access” of healthcare services to rural areas. In opt out states, nurse anesthetists can administer anesthesia for any type of medical procedure – including major surgeries like open heart surgery and lung transplants in any medical facility (rural or urban) – without a physician’s supervision.

How many states currently opt out?

Sixteen states have opted out, to date.

Do nurses and physicians receive the same amount of anesthesia training?

No. Anesthesiologists are physicians who have received a medical education including at least eight years of post-college education and training. Nurse anesthetists have nursing education including two to three years of post-college education. Nurse anesthetists are competent to perform the technical aspects of the administration of anesthesia, but do not have the education, skills or training to fully manage patients, respond to medical complications, or advance the science of anesthesiology.

As the population ages, more and more complex medical conditions will require highly educated and skilled anesthesiologist’s.

Does opting out cut healthcare costs?

No. Medicare and many private payers pay anesthesiologists and nurse anesthetists at the same rate, therefore no cost savings to taxpayers occurs.

This means that for identical cases a nurse who administers anesthesia receives the same payment under Medicare (and many private payers) as an anesthesiologist who provides the anesthesia.

Is it less costly to employ nurses than employing doctors?

No. Some have argued that nurse anesthetists make less money, and therefore cost the health care system less. Nurse anesthetists are the highest paid nurses in their profession. According to the Merritt Hawkins and Associates salary report, nurse anesthetists’ salaries have increased 85 percent to $189,000 since 1999.

Will opting out expand access in rural states?

No. Opting out will not improve access to anesthesia care. Patients in rural hospitals have had access to appropriate anesthesia care since 1965.

Instead, opting out replaces physicians with nurses in the rural setting and creates two standards of care. Patients in urban and rural areas should receive the same quality of anesthesia care. Federal law requires physician supervision of nurse anesthetists during the administration of anesthesia. In the absence of an anesthesiologist, the operating practitioner is present to supervise the nurse anesthetist.

Anesthesiology care remains a life-or-death matter.

Physicians involved in anesthesiology have improved its safety and delivery for the benefit of their patients. They have designed safer anesthesiology medicines, devices and methods in efforts to decrease preventable mishaps. A physician applies advanced medical knowledge to diagnosing and preventing factors that contribute to complications of patients receiving anesthesia.

[RAYMAN]

Wow....so many holes, so much B$, so little time

[MmacFN]

Wow... talk about low hanging fruit.

Ok.. here we go.



Some politicians and bureaucrats want to change the face of health care in the United States by replacing physicians with nurses.

This isnt new, it has been proven and is safe.


They claim it will “cut costs” and “increase access,” but no objective analysis supports such claims.

There have been many studies which have shown this. Try google scholar and medline.


Allowing nurses to administer anesthesia without supervision may put you and your family at risk

Now this is an outright lie. Nurse Anesthetists have been doing SOLO anesthesia and anesthesia without MDAs for over a century. Even after over 60 studies none have proven any difference in ANY metric between MDAs and CRNAs doing anesthesia. There is no risk, there are no concerns and that is a fact.


it’s the advanced skill and experience learned during eight or more years of medical training that enables the anesthesiologist or supervising physician to identify, diagnose and prevent anesthesia complications. These actions could save a patient’s life.

Yet after DECADES of trying they STILL CANNOT PROVE THIS STATEMENT. Somehow the ASA thinks "evidence by proclamation" will convince people but those days are LONG gone.


Federal rules require that a physician supervise the administration of anesthesia. This long-standing federal requirement has successfully protected patients for 45 years and provided access to the highest standard of medical care available.

No this isnt what it means. It means that in order for the hospital to bill medicare part A. These are the COPs (conditions for participation) for hospitals to participate in medicare. It means there must be an operating practitioner to order anesthesia. It does NOT have to be an MDA.

