Why don't CRNA's like AA's - page 2

i've noticed a sense of hostility on this forum towards aa's by nurse anesthetist or student nurses of anesthesia. why so hasty? i always read on this forum about the shortage of anesthesia... Read More

  1. by   smk1
    Quote from user69
    I wonder if this argument would have ever come up if they had made it where AAs were supervised by MDA or CRNA?
    well that is an interesting proposition. I am a student but wonder why AA's can't be supervised by CRNA's if CRNA's have no need for supervision? Would this be plausible?
  2. by   ep71
    Quote from smkoepke
    well that is an interesting proposition. I am a student but wonder why AA's can't be supervised by CRNA's if CRNA's have no need for supervision? Would this be plausible?
    I would think because they are not nurses. Do nurses of any speciality supervise non-nurses? I would think that AA's would be offended by the suggestion being that they probably feel that they had to endure a much more rigorous undergraduate curriculum.
  3. by   Busy20yo
    how much do they make!!??

    Just curious
  4. by   trakstar
    Quote from gaspassah
    this is the deal. no 2 ways about it. control of the money. bill the same dollar to patient, pay less money to aa who does the case = more money in mda pocket. mda has no fear of aa they MUST be supervised by law. less work for mda, more money for mda. hmm......plus cut competition of alternate provider (crna) = whole or most of the market.
    I agree. Let's look at the AA vs. CRNA medicare reimbursement which was looked at during my masters health policy class. Please note this is a gross comparison for simplicity reasons. If you look at each case in terms of reimbursement it looks like this. MDA gets full reimbursement for one case or the MDA can supervise 4 cases and split the reimbursement costs due with the AA since the AA has to be supervised under medicare reimbursement. If you look at the language I wish I had the reference to the medicare rule number. The MDA gets to collect on 4 cases at 50% of the total reimbursement. If you do the math 4-halves= 2 wholes. The MDA is able to collect reimbursement equivalent to two surgical cases or get paid 2x the amount grossly in comparison to if they worked cases alone. The CRNA makes more fiscal sense and collects 85% of the total medicare reimbursement. The financial gains are well disguised. Medicare reimburses the same amount of money for each case (grossly). But the difference between the MDA & AA or CRNA alone is how the pie is divided up. Reimbursement rates grossly go as follows. MDA independently 100%, CRNA independently 85%, MDA supervising AA (up to 4 cases stimultaneously) MDA 50% for each case & AA 50%. MDA supervising CRNA (up to 4 cases stimultaneously) MDA 50% for each case & CRNA 50%.You can take the case further to cost effectiveness in employing MDA & AA or CRNAs, just compare the salaries. Again this is not an exact measurement of economics the picute is drawn up grossly for simplistic reasons I hope this sheds new light to those skeptics who do not believe it is about money.
    Last edit by trakstar on May 20, '04 : Reason: More reimbursement info
  5. by   smk1
    Quote from ep71
    I would think because they are not nurses. Do nurses of any speciality supervise non-nurses?

    yes techs nursing assistants, medical assistants etc... This is why I asked the question. I won't get into the whose education is more "rigorous" battle because it is a no win argument. I do agree that some AA's might feel "insulted" by having a CRNA supervise them. but then many CRNA's probably feel the same way when MDA's "supervise" them and restrict their practice though it is not required. It seems to me that this is a logical and economical step. So I ask again are there any real reasons why a CRNA can't supervise an AA? I freely admit I do not know much about this subject. enlighten me guys!
  6. by   gaspassah
    i think it is how it's written into law. that aa's must be medically directed by a mda. not just directed.
    d
  7. by   Sheri257
    This is an interesting document. The Rural Hospital Coalition in Lousiana is supporting AA's because "the CRNA shortage has become acute."

    http://69.2.40.145/LANA/Admin/Upload...spitalMemo.pdf

    Looks like a hellava fight since both the AA bill and another bill banning AA's have gotten out of committee.

  8. by   user69
    Quote from trakstar
    i agree. let's look at the aa vs. crna medicare reimbursement which was looked at during my masters health policy class. please note this is a gross comparison for simplicity reasons. if you look at each case in terms of reimbursement it looks like this. mda gets full reimbursement for one case or the mda can supervise 4 cases and split the reimbursement costs due with the aa since the aa has to be supervised under medicare reimbursement. if you look at the language i wish i had the reference to the medicare rule number. the mda gets to collect on 4 cases at 50% of the total reimbursement. if you do the math 4-halves= 2 wholes. the mda is able to collect reimbursement equivalent to two surgical cases or get paid 2x the amount grossly in comparison to if they worked cases alone. the crna makes more fiscal sense and collects 85% of the total medicare reimbursement. the financial gains are well disguised. medicare reimburses the same amount of money for each case (grossly). but the difference between the mda & aa or crna alone is how the pie is divided up. reimbursement rates grossly go as follows. mda independently 100%, crna independently 85%, mda supervising aa (up to 4 cases stimultaneously) mda 50% for each case & aa 50%. mda supervising crna (up to 4 cases stimultaneously) mda 50% for each case & crna 50%.you can take the case further to cost effectiveness in employing mda & aa or crnas, just compare the salaries. again this is not an exact measurement of economics the picute is drawn up grossly for simplistic reasons i hope this sheds new light to those skeptics who do not believe it is about money.
    great information. help me a lot in understanding the financials behind my chosen (soon to be) career. if i am reading this correctly, then there is no additional net charge for having one mda and 4 aas or crnas in s "anesthesia care team" than to have just 4 mdas. the only way to decrease the actual billed amount is to have crnas work independently and bill directly for 85% of what an mda or "anesthesia care team" would charge.



    why are crnas willing to work for mdas and settle for 50% instead of just billing directly and getting the 85%?



    does medicare intend to imply that crnas are only 85% as skilled as a mda by there reimbursement policy?
  9. by   jwk
    Quote from smkoepke
    well that is an interesting proposition. I am a student but wonder why AA's can't be supervised by CRNA's if CRNA's have no need for supervision? Would this be plausible?
    AA's have a sponsoring physician, just like PA's do. Our licenses are tied to that physician. In Georgia, a physician may only have two AA's or PA's affiliated with them. In addition, an AA may have any number of supervising physicians, as long as those physicians names are on file with the state licensing folks. That enables us to function within a group practice. An AA can also have several sponsoring physicians, so if they choose to have more than one employer, or work on a locum tenens basis, they can do that as well.

