Anesthesia Provider Pay to Drop 60%

[Screen name]

http://online.wsj.com/article/SB10001424052970204683204574358281875211014.html

Incredibly, Congress's proposed health-care reform plan risks skimping on anesthesia. According to one of the health-care bills in Congress, H.R. 3200, the public option would reduce reimbursement for anesthesia by over 50%.

How do you think Healthcare Reform is going to effect the field of anesthesia?

From another blog:

I am shocked that no one is commenting on the potential impact of President Obama's Healthcare reform. As many of you may be aware, under the current proposals, payment of Anesthesiolgists and CRNAs will be a Medicare rates which are about 30% the level of private insurance. My state Anesthesiologist association projects that the bottom-line affect for most anesthesiologists will be a 50% cut in reimbursement. It is a foregone conclusion that in order to compete with the government option, private insurers will drop their reimbursement to the same levels as government.

Now Mr. Orzak, President Obama's budget director, states that there will be further 20% cuts in physician reimbursement in the future. This means that an Anesthesiologists or CRNAs income will be cut 60%.

Don't know if this is still active, but this tries to exempt anesthesia from the reform rates. All anesthesia providers can sign...

http://www.theanesthesiablog.com/2009/10/health-care-reform-updated-daily-well.html

[wtbcrna, MSN, DNP, CRNA]

Good post, wtbcrna. Edited mine so you wouldn't feel so imitated by a lowly "student" (not that it should matter too much). I'm quoted for reference anywho.

Lol...merely pointing out that as a nursing student you cannot fully understand these issues yet. When you become an anesthesia provider a lot more if this will make sense. Most of the political things that are discussed rarely effect CRNAs or MDAs on a day to day level. As far as paindoc goes I think he is just bored lately because if I remember correctly he practices interventional pain medicine fulltime and I can't remember the last time he posted anything helpful on here. He will keep you on your toes argueing though.

[Screen name]

Oh don't get me wrong, I agree with you. My post may have been sarcastic, but not meant to be rude. You're post really helps clarify key issues. I think having access to articles like the on you posted is vital- articles I couldn't click on because I'm not a member of the AANA (there looked to be some good ones posted). Just don't get twisted that I'm ignorant about the nursing or CRNA fields- I've shadowed over 100 hours and tech in an SICU, already forming those relationships necessary. I'm not here to ask questions about, "Is my GPA high enough?", "What classes do I need to take?", "What foes a CRNA do?"- I am concerned about my future profession an like to be involved as much as possible at this stag in my education.

Keep the good info coming! What's it going to be like for CRNAs in 10 years if this passes? An if paindoc responds again I hope that people would ignore it... As I said, I'd like to keep this free of arguments.

[paindoc]

The wonderful thing about being in private practice, and not a technician chained to an anesthesia machine is that I can decide exactly which patients I will or won't see, what services I will or won't provide, how many hours I am willing to work and exactly what those hours are....I can vary them week to week or day by day through advanced scheduling, and how much vacation I will take. CRNAs are typically hospital employees, employees of an anesthesia group, or work in small hospitals where they must provide coverage for the surgeons. But you can't really select what your payor class mix is can you? What would your hospital do to you if you began to refuse to see Medicaid patients or refused to give anesthesia to Medicaid patients? You would find yourself booted out the door ASAP. So, yes, I will take a hit in income if I continue treating Medicare patients as I do now, however it depends on what services I provide, and I can elect to provide those services that generate the most revenue if Medicare cuts too deep. You effectively get paid the same no matter what you do for the patient....you bill by time units and have no way to generate more revenue. CRNAs will definitely take a hit if the SGF is not fixed, and it will be completely out of your control since you are financial slaves to your masters.

[wtbcrna, MSN, DNP, CRNA]

The wonderful thing about being in private practice, and not a technician chained to an anesthesia machine is that I can decide exactly which patients I will or won't see, what services I will or won't provide, how many hours I am willing to work and exactly what those hours are....I can vary them week to week or day by day through advanced scheduling, and how much vacation I will take. CRNAs are typically hospital employees, employees of an anesthesia group, or work in small hospitals where they must provide coverage for the surgeons. But you can't really select what your payor class mix is can you? What would your hospital do to you if you began to refuse to see Medicaid patients or refused to give anesthesia to Medicaid patients? You would find yourself booted out the door ASAP. So, yes, I will take a hit in income if I continue treating Medicare patients as I do now, however it depends on what services I provide, and I can elect to provide those services that generate the most revenue if Medicare cuts too deep. You effectively get paid the same no matter what you do for the patient....you bill by time units and have no way to generate more revenue. CRNAs will definitely take a hit if the SGF is not fixed, and it will be completely out of your control since you are financial slaves to your masters.

The exact same thing could be said for MDAs.

[stanman1968]

Well I guess those surgeons who have to accept Medicare and Medicaid will be jacked too, unless they perform surgeries for private pay patients, who will pay for anesthesia with cash or private pay. Your logic is so linear and as to be worthless.

[Jdog19s]

Or a CRNA could head for an opt out state with no supervision and be free from slavery and do just as you suggest paindoc. Eventually it will come down to how much money is spent on ACT practices to have an MD for 4 CRNAs..waste of money. If they want someone for backup in case things go south, just use another CRNA. If its legal to practice independently in some states, its obviously not unsafe to go without MD supervision and far cheaper to go with advanced practice nurses.

[wtbcrna, MSN, DNP, CRNA]

Or a CRNA could head for an opt out state with no supervision and be free from slavery and do just as you suggest paindoc. Eventually it will come down to how much money is spent on ACT practices to have an MD for 4 CRNAs..waste of money. If they want someone for backup in case things go south, just use another CRNA. If its legal to practice independently in some states, its obviously not unsafe to go without MD supervision and far cheaper to go with advanced practice nurses.