Supervision, PER the CMS explanation ((42 CFR §482.52)) DOES NOT MEAN:

MD has to have specific anesthesia training---- NOPE

MD has to be specifically privileged to supervise
CRNAs ---- NOPE

Supervising practitioner has to be an anesthesiologist ---- NOPE

Does not impose liability on surgeons who are the
“supervising” MD (NOPE NO LIABILITY OR THE SUPERVISING PRACTITIONER)

So, since its inception there has NEVER been any requirement for the 'supervising practitioner' to have ANY interaction or direction over the CRNA. None nadda nix. Clearly, this means the CRNA has been the one to direct this care. So the COPs are irrelevant when it comes to how the anesthetic will be done and who makes those decisions. Moreover, the fact of the matter is that no matter WHO is doing the anesthetic there will always be an operating practitioner available since there must be one to do the operation. Clearly this shows there is no need for 'supervision' as it is meaningless.

Some states are choosing to “opt out” of this requirement on the basis that it will “cut-costs” and “expand access” of healthcare services to rural areas. In opt out states, nurse anesthetists can administer anesthesia for any type of medical procedure – including major surgeries like open heart surgery and lung transplants in any medical facility (rural or urban) – without a physician’s supervision.

THAT is what opt out means.



Nurse anesthetists are competent to perform the technical aspects of the administration of anesthesia, but do not have the education, skills or training to fully manage patients, respond to medical complications, or advance the science of anesthesiology.

No Proof for any of this whatsoever. I "fully manage patients" every single day as so thousands of CRNAs.


As the population ages, more and more complex medical conditions will require highly educated and skilled anesthesiologist’s.

The average age of admission where I work is 78. Yet we have no problems and in fact the facility is happier as are the patients, staff and surgeons since we replaced the all MDA practice.


No. Medicare and many private payers pay anesthesiologists and nurse anesthetists at the same rate, therefore no cost savings to taxpayers occurs.

Incorrect. The only one which pays the same for CRNAs or MDAs is CMS. private payers have been shown to pay between 5-10$ more per unit for MDA services (why i dont know). Also, this ABSOLUTELY neglects the cost of STIPENDS the hospital must pay to maintain the high salary of MDAs for the same service. Over 85% of MDA run groups require this and it ranges from 1-5 million per practice. This cost is DIRECTLY passed on to the patients.



No. Some have argued that nurse anesthetists make less money, and therefore cost the health care system less. Nurse anesthetists are the highest paid nurses in their profession. According to the Merritt Hawkins and Associates salary report, nurse anesthetists’ salaries have increased 85 percent to $189,000 since 1999.


Quick math. Average MDA salary 375-450K PLUS perks. Average CRNA salary per the AANA in 2009 was 160K plus bennies. So, you can get 2 CRNAs for every MDA. Having said that, the MDAs in this area are making 500-750K a year. So that would be FOUR CRNAs for every 1 MDA.


No. Opting out will not improve access to anesthesia care. Patients in rural hospitals have had access to appropriate anesthesia care since 1965.

By CRNAs. There is a reason why over 85% of all rural anesthesia is provided by CRNAs and that is because they are the only ones who are there to do it.


Physicians involved in anesthesiology have improved its safety and delivery for the benefit of their patients.

No proof at all for this statement but considerable proof to refute it. Again, "evidence by proclamation".


So, end assessment, total bullshit.

[deepz]

.......Quick math. Average MDA salary 375-450K PLUS perks. Average CRNA salary per the AANA in 2009 was 160K plus bennies. So, you can get 2 CRNAs for every MDA. Having said that, the MDAs in this area are making 500-750K a year. So that would be FOUR CRNAs for every 1 MDA.......

Their position COMPLETELY ignores the wide gap in training costs -- ours, mostly paid by our own damn selves; theirs, mostly paid by the guvmint via Medicare.

A$Aholes!

[sandmanpk]

I just navigated through their site. How many things will they try in order to put down CRNAs? The stupidity of the site is that some people may stumble upon it looking for information on "modern medicine". What they'll find is BS about how MDAs will essentially be your family physician, but only during your surgical experience.

This from the website: "Anesthesiologists are concerned with your well-being. After all, we’re the physicians that manage your overall health and vital signs when you are the most vulnerable".

