"Anesthesiologists are gaming the system" - page 6

by wtbcrna Guide

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To make this whole issue even more absurd are two recent studies published in the journal “Anesthesiology,” the official publication of the ASA, and “Anesthesia & Analgesia.” In one, communications with “supervising”... Read More


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    jwk....I have to share this as well. I have several personal friends and colleagues who own substantial multi-million dollar anesthesia businesses around the country. I am talking about easily over 100 million in billing and over 100 facilities. Their success has been ALMOST exclusively predicated on eliminating MD/CRNA ACT model type practices who require stipends. Their achievements have resulted in less than 10% of their facilities needing to pay stipends. In the situations where they do require a stipend, it is less than 25% of what the facility had been paying utilizing the ACT model. These practices consist of CRNA only and in many instance MD/CRNA. The difference is, where MDAs are employed or requested for one reason or another, they are working in rooms. This saves money. The fact is, the CRNAs and the MDA that work in these practice also make much more money than they would in an ACT money. I don't care to disclose the amounts, but it is substantial...especially for the MDAs. I wonder why more MDAs wouldn't want this.....these guys are making a killing. The CRNAs do well as well.

    jwk....I understand your point about patient savings not being directly affected by this....or should I say the potential. However, as providers we can only do our part. If the facility does not pass on those savings onto the patients, then we need to look at what they are doing to drive costs up or down. Regardless, system costs need to be assessed globally not locally. Saving money, here and there, adds up to millions up millions of dollars.

    personally, I have no issue working with MDAs at all, but I don't think the ACT model is cost effective or necessary. I haven't personally worked with MDAs for the last 5 years but that doesn't mean I wouldn't...just not in an ACT model - I have a choice. Just my opinion.
    nomadcrna and wtbcrna like this.
  2. 0
    Quote from mcvcrna
    jwk....I have to share this as well. I have several personal friends and colleagues who own substantial multi-million dollar anesthesia businesses around the country. I am talking about easily over 100 million in billing and over 100 facilities. Their success has been ALMOST exclusively predicated on eliminating MD/CRNA ACT model type practices who require stipends. Their achievements have resulted in less than 10% of their facilities needing to pay stipends. In the situations where they do require a stipend, it is less than 25% of what the facility had been paying utilizing the ACT model. These practices consist of CRNA only and in many instance MD/CRNA. The difference is, where MDAs are employed or requested for one reason or another, they are working in rooms. This saves money. The fact is, the CRNAs and the MDA that work in these practice also make much more money than they would in an ACT money. I don't care to disclose the amounts, but it is substantial...especially for the MDAs. I wonder why more MDAs wouldn't want this.....these guys are making a killing. The CRNAs do well as well.

    jwk....I understand your point about patient savings not being directly affected by this....or should I say the potential. However, as providers we can only do our part. If the facility does not pass on those savings onto the patients, then we need to look at what they are doing to drive costs up or down. Regardless, system costs need to be assessed globally not locally. Saving money, here and there, adds up to millions up millions of dollars.

    personally, I have no issue working with MDAs at all, but I don't think the ACT model is cost effective or necessary. I haven't personally worked with MDAs for the last 5 years but that doesn't mean I wouldn't...just not in an ACT model - I have a choice. Just my opinion.
    Similarly, I have personal friends and colleagues who are in groups or practices that have been bought out by AMC's. Those who were present prior to and during buyout almost universally regret it and wish things could go back to the way they were. Those who came later simply don't know any better. Much of the sweet-talking about the joys of being an employee rather than an owner were just that - talk. Salaries did in fact increase for some, but was more than offset by the huge decrease in benefit packages leading to an decrease in the value of total compensation. You've simply traded a set of local owners for a set of managers that answer to stockholders.

    Of course the facility doesn't pass those savings onto patients. That would be a fantasy.
  3. 1
    Puhleeze.....I am a military CRNA. I do not make more money by seeing ACTs eliminated. I do find benefit in anesthesiologists, but is not through medical direction/supervision.

    IMHO AAs are political tools invented and used by the ASA to try control CRNAs.
    nomadcrna likes this.
  4. 0
    Quote from wtbcrna
    Puhleeze.....I am a military CRNA. I do not make more money by seeing ACTs eliminated. I do find benefit in anesthesiologists, but is not through medical direction/supervision.

    IMHO AAs are political tools invented and used by the ASA to try control CRNAs.
    So if you've got no dog in this hunt, why do you care? There's certainly no quality of care/lack of education argument. There can only be a financial/anti-competition argument which translates only to greed.

    AA's were not "invented" as a political tool, but I realize it's pointless to argue that with you because we'll never agree. However, CRNA's are doing a fine job shooting themselves in the foot over and over and over again with their claims of equivalency to anesthesiologists, demanding the same practice rights as anesthesiologists without the educational background and training to back it up, and then whining when anesthesiologists say "enough is enough" and stop training student nurse anesthetists, even though they lose their free labor in the process. Do I personally as an AA benefit from all that? Absolutely.

    We're not in overproduction mode as CRNA's are. We weren't noticed much when there were just 25 of us graduating each year, but with more than 200 graduating this year and two new schools that just started and more committed, we are much more of a factor than we used to be. Anesthesia groups around the country are hiring AA's as fast as they can find them, and working at enabling AA practice in states where we don't currently practice. If some of the motivation for that is anesthesiologists thumbing their collective noses at CRNA's and CRNA "professional" organizations, I couldn't be happier. True, we're still much smaller as a profession than nurse anesthesia, but we're infinitely more noticeable and recognized than we were 20 years ago.
  5. 2
    [QUOTE=
    IMHO AAs are political tools invented and used by the ASA to try control CRNAs.[/QUOTE]

    I cannot fathom how anyone could disagree with this. Except an ASA member or AA. And even the more reasonable members of those cohorts would agree with it. I have seen no plausible explanation for the expansion of the AA programs in recent years.
    PMFB-RN and nomadcrna like this.


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