CRNAs can and do practice independently in every state. Opt out has only to do with billing independently for Medicare/Medicaid patients. There are no laws in any state that I know of that doesn't allow for CRNAs to practice independently.

[Jdog19s]

However I do not think it makes sense to run an independent practice in states that have not opted out as the majority of people you will see will have medicare and you will not be reimbursed, correct? And most hospitals in these places wont allow you to work without "supervision" because of this lack of reimbursement- but then again, I'm a year into school and still learning all the rules and regulations- although it is true, there is no law saying its illegal in any state to practice independently, it was put onto the states to decide what would be reimbursable as I understand it.

[Screen name]

Trying to stay on topic, although we look cheaper on paper now, will we still look too expensive to the government down the road? Would being a "DNAP" help, hurt, or not matter to us in this situation of healthcare reform? How about those independent CRNA's who do not work under a MDA at all?

[wtbcrna, MSN, DNP, CRNA]

However I do not think it makes sense to run an independent practice in states that have not opted out as the majority of people you will see will have medicare and you will not be reimbursed, correct? And most hospitals in these places wont allow you to work without "supervision" because of this lack of reimbursement- but then again, I'm a year into school and still learning all the rules and regulations- although it is true, there is no law saying its illegal in any state to practice independently, it was put onto the states to decide what would be reimbursable as I understand it.

It doesn't work that way. CRNAs don't have to be "supervised" by MDAs to bill for Medicaid/Medicare. Most rural practices don't have MDAs at all. The surgeon in most cases orders the anesthesia services, signs off on the chart, and that in most cases is enough to qualify for the CMS requirements of "supervision", and no despite ASA claims the surgeon is not held any more liable for the CRNAs action when they work independently or under the direction of an MDA.

http://www.aana.com/finalsupervisionfaqs.aspx

From the AANA:

Q.Does the new rule require nurse anesthetists to be supervised by anesthesiologists?

A.No. The rule does not require CRNAs to be under the supervision of anesthesiologists. Every state permits CRNAs to practice without anesthesiologist supervision. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) does not require anesthesiologist supervision either.

Q.Does Medicare (CMS) define or require hospitals to define "supervision"?

A.No. CMS does not define supervision, and hospitals are not required to define supervision. Defining supervision can create complicated compliance issues that many hospitals would prefer to avoid. See the following: Gene A. Blumenreich, JD, "LaCroix case," AANA Journal, Oct. 1997, Vol. 65, No. 5; and Denton Regional Medical Center v LaCroix, 947 S. W.2d 941 (1997). Further, the JCAHO does not define supervision or require such definition.

Q.Does the role of the supervising physician change when working with a CRNA?

A.

No. The responsibility of the operating or diagnostic physician does not change based on who is providing the anesthesia. Typically, the physician:

determines whether a patient requires a surgical or diagnostic procedure;

requests that an anesthetic be administered; and

determines that the patient is an appropriate candidate for the planned procedure and anesthetic.

Q.Does the supervising physician need to be privileged in anesthesia?

A.No. The supervising physician is not required to have privileges to actually administer anesthesia.

Q.Is a physician or surgeon more liable when working with CRNAs?

A.

No. Surgeons are no more likely to be held liable for the actions of nurse anesthetists than the actions of anesthesiologists. The courts have not found physicians and surgeons to be automatically liable for the actions of CRNAs, nor are physicians/surgeons immune from liability when working with anesthesiologists.

While physicians/surgeons commonly request nurse anesthetists to give anesthetics, CRNAs are accountable for their own actions. Courts generally do not look at the status of the anesthesia provider, but at the amount of control the physician/surgeon exercises over the anesthesia provider, regardless of credential.

[Jdog19s]

Hey, great post, thanks for the information and setting the record straight for me-

[jrv100]

I have been reading some of these posts and felt like chiming in. First, I find it amazing how many people take a negative view of someone (future CRNA) who holds amount of salary as an important factor in their decision to becoma a CRNA. Frankly, I'd rather have a money hungry highly competent CRNA taking care of me than someone who might be less so and who is "in it" because of the love of pushing anesthetic agents or taking care of people. I laugh each and every time someone places their own value, judgement and belief system as being more correct, more appropriate or more acceptable than that of another. I personally find that type of thinking utterly repugnant.

As for salary decreases, I highly doubt significant pay cuts for CRNA's or for nurses. There will come a time when hospitals will not be able to fill the "competent shoes" necessary for ICU (and other highly skilled nurses) as well as CRNA's. Moreover, if so many people eventually get this "Obamacare", hospitals will absolutely need to hire MORE people to work in these positions. All it will take will be a few deaths and resultant lawsuits by families, unions and even hospitals and you will see the political landscape quickly understand the importance of having well trained professionals. This will take place at both the federal and state levels.

As an aside, the problem with social welfare programs happens because too many people are sucking the system dry and not enough people are putting into the system. This is one of the biggest reasons as of late around the country with many of the protests against the new healthcare bill. Hardworking people are simply getting disgusted by having to pay for everyone else. For example here in California, illegal immigration has risen to just plain silly levels and the funny part is, almost everything is covered, healthcare, schooling etc. That's like having a budget for a family of four....now there are 8....with NO NEW MONEY.....so what happens is everyone had to suffer for it.

Here in California however, the politicians are too worried about votes to do anything about it and when a politician does try and do something constructive, all of the illegal alien immigration defense funds crucify them. Get me outta here!!!!!!!!!!!!!