Quote from Trauma Tom
......I do not understand why this is an issue, or do you get less compensation if not supervised by a physician? Does the supervising physician bill medicare and then they reimburse the CRNA. Or does this requiremnt somehow limit the compensation the CRNA gets paid......
Very confusing stuff, T-Tom. First, CRNAs are paid the same local rate as MDAs by Medicare under Part B. Anesthesia is anesthesia. CRNAs were the first APRNs to be granted independent Medicare billing rights, back about 1987 or so.
The current Opt-Out issue concerns the COP (conditions of participation) for hospitals. An institution cannot 'participate' and receive their *Part A* reimbursement from Medicare unless, basically, either, 1 -- CRNAs are nominally 'supervised' in whatever manner the institution chooses, or, 2 -- that State in question has been granted the Opt-Out by their Governor sending a letter to CMS, notifying CMS that the State will take advantage of the option. No need for approval back from CMS, etc.; sending the letter constitutes the Opt-Out.
For CRNAs who function under condition 1 above, the concern has long been that, because of the nominal administrative function the 'supervising' doc (usually the surgeon) serves, even so simple a 'supervision' as co-signing a Pre-Anesthetic Evaluation H&P, that by that act the doc will incur vicarious legal liability for the acts and ommissions of the CRNA. MDAs are known to push this line. It is not true, but doc-to-doc misinformation often passes unquestioned, especially if repeated often enough and devised in a manner so as to appeal to some physicians' egos -- "Hey, you're in charge, aren't you?"; but in fact courts sank the Captain of the Ship Doctrine as it applies to medical liability long ago. We CRNAs are liable for our own acts, just as the surgeons are for theirs. AANA.com has a lot to read on this issue. Essentially, the surgeon's fear of vicarious liability is minimized in Opt-Out States.
Very confusing stuff.