Gag factor is 10/10 on this one. One more reason I hate'em.

[deepz]

The Curdle Zone, where the cream of nursing rises to mingle with the dregs of medicine.

[Levi]

It is pretty sad that a few people in one profession, (anesthesiology), are so determined to trample on another profession (nurse anesthesia). I don't often read posts from CRNAs running anesthesiologists through the mud. Is it too much to ask for a respected and safe group of professionals to practice independant from another group? It is nice to see it mentioned in previous posts on this thread that the "supervising doctor" for many CRNAs is the surgeon doing the case. Now, what appreciable help is an orthopod in an emergency involving anesthesia? I am not knocking the profession of orthopedics, but it does seem strange that a surgeon would be an acceptable and valuable help in a field that they have no training. Should a CRNA be the go-to person for the surgeon? Now, I will agree that in my brief education, it seems that physicians have driven most of the research in anesthesia, but that doesn't seem like a valid reason for them to control and supervise the profession. Maybe, since anesthesiologists didn't invent the car, they shouldn't be allowed to drive one without a supervising engineer.

[MmacFN]

Hey

Have to keep in mind that 'supervision' is a billing term and has nothing to do with who knows what. When in a non-opt-out state and a CRNA is working independently the COPs (condition for participation) for medicare part A for the hospital is that a physician order anesthesia. They take and have no part in the delivery of the anesthesia nor do they have any liability.



It is pretty sad that a few people in one profession, (anesthesiology), are so determined to trample on another profession (nurse anesthesia). I don't often read posts from CRNAs running anesthesiologists through the mud. Is it too much to ask for a respected and safe group of professionals to practice independant from another group? It is nice to see it mentioned in previous posts on this thread that the "supervising doctor" for many CRNAs is the surgeon doing the case. Now, what appreciable help is an orthopod in an emergency involving anesthesia? I am not knocking the profession of orthopedics, but it does seem strange that a surgeon would be an acceptable and valuable help in a field that they have no training. Should a CRNA be the go-to person for the surgeon? Now, I will agree that in my brief education, it seems that physicians have driven most of the research in anesthesia, but that doesn't seem like a valid reason for them to control and supervise the profession. Maybe, since anesthesiologists didn't invent the car, they shouldn't be allowed to drive one without a supervising engineer.

[Anthony]

Heres another angle....in some other facilities - when the terms are used (supervised/directed) it is used to describe the relationship of how to manage the CRNAs ...meaning that they are is literally supervised and directed by the MDAs - which is what is told to the patients


Hey

Have to keep in mind that 'supervision' is a billing term and has nothing to do with who knows what. When in a non-opt-out state and a CRNA is working independently the COPs (condition for participation) for medicare part A for the hospital is that a physician order anesthesia. They take and have no part in the delivery of the anesthesia nor do they have any liability.

[jwk]

It is pretty sad that a few people in one profession, (anesthesiology), are so determined to trample on another profession (nurse anesthesia). I don't often read posts from CRNAs running anesthesiologists through the mud. Is it too much to ask for a respected and safe group of professionals to practice independant from another group? It is nice to see it mentioned in previous posts on this thread that the "supervising doctor" for many CRNAs is the surgeon doing the case. Now, what appreciable help is an orthopod in an emergency involving anesthesia? I am not knocking the profession of orthopedics, but it does seem strange that a surgeon would be an acceptable and valuable help in a field that they have no training. Should a CRNA be the go-to person for the surgeon? Now, I will agree that in my brief education, it seems that physicians have driven most of the research in anesthesia, but that doesn't seem like a valid reason for them to control and supervise the profession. Maybe, since anesthesiologists didn't invent the car, they shouldn't be allowed to drive one without a supervising engineer.

It is pretty sad that a few people in one profession (CRNA's) are so determined to trample on another profession (AA's).

Really dude - you don't see posts with CRNA's knocking anesthesiologists? They're all over this website - you gotta be friggin kidding me.

[MmacFN]

AAs are not in the same category as MDAs and CRNAs. I dont have to hold you back, your job description does.

