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  • ASA President Desperate to Confuse Legislators, Surgeons & Hospital Administrators

    American Society of Anesthesiologist (ASA) President Dr. Jeff Plagenhoef recently sent out an email to all members of the ASA imploring them to fill out a SURVEY comparing Certified Registered Nurse Anesthetist (CRNAs) and Anesthesiologist Assistants (AAs) when under medical direction.

    In his email (see below) he asks that all Physician Anesthesiologists (MDA) who work with both providers in the same practice under a highly restrictive medical direction model respond to this 15 question survey. Surveys have long been regarded as being of limited reliability and validity in the research community. You can learn more about the reasons why here.

    Every American can much more easily understand how such data is unreliable when we consider the severe failure of polls and surveys accuracy in the last Presidential election

    One of the reasons surveys are often unreliable is bias inherent both the questions and those selected to fill them out. The ASA has spend a number of years trying to force AAs into every state they can. They do so not because they have some altruistic goal to expand healthcare, but to protect their pocketbooks and control the anesthesia market.

    There are two main reasons they want to promote AAs:

    1) When an MDA 'medically directs' up to 4 AAs or CRNAs they can bill 50% of each of those 4 cases effectively generating 200% of what they would sitting cases themselves. Clearly there is a financial incentive to maintain this model of care for MDAs.

    Even though it was published in the ASAs own journal "Anesthesiology" that even in a 1:2 ratio (MDA:AA/CRNA) medicare fraud occurred 35% of the time meaning that the MDA was not there when they were legally obligated to be. Found HERE

    2) They want to protect themselves (and their pocketbooks) from CRNAs expansion. You see, a CRNA can work independently and has been able to since the beginning of the profession. In fact CRNAs did anesthesia before physicians did and continue to be the primary providers across the country and in all rural areas whereas AAs cannot. Essentially AAs are tools to make money for MDAs and CRNAs can be competitors. The ASA promotes AAs to control the market through anti-competitive means so they have a monopoly.

    The difference between CRNAs and AAs is clear in their titles. An AA MUST always work with an MDA as they are trained to be assistants not independent practitioners of anesthesia as CRNAs and MDAs are. Their role is that of a flight attendant whereas an MDA or a CRNA can function as pilots. This means that AAs cannot expand access to care just MDAs pocketbooks.

    CRNAs are not required nor do they need MDAs in order to provide highly efficient, cost effective and near 6 sigma safe anesthesia care. The evidence for this cannot be denied and it can be read HERE.

    In practices where CRNAs and AAs both work the CRNAs are limited to the practice level of an AA. So this survey attempt basically asks if the two providers are the same when one is artificially limited for political reasons under the same restrictive practice. It could not be more invalid.

    Such a survey is like asking a defense lawyer if they believe their clients story. Of course they do, its in their best (read: financial) interest to do so.

    I have little doubt the ASA will tout this "survey" as "evidence" of equivalency between AAs and CRNAs. However the truth is it would be no more valid than if we looked at the historical justifications for slavery from those who profited from it.

    As with all things, the answer is MONEY, what was the question?