US Supreme Court upholds healthcare reform law

Anyone care to comment on the impact of section 2706 of the act? I know with medicare we are reimbursed the same as MDA, but with private payers it can be different CRNA vs MDA ie Wellmark BCBS IA.

Well the best part is this will help back the provider non-discrimination bill we are fighting for. This would help us, in the end, get parity with insurance industry.

Originally Posted by chansoncrna

Anyone care to comment on the impact of section 2706 of the act? I know with medicare we are reimbursed the same as MDA, but with private payers it can be different CRNA vs MDA ie Wellmark BCBS IA.

I think few people in our association realize the real world impact of this. The last time I worked in a supervised setting we had one MDA and four CRNAS in our group. $ologist who would sign on cases (medically direct) when patients had various private insurance carriers. Why? Third party payers reimbursed at a higher rate when we were medically directed vs indy CRNA. We know medicare bills reimburses at the same rate, but private insurers reimburse in my state at almost 3 times the rate/unit Medicare does. What will happen now, will reimbursement for MDAs decrease or CRNAs increase with Third party payers. Again not medicare. I will also state that as one looks at payer mix, third party payers such as BCBS are the greatest source of revenue to an anesthesia provider. So to me very BIG implications in this act, especially now that I am in an indy practice, because I know in my state there is a difference in reimbursement rates by third party payers. Surprisingly to me, our association hasn't seemed to be as informative about the implications of eliminating provider discrimination. Lastly, my understanding is that section 2706 effectively does eliminate provider discrimination.

I believe individuals in our association are aware of the various issues associated with this Health Reform. I know the AANA reviews and reviews the bill, evaluates aspects of it that affect CRNAs in practice and in business. Sure there are states in which Third party payers pay anesthesiologists more than CRNAs and there are some in which the third party payers refuse to recognize CRNAs at all. In part WE as CRNA must become more adept at making sure our side of the bargaining table - has a representative. Too often it is left to someone else to negotiate for CRNAs.

This is exactly why the AANA took a front position on provider discrimination when the bill was being formed. The AANA expended a few "chits" to be sure this part of the reform was kept, much to the chagrin of the A$A.

I am not currently on the AANA BOD, not until August but I can tell you as an Anesthesia Payment Policy Control Panel (APPCP) consultant, we have had numerous discussions on this topic. The truth is in part it will cost the AANA in legal and consultant fees as well as hard work to hone this piece of legislation and influence further pro-CRNA language to provide a matter of fact answer.

The future in this regard will help MANY CRNAs in MANY states overcome problems. At this time, I think the AANA like most other organizations were waiting to get an answer from the Supreme Court before spending a ton of money on something that could have been dismissed by the stroke of a pen.

My .02

Juan F. Quintana





QUOTE=chansoncrna;157922]I think few people in our association realize the real world impact of this. The last time I worked in a supervised setting we had one MDA and four CRNAS in our group. $ologist who would sign on cases (medically direct) when patients had various private insurance carriers. Why? Third party payers reimbursed at a higher rate when we were medically directed vs indy CRNA. We know medicare bills reimburses at the same rate, but private insurers reimburse in my state at almost 3 times the rate/unit Medicare does. What will happen now, will reimbursement for MDAs decrease or CRNAs increase with Third party payers. Again not medicare. I will also state that as one looks at payer mix, third party payers such as BCBS are the greatest source of revenue to an anesthesia provider. So to me very BIG implications in this act, especially now that I am in an indy practice, because I know in my state there is a difference in reimbursement rates by third party payers. Surprisingly to me, our association hasn't seemed to be as informative about the implications of eliminating provider discrimination. Lastly, my understanding is that section 2706 effectively does eliminate provider discrimination.[/QUOTE]

Thank you for your input and work in the future on the national level. My comments about members in our association is directed to many who are dismissive of the act without knowledge of this language in the act. I personally wish that more rank and file members of our association knew the importance of the act, and future honing of this legislation. I personally feel that eliminating third party payer provider discrimination on reimbursements will have a bigger impact on our future practice than additional patients now having coverage.

Originally Posted by MmacFN

2) It will result in hospitals looking closely at where to cut costs in order to do more with less. The low hanging fruit are anesthesia stipends. Who needs anesthesia stipends the most? ACT practices and MDA only practices. If we are graduating full service providers CRNAs can compete with an advantage against MDAs for contracts cause we dont require a stipend in order to maintain a 400K salary.

4) Hospitals will be looking closely at duplication of services. Why pay 2 people to do one job (ACT practices)? Especially when all available evidence shows that CRNAs have equal quality and outcome measures. They wont be doing that much longer.

6) The expectation to provide flexible and cost effective services will make AAs a much less attractive choice vs CRNAs. AAs require MDA supervision by law at all times and that means increased cost for services.

7) The overall cost to the system for CRNAs is much less than MDAs. This includes the training as well as the stipend cost for services. The system will favor CRNA heavy models and CRNA only models.

2) That's assuming they pay a stipend. Some do, some don't. Those that don't pay a stipend won't have any costs to cut. And the idea that CRNA's and CRNA-only groups don't take stipends is a total mis-statement. Of course you know that.

4) Not an issue if the hospital doesn't employ the anesthetists and/or anesthesiologists.

6) Wishful thinking - you know we have to agree to disagree on this one.

7) Take out the training costs - it's a non-issue.

2) That's assuming they pay a stipend. Some do, some don't. Those that don't pay a stipend won't have any costs to cut. And the idea that CRNA's and CRNA-only groups don't take stipends is a total mis-statement. Of course you know that.

75% of all ACT practices require a stipend per MGMA. less than 40% of CRNA groups do and the stipends are less than 50% as much.

4) Not an issue if the hospital doesn't employ the anesthetists and/or anesthesiologists.

Ah but it is, that is why these hospitals have to pay a stipend to these grps.

6) Wishful thinking - you know we have to agree to disagree on this one.

We can disagree but it is true. AAs are limited to ACT practices which by their vary mature are less flexible than CRNA only, CRNA/MDA (where each runs their own rooms) and MDA only. Additionally, cost effectiveness of ACT practices are also much lower.

7) Take out the training costs - it's a non-issue.

I agree with this statement to some degree. The cost to train one MDA pays for 6 CRNAs. That is a pretty significant cost to society. However, many private payers pay CRNA only grps at a lower amount per unit vs MDAs. The increased cost per unit for MDAs certainly drives up cost for no proven increase in quality.

Originally Posted by merlebo02

Long term [B]I FEEL[B] this will ruin the healthcare industry. What will eventually happen is the government run insurance will squeeze the private insurance companies out of busines. At this point, the government will pretty much own the healthcare industry which is what they have wanted all alone… Our government couldn't keep a whore house selling alcohol in the green much less healthcare!!!!

Government run insurance? What are you talking about? Under the ACA the government does not take on the responsibility or role of providing or running an insurance 'company' or service. Private insurance companies continue as they always have with the exception of not being able to deny policies or benefits based on pre-existing conditions or whether you get sick.

I am willing to give it a chance... we will see. I hope I am pleasantly surprised. Only time will tell. If only the people without insurance are penalized then I am good....

Originally Posted by armygas

I am willing to give it a chance... we will see. I hope I am pleasantly surprised. Only time will tell. If only the people without insurance are penalized then I am good....

Same here

Originally Posted by gregsto

Government run insurance? What are you talking about? Under the ACA the government does not take on the responsibility or role of providing or running an insurance 'company' or service. Private insurance companies continue as they always have with the exception of not being able to deny policies or benefits based on pre-existing conditions or whether you get sick.

Spoken like a true liberal.