As for the comments about MDAs. I think I speak for everyone here when I say that MDAs are generally good people who do a great job for patients. Very few here have ever disparaged MDAs as a group of providers. However, many have fought back against their association (ASA) lying about and attempting to control our profession which they have no right to do.


It is prettry sad that a few people in one profession (CRNA's) are so determined to trample on another profession (AA's).

Really dude - you don't see posts with CRNA's knocking anesthesiologists? They're all over this website - you gotta be friggin kidding me.

[LouisiAnimal]

It is prettry sad that a few people in one profession (CRNA's) are so determined to trample on another profession (AA's).

Really dude - you don't see posts with CRNA's knocking anesthesiologists? They're all over this website - you gotta be friggin kidding me.

He said he doesn't READ posts from CRNAs knocking anesthesiologists. Pay attention

[jwk]

AAs are not in the same category as MDAs and CRNAs. I dont have to hold you back, your job description does.

All I was doing is paraphrasing. Once again, the hypocrisy is amazing. And just so I'm clear on what you're saying - you're denying that CRNA's make any attempt to limit or block AA practice?

[MmacFN]

Oh no, our association and the state associations will fight AAs all the way. As well they should. However, your professions future is limited because of your absolutely lack of flexibility and options in the anesthesia marketplace. Practices like mine are springing up all over the country taking over all MD and ACT practices. AAs could not work in my practice, at all. The economics of healthcare preclude the spread of your profession and, as is highly clear based on recent events, everyone who matters knows where we are headed and supports it. Even if magically tomorrow AAs were available in every state, the practice opportunities for AAs will only dwindle. It is a basic economic fact and the research, no matter what rhetoric the ASA likes to spew, is absolutely in favor of the model I work in and CRNA only models. The days of 2 people being paid to do one anesthetic, hospital stipends and unproductive staff are over. Evidence by proclamation is the ASAs ONLY response and here is the kicker, NOONE is believing them anymore. Noone.

Be glad yer closer to retirement jwk, cause AAs future is anything but bright and we both know it.


All I was doing is paraphrasing. Once again, the hypocrisy is amazing. And just so I'm clear on what you're saying - you're denying that CRNA's make any attempt to limit or block AA practice?

[Levi]

Sorry there JWK, didn't mean to inflame the issue between AAs and CRNAs. I only mean to point out that CRNAs don't go around saying that MDAs are crappy providers but the reverse seems to be true. I haven't heard all of the arguments between AAs and CRNAs. I would think that your fight would be with MDAs and i really don't see why AAs would even bother fighting with CRNAs. As I understand it, you are working under the supervision of MDAs, not CRNAs. The term anesthesia assistant- like physician assistant- seems to be the catch that is keeping yall from having a great argument for independant practice. Come up with a different moniker and maybe yall can cut the cord and roll on. I would think that if you could re-name the practice and if the research showed the same outcomes between all 3 groups that provide anesthesia, there would be no way that you could be reasonably held back from independant practice. It is my humble opinion that the fields of physician assistant and anesthesia assistant were created was to prevent them from ever being able to challenge for independant practice. I am in school with a bunch PAs and it seems that they are getting a very high quality education and I assume that the AA program is just as rigorous. If It is interesting to note that in the hospital I worked at before starting school, CRNAs were not able to practice in the hospital unless taking SRNAs through a case or in an emergency as a last resort. Now that hospital has opened up an AA school. Hmmm, don't want CRNAs to practice there, but will train a bunch of AAs. Yep, I do believe that MDAs are trying vigorously to train up a bunch of AAs so that they will be able to control them and can maybe edge out a few CRNAs in the process.

[Anthony]

Its not just the moniker - they are trained with dependency built in - there must be connection/supervision - no ifs or buts about it... the word independence doesn't exits in their job description being that they were created by the ASA.


