Day in Life of CRNA, Office Anesthesia

[yoga]

I am in private practice in an office setting doing anesthesia for a group of plastic surgeons. This would be a typical day for me. However, there are not many typical days in an anestheia practice, so we learn to adapt.

Night Before
call patients, review history, remind them to be NPO and to take their regular a.m. meds, if necessary

Surgery Day
Set up anesthesia machine, suction, airways equipment and meds
Review patient's chart
Have patient sign anesthesia consent
Review discharge arrangements
Administer anesthesia
Transport patient to PACU and transfer to RN care
Clean up anesthesia equipment and prepare for next case

Repeat above, per schedule

No coffee breaks, lunch breaks (except between cases) or relief

Stay until all patients are discharged

Collect money for day

Check schedule for following day

Extra Duties
Inventory and order anesthesia supplies
Troubleshoot equipment
Anesthesia QA
Make nice with office staff (they are important to your practice)
Read current anesthesia journals

Check Nurse-anesthesia.org for interesting posts

This is a different type of practice than hospital anesthesia. I work alone--no other anesthesia professional, so I rely on my nurses to help me with induction.

Since I am in my own business, professionalism is very important. I wear business clothes to work, treat my patients very well, respect my co-workers and try to make the environment fun and enjoyable for everyone. It works--I have had the same group of nurses working for us, for over 15 years. Everyone loves to come to work. Of course, it helps to work with very good surgeons.

I will probably think of more later.

Yoga

[WakingLife]

I am currently in the beginning of my nurse anesthetist education and I notice that there are no business classes/topics in any of my classes. I realize this is probably because they really want the focus to be on experience after school, not on jumping into an unsupervised situation, but I am curious about office anesthesia with regards to the business side of things.

When you are in business as a CRNA in the office setting...Are you there as an independent contractor? As a "business of one"? Are you a partner? Do you help with leasing the building, running the phones, billing, hiring...the general office management? Or do you focus primarily on the anesthesia side of things?

Thanks in advance for any insight!

[yoga]

Waking,

You have asked some good questions, but before I answer them, please do me a big favor. Do not use the word "SUPERVISE" in my presence. As a student, you need to be supervised in the clinical area. CRNAs do NOT. That term is simply inaccurate and misleading. While I am certain you used it innocently, please consider the connotation of its usage. Supervision implies that someone else is directing our practice or is legally responsible for our acts. That is neither a legal or practical reality for CRNAs.

Now, to your question, there are many ways of practicing as a CRNA. Your choices are related to your creativity and opportunities and personal choices. It doesn't matter if you are in a hospital-based practice, ASC or office setting. Many years ago, I selected to be a private practitioner and have worked in a partnership, corporation with other CRNAs and in my own professional corporation. Also, in my long career, I have been MD employed, Hospital employed, University employed and straight contract employed, and often a combination of various settings.

Nurses tend to think of only being hospital-employed, because that is where most of the opportunities are. CRNAs are independent practitioners and frequently businesspeople who understand marketing, reimbursement and business practices.

There are pros and cons of all settings and each individual has to take many factors into consideration, but the beauty of being a nurse anesthetist is having so many options.

Hope that helped.

Yoga

[JillCRNA]

Yoga,

Thank you so much for starting this thread! I tried starting a thread about independent practice but I guess it wasn't too exciting. ;) As a SRNA, I'd like to learn more about independent practitioners and how they manage the business aspect of their practice. Would you be willing to shed some insight as to how you learned your business knowledge needed to start and maintain your business? It seems that there are a number of options out there such as earning an MBA or partnering with a business associate to manage the business aspect or even using a consulting firm to manage some business aspects. I, for one, would be extremely interested in your opinion as well as other CRNAs who may be in independent practice! -Thanks! -Jill

[MmacFN]

Cool

I too plan to work in an indy. practice eventually. Its very interesting to me!

[WakingLife]

Yoga,
Thank you for the info! You cleared up some of the questions I had about the logistics of independent practice. Sorry about the inappropriate use of "supervise". (Thanks for clearing that up too!)

[crnasoldier]

I have just started a CRNA group and have absolutely no idea about billing for cases. If i use the ((base units) + (time units)) X conversion factor, i come up with an amount that is not much more than i am making in the hospital. How can this be? I am worried that if i leave the hospital setting, i wont be making any more than i am now and will have all the headaches of my own business. Any words of wisdom out there?

[yoga]

Wow soldier, you made a big move and hopefully a great one. Perhaps you could share some more information. Did you set up the group before having a contract for anesthesia services? If you do have a contract, was compensation discussed? How many CRNAs in your group?

Now for the answer on reimbursement. If you are doing insurance billing, then use the ASA Relative Value Guide, which is base units + time units x conversion factor. You establish your own conversion factor and then the insurance companies and Medicare tell you how much you will get reimbursed. I always advise people to get a billing service, because they are able to do electronic billing and the audits that are necessary to comply with government regulations.

If you are doing a cash practice, it may be best to come up with some sort of flat rate billing for advance payment or hourly rate for post-procedure billing. I recently heard of a CRNA who has a contract with a fertility clinic and charges $500 per procedure. She gets the money in advance of the anesthetic and there is no time factor involved.

My biggest expense is malpractice insurance and health coverage for myself through my corporation.

My book, The Business of Anesthesia is somewhat outdated, but can be purchased through the AANA bookstore.

Feel free to send me a PM if I can be of additional help to you.

Jan Mannino, CRNA, JD

[crnasoldier]

hi yoga, starting my group has been very a very xciting process. what is discouraging is our local market. but im not quiting yet.

i have been a CRNA for 4years (not a lot of experience, I know) and have worked in a variety of hospital settings from level 1 trauma centers (my current employer) to small 4 OR community hospitals. there was always something i wanted but didnt know what it was or how to get it. so, next thing i know i get deployed to Al Asad Iraq, a small combat support hospital. while there i met a CRNA who has been in her own group practice for 10 years. i picked her brain as best i could and she encouraged me to go out on my own. while i was out there i did all my own cases without an mda. they ranged from massive trauma to pediatric wound deridment. i realized this is what i was looking for in all those hospitals.

when i returned home and went back to the same old job, i felt it was time to go out on my own. my partner and i got all of our insurance, paper work and licensing in order as well as legal contracts written (not cheap) before we started looking for offices of opportunity. now all we need is a place to do business. i was getting a litte scared about the reimbursement until you set me straight. i am now very excited. many people want us to fill in one day here and there, but no full time anesthesia yet. its only a matter of time. thank you again for your help, mike.