AANA members

URgettingsleepy · May 18, 2006

This bill is very important for the future of SRNA education. AANA members please log onto the members area and follow the link to contact your states senators. The A$A is busy lobbying for this bill we must do our best to stop it. To me this bill rewards MD training and will hurt SRNA training. If you do not believe me read it for yourself, and email now. UR

CRNAtoMD · May 18, 2006

It will definitely NOT hurt SRNA training and once again, if it passes, the AANA has all the ammunition to either get a corollary bill passed for SRNA education or to file suit and force CMS to change the rule for SRNA education.

There cannot be a sudden expansion of residency programs and as I have stated before many programs are just struggling to keep out of the red (usually by overworking residents and SRNA's and cutting faculty and CRNA hours). Also remember that this applies ONLY TO ACADEMIC CENTERS, NOT PRIVATE PRACTICE/NON-ACADEMIC AFFILIATED HOSPITAL SYSTEMS. SRNA programs not in academic settings would not be hurt or helped by the bill. Why? Because those hospital systems do not rely on Medicare for the BULK of their revenue streams. With hearts and major vascular trending toward being concentrated in academic centers and out of private hospital systems, the latter would have even MORE difficulty trying to start any residency.

Heck, even the current academic residencies have problems meeting numbers for hearts and kids and have to send their residents, sometimes cross country, to places like Texas Heart Institute and Children's Hospital of Philadelphia and these major referral centers have already distributed all of their available monthly training slots to existing programs (I know because I tried to get more experience for my current residents to rotate there and was flatly told there were no more spots available) and their own fellowship programs.

If you look over the past five years alone, there have been NO new residencies started in even the most affluent hospitals and hospital systems. Why? These programs do not benefit to any significant degree from Medicare. The cost of maintaining a residency program, providing residents with benefits, providing comprehensive liability coverage including tail coverage, and providing health, educational, and other stipends, far outweigh any benefit for increasing Medicare income (not doubling Medicare income as it would require all of the Medicare cases at any time of day or night be done by residents. Medicare pays 12-16 dollars per billing point compared to 50-90 dollars from private insurance and 30-40 from worker's comp).

ON TOP OF THAT, the academic programs that do benefit from it will only benefit if RESIDENTS do the bulk of the medicare cases. That means that a good portion of their clinical training will have to be in those facilities with those patients, leaving the better hospitals to be filled with the SRNA's. If you want to think of it that way, it means that SRNA's would get to train in the better facilities and not in the dungeon county hospitals since to maximize the revenue stream, a resident now has to do the cases in that facility.

Also don't think that the ASA is the only one spending money on this issue. The AANA has probably spent as much if not more in opposing it and what a WASTE of resources it has been for both sides. Every time I see a faculty member or CRNA leave my program because of inadequate/noncompetitive salary or capped work hours, I drift back to this thread and this topic and think how an extra $30,000,000 could help. We haven't even been able to renovate a 40 year old anesthesia lounge with a new refrigerator or chairs!

So when you pick up that pen or pick up the phone to do something to oppose HR5246, think about Mike ****, CRNA, Vanessa ******, CRNA, Ephraim ******, MD, Kenneth ******, CRNA, and Peter *****, M.D., all gone from my program in just the past 3 months. Their teaching, their comradery, their dedication, their DECADES of experience, and their ability to mold young minds can NEVER be replaced. In their stead, you have me teaching residents and SRNA's. Me with all of my two years as a CRNA and two years as a private practice MD. wow.

jwk · May 18, 2006

So when you pick up that pen or pick up the phone to do something to oppose HR5246, think about Mike ****, CRNA, Vanessa ******, CRNA, Ephraim ******, MD, Kenneth ******, CRNA, and Peter *****, M.D., all gone from my program in just the past 3 months. Their teaching, their comradery, their dedication, their DECADES of experience, and their ability to mold young minds can NEVER be replaced. In their stead, you have me teaching residents and SRNA's. Me with all of my two years as a CRNA and two years as a private practice MD. wow.

