Golden Era for CRNA?

Many physicians are concerned about the expansion of services being provided by advanced practice nurses ("APN") and nurse practitioners ("NP"). The anesthesiologist and CRNA relationship is no different. While some CRNAs may feel that recent rulings on independent practice is the start of a golden era, there is evidence that the opposite may be true.


What? Years of struggle by CRNAs to end, not as well regarded independent anesthesia professionals, but as APN employees of facilities? As hard as it is to believe, some facilities would rather have greater costs employing CRNAs, or any anesthesia professionals, than spend less for more and better services. Go figure. Is employment of anesthesia professionals really better than a well-crafted contract with a service orientated anesthesia group?


CRNAs may have a particularly difficult problem at rural locations in the future. CRNA compensation and benefits in some small towns may be greater than the majority of the physicians in the community. A CRNA or group of CRNAs should not assume that they have impenetrable support when financial or political issues are involved.


Assuming that a CRNA group has avoided contracting with a facility because of actual or implied excessive lo-no revenue obligations in the contract, a particularly high-risk situation exists. Consider this scenario. For whatever reason, the facility or medical group employs an anesthesiologist. Soon the employee anesthesiologist is taking their choice of cases to mitigate their cost to the organization. Between the impact of an additional anesthesia staff member on the schedule, the financial impact of fewer available cases per provider, and better-compensated cases going to the anesthesiologist, a CRNA group's operational and financial foundation can be damaged very quickly. This is real world problem, not a hypothetical situation.


So the golden era could be tarnished, but it can be restored. CRNA groups, just like any other anesthesia group, need:


To act like a business,
To understand well-known methods to deal with actual or implied excessive service obligations,
Have well-developed human resource management
Focus on patient and referral physician satisfaction
To be able to work with facilities in collaborative manner


The risks of an internal focus are just as great for CRNA groups as any other anesthesia group. "Just doing cases and going home" is not an option for independent practice in anesthesia.


That recent rulings allow CRNAs to practice more independently in some areas doesn't mean that a competitive marketplace will allow them to do so. The process of "opting out" of the physician supervision may lead to being "pushed in" to less desirable employment options. Without CRNA groups acting like businesses, CRNAs may yet "snatch defeat from the jaws of victory."


Take Home Points:


Ineffective CRNA anesthesia groups will share the same fate as ineffective anesthesia groups led by anesthesiologists.
The process of "opting out" of the physician supervision for CRNAs may lead to being "pushed in" to less desirable employment options.

By William Hass, MD, MBA found HERE