AANA urges Medicare to consider hospital anesthesiology efficiency measures

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    AANA Urges Medicare to Consider Hospital Anesthesiology Efficiency Measures
    The AANA has recommended that Medicare consider the costs of various anesthesia delivery models and of hospital anesthesia subsidies per anesthetizing location as part of quality measures intended to capture the efficiency of hospital anesthesia services.

    The June 21 letter, signed by President Janice Izlar, CRNA, DNAP, stated, “The Agency may want to consider the costs of meeting the seven medical direction steps as part of the anesthesiology spending and cost-efficiency measure. Under the medical direction practice model, the medical directing anesthesiologist must complete seven steps in order to bill for this modality. The Agency has clearly stated that medical direction is a condition for payment for anesthesiologist services and not a quality standard.”

    The AANA discussed the ways that the requirements associated with anesthesiologist medical direction claims contribute to healthcare cost growth, noting specifically the requirement that the anesthesiologist be “present at induction.” “For every minute spent waiting for an anesthesiologist to arrive and be present at induction, some of the costliest resources in the hospital are wasted. The clock is running on the surgeon, circulating nurse, scrub tech, and nurse anesthetist waiting in the operating room. Waiting costs cascade throughout the day, postponing the surgery schedule to require overtime and on-call staff, delaying the surgeon’s rounds to affect patient care and discharge of the patient from the healthcare facility. Waiting costs also add opportunity costs, diverting needed resources from other patient care,” continued the letter.

    The letter also recommends including the cost per anesthetizing location as part of the proposed anesthesiology measure since hospitals pay an average of $160,096 per anesthetizing location to anesthesiology groups, and increasing the weight placed on clinical process of care measures, such as the Surgical Care Improvement Project (SCIP) measures, under the hospital value based purchasing program.
    Joe V and SummitRN like this.

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  2. 104 Comments...

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    I wish that we would learn how to properly place initials after our name.

    President Janice Izlar, CRNA, DNAP SHOULD be Janice Izlar DNAP, CRNA
    In the US[edit]

    In the United States, standard protocol is:

    1. Religious institutes
    2. Theological degrees
    3. Academic degrees
    4. Honorary degrees, honors, decorations
    5. Professional licenses, certifications and affiliations
    6. Retired uniformed service (active duty service brackets the name – e.g., Firefighter John Doe, CFD – and active duty armed services do not display postnominals other than branch of service)[1
    SummitRN likes this.
  4. 0
    Quote from nomadcrna
    I wish that we would learn how to properly place initials after our name.

    President Janice Izlar, CRNA, DNAP SHOULD be Janice Izlar DNAP, CRNA
    In the US[edit]

    In the United States, standard protocol is:

    1. Religious institutes
    2. Theological degrees
    3. Academic degrees
    4. Honorary degrees, honors, decorations
    5. Professional licenses, certifications and affiliations
    6. Retired uniformed service (active duty service brackets the name – e.g., Firefighter John Doe, CFD – and active duty armed services do not display postnominals other than branch of service)[1
    There is no hard and fast rule in what order you put your initials after your name. In this case I think it is in the correct order. She is showing that she is first and foremost a CRNA. IMO this is important when you are representinting CRNAs with all sorts of academic backgrounds.
  5. 0
    Actually you are incorrect. There are rules and I posted them above.
    Professional licenses, certifications should come AFTER the academic degree which in her case is the DNAP.
    Here is another reference.

    Academic Degrees, Licenses, Credentials


    Spelling and Format
    Do not use periods in academic degrees, licenses, or other credentials.
    MD, PhD, RN, LCSW, FACP
    Do not capitalize generic degrees. Note correct use of apostrophes and spelling.

    • bachelor's degree; bachelor of arts
    • master's degree; master of science in nursing; master of public health
    • doctoral degree; doctorate (not doctorate degree)
    • doctor of medicine
    • medical degree (a generic term for MD, DO, and all foreign equivalents)

    When used after a name, set off the degree with commas.
    Nancy Brown, MD, joined the institution in 1990.
    Inclusion of Degrees in Text
    As an academic institution, we value educational and professional credentials. At the same time, we need to make an effort to maintain readability and accessibility.
    In items such as business cards, stationery, and publicity pieces for events, degrees and credentials are at the discretion of the individual in reference.
    A more conservative approach is used in running text.
    Bachelor's Degrees: Bachelor's degrees are generally not included. Exceptions may be made, upon request, for specialized professional degrees (e.g., BSN, BPharm) when it is the highest degree obtained.
    Master's Degrees: If an individual does not hold a doctorate, master's degrees will be considered upon request. If an individual does hold a doctorate, master's degrees will not be included, unless the master's degree represents a specialized field or a field different from that represented by the doctorate (e.g., MPH or MBA for an individual with a medical degree).
    Licenses, Certifications, and Professional Designations: Only relevant clinical licenses will be included (e.g., RN, PT, RD), but not certifications or other designations (e.g., FACP, CCRN). List the academic degree first, followed by the license.
    On business cards: Sarah Sampson, MS, PhD, RN, CCRN
    In text: Sarah Sampson, PhD, RN

    Other Points
    Do not use MD or PhD as an abbreviation for physicians or scientists, or RN as an abbreviation for nurses. These abbreviations should be reserved for degrees and licenses, not people.
    In the first reference, use the academic degree. In subsequent references, use Dr. Never use Dr. when also using the academic degrees in the same reference.