Sorry there JWK, didn't mean to inflame the issue between AAs and CRNAs. I only mean to point out that CRNAs don't go around saying that MDAs are crappy providers but the reverse seems to be true. I haven't heard all of the arguments between AAs and CRNAs. I would think that your fight would be with MDAs and i really don't see why AAs would even bother fighting with CRNAs. As I understand it, you are working under the supervision of MDAs, not CRNAs. The term anesthesia assistant- like physician assistant- seems to be the catch that is keeping yall from having a great argument for independant practice. Come up with a different moniker and maybe yall can cut the cord and roll on. I would think that if you could re-name the practice and if the research showed the same outcomes between all 3 groups that provide anesthesia, there would be no way that you could be reasonably held back from independant practice. It is my humble opinion that the fields of physician assistant and anesthesia assistant were created was to prevent them from ever being able to challenge for independant practice. I am in school with a bunch PAs and it seems that they are getting a very high quality education and I assume that the AA program is just as rigorous. If It is interesting to note that in the hospital I worked at before starting school, CRNAs were not able to practice in the hospital unless taking SRNAs through a case or in an emergency as a last resort. Now that hospital has opened up an AA school. Hmmm, don't want CRNAs to practice there, but will train a bunch of AAs. Yep, I do believe that MDAs are trying vigorously to train up a bunch of AAs so that they will be able to control them and can maybe edge out a few CRNAs in the process.

[Levi]

Its not just the moniker - they are trained with dependency built in - there must be connection/supervision - no ifs or buts about it... the word independence doesn't exits in their job description being that they were created by the ASA.

Thanks for the info Anthony.

[JadamR15]

Sorry there JWK, didn't mean to inflame the issue between AAs and CRNAs. I only mean to point out that CRNAs don't go around saying that MDAs are crappy providers but the reverse seems to be true. I haven't heard all of the arguments between AAs and CRNAs. I would think that your fight would be with MDAs and i really don't see why AAs would even bother fighting with CRNAs. As I understand it, you are working under the supervision of MDAs, not CRNAs. The term anesthesia assistant- like physician assistant- seems to be the catch that is keeping yall from having a great argument for independant practice. Come up with a different moniker and maybe yall can cut the cord and roll on. I would think that if you could re-name the practice and if the research showed the same outcomes between all 3 groups that provide anesthesia, there would be no way that you could be reasonably held back from independent practice. It is my humble opinion that the fields of physician assistant and anesthesia assistant were created was to prevent them from ever being able to challenge for independent practice. I am in school with a bunch PAs and it seems that they are getting a very high quality education and I assume that the AA program is just as rigorous. If It is interesting to note that in the hospital I worked at before starting school, CRNAs were not able to practice in the hospital unless taking SRNAs through a case or in an emergency as a last resort. Now that hospital has opened up an AA school. Hmmm, don't want CRNAs to practice there, but will train a bunch of AAs. Yep, I do believe that MDAs are trying vigorously to train up a bunch of AAs so that they will be able to control them and can maybe edge out a few CRNAs in the process.


Bad assumption.

Don't tell JWK that. AA's are around to have a more scientifically advanced provider, don't ya know?

Whatever.

[nurse9288]

Bad assumption.

Don't tell JWK that. AA's are around to have a more scientifically advanced provider, don't ya know?

Whatever.

NO AA's are not more scientifically advanced. That's completely wrong, and AA's does not equal MDA. If it did, where are the outcome studies? I think it is ridiculous to suggest an AA has the same amount of training as an MDA/CRNA

[jwk]

NO AA's are not more scientifically advanced. That's completely wrong, and AA's does not equal MDA. If it did, where are the outcome studies? I think it is ridiculous to suggest an AA has the same amount of training as an MDA/CRNA

I think you're confused. AA's have never suggested that we are equal to an anesthesiologist. CRNA's are the ones that claim that (incorrectly of course). You're also extremely confused if you think a CRNA has the same amount of training as an anesthesiologist.

[nurse9288]

well the facts r the facts. outcome studies show that CRNA's are the same (in some cases, better outcomes, but not past the statistical significance so it is more fair to say equal). The Extra MDA knowledge is erroneous, it's cool to have, but has zero percent impact on the delivery of anesthesia.