    There are no government, private payor, or malpractice carrier provisions that would allow a CRNA to provide medical direction/supervision of another provider, either CRNA or AA.
  10. by   jwk
    Quote from Busy20yo
    I think some people are afraid to lose their jobs to AA's.


    BTW. What is the average salary of an AA?
    The salaries / compensation packages for AA's are identical to CRNA's in the same practice, with comparable levels of experience. In my practice, as with all the others I'm familiar with, an AA and CRNA who have both been in practice for 10 years would be offered an identical compensation package.
  11. by   Trauma Tom
    JWK,

    I am not familiar with georgia law as it pertains to the use of AA's, however if Georgia law only allows for physicians to supervise 2 AA's or CRNA's than there is no financial benefit to using AA's unless they are willing to work for less than a CRNA. If this is a fact then you can see why CRNA's are against the use of AA's as it diminishes our earning potential? Because in markets that use AA's, MDA's will not want to employ CRNA's because of higher pay. Please check and make sure you are correct about Georgia law. I thought is was the same as federal law for medicare reimbursement?
    Quote from jwk
    AA's have a sponsoring physician, just like PA's do. Our licenses are tied to that physician. In Georgia, a physician may only have two AA's or PA's affiliated with them. In addition, an AA may have any number of supervising physicians, as long as those physicians names are on file with the state licensing folks. That enables us to function within a group practice. An AA can also have several sponsoring physicians, so if they choose to have more than one employer, or work on a locum tenens basis, they can do that as well.

    There are no government, private payor, or malpractice carrier provisions that would allow a CRNA to provide medical direction/supervision of another provider, either CRNA or AA.
  12. by   jwk
    Quote from nilepoc
    Let me equate this to something you should be able to relate to if you are an RN.

    there is currently a shortage of RN's. To fix this shortage, I am going to allow anyone who is interested to become an RN. I am going to require them to have no experience and i am going to only give them positions in the ICU upon completion of their program. At the same time, i am going to cut the pay of current ICU RNs and additionally I am going to place restrictions on the practice of ICU RNs, so that I do not have to administrate more than one kind of provider.

    This is what is happening to CRNAs in some markets. AAs move in, the MDAs don't want to supervise two types of providers, so they limit the practice of CRNAs to equal the practice of AAs in that facility. Later taht year, administration asks the question why are we paying CRNAs more if they are doing the same limitted job of the AA? CRNA salaries fall, and CRNA practice deteriorates. Over time, this has the potential to become the norm in big hospital practice. It would not take many AAs in a hospital to bring about a change like this.

    IMHO this is one of the reasons CRNAs are less than friendly in supporting the practice of AAs.
    I'd love to see even one specific example of how a CRNA's compensation has been cut due to AA's. Not the generalizations such as "they're lower in Georgia because of AA's". I know lots of CRNA's in Georgia in both hospital and group practices making $150k+, some much more than that, particularly those in smaller hospitals or working locum tenens. For a part of the country with a substantially lower cost of living than the Northeast or the West Coast, I would bet very few of your colleagues are complaining about their standard of living in Georgia.
  13. by   TheBigBadDog
    Quote from jwk
    i'd love to see even one specific example of how a crna's compensation has been cut due to aa's. not the generalizations such as "they're lower in georgia because of aa's". i know lots of crna's in georgia in both hospital and group practices making $150k+, some much more than that, particularly those in smaller hospitals or working locum tenens. for a part of the country with a substantially lower cost of living than the northeast or the west coast, i would bet very few of your colleagues are complaining about their standard of living in georgia.
    i don't think that you have sufficiently grasped the economics of this issue. the only thing that determines the price (salary) is supply (of providers) and demand (for the services). assuming that demand remains constant and the supply is increased the price (salary) will decrease. the amount of the salary decrease is determined by the slope and shape of the demand and supply curves.

    the supply is determined by a number of factors, but the barrier to entry into the market is probably the most important factor. what is a barrier to entry? it is something that prevents other would be suppliers of the service from competing against you. licenses, education, and experience are three of the most common and useful barriers that are used in the usa to prevent competition. if erode the barriers you will see lots of new entries into the market who are willing to provide this service, hence direct competition!

    new crna schools maybe a bigger threat to the existing salaries of crnas, but if the difficulty of achieving a crna certification, license, etc. are maintained then many of the would new competitors will not become a crna.

    there is one overriding economic principle that will affect crnas salaries, especially if it suddenly becomes easier to become a service provider, "excess profits breeds ruinous competion"! that means that the salaries of crnas climb higher more competitors will want to enter the market until there is glut of competitor and jobs will become scarce and wages will fall.

    these are basic economic that effect all professions. anyone who has a profession or a job should always be concerned about competition between service providers. i think the ama has shown that it understands these ideas, and it is willing and able to come up with ways to avoid competition. remember for the service provider competition is always bad!
    Last edit by TheBigBadDog on May 20, '04

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