    Quote from wtbcrna
    There is no hard and fast rule in what order you put your initials after your name. In this case I think it is in the correct order. She is showing that she is first and foremost a CRNA. IMO this is important when you are representinting CRNAs with all sorts of academic backgrounds.
  6. 0
    Actually that is the way the AANA/AMA uses for their authors....Information for Authors

    · Author Information – A short biographical sketch of each coauthor, with principal author indicated, must accompany the title page of the manuscript. Please include an email address that can be published for the principal author. Example: James R. Johnson, CRNA, PhD, is program director of ABC School of Anesthesia, Mountain View, Montana. Email: jrjohnson@mountainview.com.
    · Author Information – A short biographical sketch of each coauthor, with principal author indicated, must accompany the title page of the manuscript. Please include an email address that can be published for the principal author. Example: James R. Johnson, CRNA, PhD, is program director of ABC School of Anesthesia, Mountain View, Montana. Email: jrjohnson@mountainview.com.
  7. 0
    And of course nobody speaks to the content of Janice's letter - although I can guess of course how most CRNA's would feel.

    Not EVERY anesthesia group receives a stipend for providing services. Many don't get a dime. It varies from location to location within a region, state, or even in cities or a different side of town. And there's always someone who will do it for less, which is one of the biggest problems with anesthesia management companies. That's when quality of patient care starts to become secondary to financial considerations.

    CRNA's in critical access hospitals already essentially get a stipend as well that's not available to anesthesiologists via the Medicare Part A "pass-through".

    And let's remember that there are plenty of CRNA-only groups that receive stipends for providing coverage as well, just like the all-MD or ACT groups. But hey, for those who get stipends, I don't begrudge them that compensation. Providing 24/7 coverage, especially in low-volume hospitals, is always a problem.
  8. 1
    Well, I hate to disagree again but the AANA appears to be wrong on how the post nominals should be placed. Although those are just examples that do not expressly address post nominals. They are discussing only how the AANA accepts research papers. I was unable to find anything from the AMA source you cited.

    I've been unable to find ANY other reference that disagrees with what I posted. I have an open mind though, please show me a reference. The MULTITUDE that I've found all address it the exact same way as I posted.
    msn10 likes this.
  9. 1
    Don't feed the troll.

    Quote from jwk
    And of course nobody speaks to the content of Janice's letter - although I can guess of course how most CRNA's would feel.

    Not EVERY anesthesia group receives a stipend for providing services. Many don't get a dime. It varies from location to location within a region, state, or even in cities or a different side of town. And there's always someone who will do it for less, which is one of the biggest problems with anesthesia management companies. That's when quality of patient care starts to become secondary to financial considerations.

    CRNA's in critical access hospitals already essentially get a stipend as well that's not available to anesthesiologists via the Medicare Part A "pass-through".

    And let's remember that there are plenty of CRNA-only groups that receive stipends for providing coverage as well, just like the all-MD or ACT groups. But hey, for those who get stipends, I don't begrudge them that compensation. Providing 24/7 coverage, especially in low-volume hospitals, is always a problem.
    SoldierNurse22 likes this.
  10. 0
    Quote from nomadcrna
    Don't feed the troll.
    Don't ya just hate it when facts get in the way of fantasy?
  11. 0
    Quote from nomadcrna
    Well, I hate to disagree again but the AANA appears to be wrong on how the post nominals should be placed. Although those are just examples that do not expressly address post nominals. They are discussing only how the AANA accepts research papers. I was unable to find anything from the AMA source you cited.

    I've been unable to find ANY other reference that disagrees with what I posted. I have an open mind though, please show me a reference. The MULTITUDE that I've found all address it the exact same way as I posted.
    The first is the reference is from the AANA information for authors. CRNA then academic title is how I was taught to prepare manuscripts from 2 different reviewers for the AANA journal.

    The AMA Manual of Style 10th edition states "If an author holds 2 doctoral degrees (e.g., MD and PhD, or MD and JD) either or both may be used, in the order preferred by the author". That is from section 2.2.3 page 14.
    I think there is only one troll on here at this current time and it is the same someone that provides no references to back up his statements.
    Last edit by wtbcrna on Jul 1, '13


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