[MmacFN]

It was not that long ago we discusses an AAs blog about his program.... lets just say it was a good laugh and not at ALL close to what CRNAs do and go through. I laughed at the "graded on a curve because the average grade was 50" comment and how they grade on a curve ALL THE TIME. We had no curve.


Bad assumption.

Don't tell JWK that. AA's are around to have a more scientifically advanced provider, don't ya know?

Whatever.

[JadamR15]

I think you're confused. AA's have never suggested that we are equal to an anesthesiologist. CRNA's are the ones that claim that (incorrectly of course). You're also extremely confused if you think a CRNA has the same amount of training as an anesthesiologist.

No comment on the "Scientific advanced" part, I see...

That's ignoring what I said, don't you think? Really diverting the point, bud.

But ya know, I can understand why you would do that. Carry on, soldier. ;)

[Johnga]

Graded on a curve? Are you kidding me? We had a lot of people fail out...if you couldn't learn you didn't graduate.
Since I am curious about AA training...do you have a link to the blog?

[MmacFN]

It is classic and displays CLEARLY how inferior their training really is. Luckily, I have downloaded and archived the ENTIRE thing.

without posting the specifics (ill send you the link in pm) this student mentions how his whole class failed an exam but because they are all graded on standard deviation they all actually pass. This apparently happens quite often. Also, they never fail, they get to 'remediate' and continue on in the program.

After all, when you are an 'assistant' and always will be under the thumb of an MDA you really dont need to know what you are doing.

PM sent.





Graded on a curve? Are you kidding me? We had a lot of people fail out...if you couldn't learn you didn't graduate.
Since I am curious about AA training...do you have a link to the blog?

[rustymills]

Get a load of what the MDAs are up to in Alabama.... They are trying to take Interventional Regional Pain Management away from us! That means no Labor Epidurals, Epidural Steriod Injections, Blood Patches, etc.! I just got laid off my job due to the economy leaving so many in the area without insurance and slowing down our surgery schedule so much. The MDA who just failed his Boards for the third time is still going to have his job though. BCBS of Alabama does not recognize us as Providers, so they simply do not pay us without an MDA in the building to sign for us. (I know what the BS stands for!) It took me all of 36 hours to find another job that pays better and (the best part)... it is a CRNA-only group! *SWEET* I am moving away from Alabama so I no longer have to deal with the most restrictive Nurse Practice Laws in the US.

[SuccsDrugs&Rocuron]

Get a load of what the MDAs are up to in Alabama.... They are trying to take Interventional Regional Pain Management away from us! That means no Labor Epidurals, Epidural Steriod Injections, Blood Patches, etc.! I just got laid off my job due to the economy leaving so many in the area without insurance and slowing down our surgery schedule so much. The MDA who just failed his Boards for the third time is still going to have his job though. BCBS of Alabama does not recognize us as Providers, so they simply do not pay us without an MDA in the building to sign for us. (I know what the BS stands for!) It took me all of 36 hours to find another job that pays better and (the best part)... it is a CRNA-only group! *SWEET* I am moving away from Alabama so I no longer have to deal with the most restrictive Nurse Practice Laws in the US.

second only to Louisiana--good for you, btw!

[ethernaut]

second only to Louisiana--good for you, btw!

i have to argue with both of you. BON in NY doesn't even recognize us as APNs, AND... the BON and higher ed are aware that we are practicing outside our undesignated scope of practice on a daily basis.

[FockerRN]

Okay, upon graduation don't move to Alabama, Louisiana or New York, check.... Anywhere else?

[JadamR15]

Okay, upon graduation don't move to Alabama, Louisiana or New York, check.... Anywhere else?


were kindve hijacking, but there are many states that are very restrictive....it's all about finding the right practice within that state.....every state has some gold nuggets.....rural ones just have more (from the practice perspective).

you can add PA to the list.

[Esper]

Okay, upon graduation don't move to Alabama, Louisiana or New York, check.... Anywhere else?

Like most states, your job is more dependent on the hospital in Alabama. For example, in my home town the entire medical community has signed and written a petition against ruling to prevent CRNAs from doing steroid injections. These rural docs are here to support the community and they know the need the CRNAs to do that.

Also there are many great independent and crna only practices here, and even some pretty autonomous ACT practices.

My point is don't write off an entire state. You really gotta look at individual practices.

[militarymd]

Get a load of what the MDAs are up to in Alabama.... They are trying to take Interventional Regional Pain Management away from us! That means no Labor Epidurals, Epidural Steriod Injections, Blood Patches, etc.! I just got laid off my job due to the economy leaving so many in the area without insurance and slowing down our surgery schedule so much. The MDA who just failed his Boards for the third time is still going to have his job though. BCBS of Alabama does not recognize us as Providers, so they simply do not pay us without an MDA in the building to sign for us. (I know what the BS stands for!) It took me all of 36 hours to find another job that pays better and (the best part)... it is a CRNA-only group! *SWEET* I am moving away from Alabama so I no longer have to deal with the most restrictive Nurse Practice Laws in the US.

I believe you are confusing/blurring the difference between "Nurse Practice Laws" with private...ie business related...reimbursement practices.....There are NO laws that requires Alabama Blue Cross to reimburse the way that they do....and btw...Alabama blue cross is one of the LOWEST paying commercial payers in the nation at around 50 per unit.

[acematt04]

Incorrect. The only one which pays the same for CRNAs or MDAs is CMS. private payers have been shown to pay between 5-10$ more per unit for MDA services (why i dont know). Also, this ABSOLUTELY neglects the cost of STIPENDS the hospital must pay to maintain the high salary of MDAs for the same service. Over 85% of MDA run groups require this and it ranges from 1-5 million per practice. This cost is DIRECTLY passed on to the patients.

MmacFN,
I was wondering if you can give me a reference or an example of private payers paying more per unit for MDA services. I wanted to use this in a debate for CRNA school, but I know that the MDA side will scream, "Show me the evidence!"
-Matt

[MmacFN]

This was done by a CRNA who called various private insurers and posed as an all MDA grp then called them again posed as an all CRNA grp. The difference was significant. You could easily do this yourself for evidence.

Private payers have no obligation to pay the same for services. This is true from hospital to hospital system for everything from providers to procedures. Its all in what you negotiate. However, generally its 5-7$ less per unit cost.

If you are looking for how we are cheaper, simply look at the cost to society for each provider to be trained. MDAs residency is entirely funded by public money and we PAY for our own.

Cost of provider to the system, while a CRNA could bill 100% medicare and still make 200K an MDA would never work for that money, so over 85% of MDA and ACT practices require a stipend paid by the hospital which ranges from 1-7 million a year with the average being 3 million. CRNA only groups dont need stipends. The cost of stipends is passed DIRECTLY onto the patient by increased insurance and copay costs. It isnt magical money coming from nowhere :)

Thats just the START !




MmacFN,
I was wondering if you can give me a reference or an example of private payers paying more per unit for MDA services. I wanted to use this in a debate for CRNA school, but I know that the MDA side will scream, "Show me the evidence!"
-Matt

[thasweepa]

Look at you, trying to get more fodder to waste us in the debate (is if your side DOESN'T HAVE ENOUGH ALREADY!!!!) See u on monday sucka!!!!!

[JadamR15]

Look at you, trying to get more fodder to waste us in the debate (is if your side DOESN'T HAVE ENOUGH ALREADY!!!!) See u on monday sucka!!!!!


Geez, your school lets you practice debating?

[thasweepa]

Well, it was an assignment for our policy and ethics class, to take a national healthcare policy that is currently under contention and lead a 1-hour debate about it. As much as presentations are annoying, this is actually turning out to be an interesting assignment.

[JadamR15]

Well, it was an assignment for our policy and ethics class, to take a national healthcare policy that is currently under contention and lead a 1-hour debate about it. As much as presentations are annoying, this is actually turning out to be an interesting assignment.

Wow, pretty cool! Enjoy!!


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