You don't get it - THEY DON'T CARE! All they care about is finding a way to undermine physicians in any way they can, and AT ANY COST!

rayman · May 18, 2006

JWK, that is not a true statement and appears to be an effort to sling mud. Frankly, I haven't yet heard a persuasive argument from anyone on why it is bad, other than suebee. CRNAtoMD is making very good points. I'm not trying to position myself against the crna brethren, but no one has stepped up to the mike yet. Any takers?.........I'm listening. Sorry, but I'm no sheep and if people want to get involved in political battles, then they should be able to explain their positions in an articulate manner. I'd love to hear a good counterpoint other than "they said". Who's got the micatin?

Balder_LPN, LPN · May 18, 2006

Besides the lousy spelling, you're incredibly naive. The AANA and it's minions donate TONS of money to politicians every year. I'm not pretending that physician's don't - but to think one side does it and not the other is ludicrous. And let's remember - Slick Willie's mom was a CRNA.

I didnt say only one side donates. Or that the AANA doesn't. Only that somebody got to the sponsor of this bill. I cant believe this Congressman (or his staff) has actually researched the issue and made an educated decision to support this bill. Someone, someway has gotten to him with money or promises of other support, or just a "Come on cuz, help me out here, I want to be the president of our professional group and this will clinch it for me". I may be many things, but naive is not one of them.

And I am not sure how a former (7years) presidents mom would play into this at all.

O, sawry fore the lowsy spiling

MmacFN · May 18, 2006

Hye ray

I have had an excellent conversation with CRNAtoMD and frankly, he convinced me. I wasent going to mention it here because i didnt want to be targeted for termination ;P

In anycase, the only thing i would advocate for is that this current bill be amended BEFORE acceptance to include the SRNA issues. In that way, there are no questions about what may or may not happen after the bill passess when the SRNA issue is brought up.

Truthfully, only a fool would blindly believe the propoganda of any political group on either side of a turf war. The truth of the matter with this bill and what the AANA and the ASA says lies somewhere in the middle of both stories. While i totally understand why both an MDA and a CRNA would certainly show solidarity to their organizaton and their profession, Im sure there are many on either side who question these issues yet do not post.

URgettingsleepy · May 19, 2006

This bill seeks 1:1 reimbursement for MD training yet does not include the same for CRNA's. It is logical to conclude a hospital would rather make more money faster. Why train SRNA's when you can bill twice as much with a resident?

You tell me if this will hurt SRNA training and eventually the profession.

CRNAtoMD posts a lot of theory about how it will not negatively impact CRNAs but read between the lines its all theory and no substance. UR

Nitecap · May 19, 2006

Hye ray
I have had an excellent conversation with CRNAtoMD and frankly, he convinced me. I wasent going to mention it here because i didnt want to be targeted for termination ;P
In anycase, the only thing i would advocate for is that this current bill be amended BEFORE acceptance to include the SRNA issues. In that way, there are no questions about what may or may not happen after the bill passess when the SRNA issue is brought up.
Truthfully, only a fool would blindly believe the propoganda of any political group on either side of a turf war. The truth of the matter with this bill and what the AANA and the ASA says lies somewhere in the middle of both stories. While i totally understand why both an MDA and a CRNA would certainly show solidarity to their organizaton and their profession, Im sure there are many on either side who question these issues yet do not post.

The AANA already went thru this last year and the ASA refused to push for ammendments to include SRNA's. I can promise you they will take the same stance. The ASA pretty much said you can get a bill introduced yourselves. This is our deal and we would like your support. Yet you can almost be sure if the AANA attempted to intro a bill to increase reimburtment for SRNA's the ASA would be the number one org lobbying against it.

MmacFN · May 19, 2006

Hey nite

If thats the case then it would seem that the ASA isnt interested in collaboration at all. I am not in favor of seeing this bill go through and hoping that AANA can get a similar bill or amendment to the old one for SRNAs.

jwk · May 19, 2006

The AANA already went thru this last year and the ASA refused to push for ammendments to include SRNA's. I can promise you they will take the same stance. The ASA pretty much said you can get a bill introduced yourselves. This is our deal and we would like your support. Yet you can almost be sure if the AANA attempted to intro a bill to increase reimburtment for SRNA's the ASA would be the number one org lobbying against it.

Here's my understanding of the issues - I'm sure if I'm incorrect, someone will let me know.

Resident reimbursement and SRNA reimbursement are separate issues. They're not paid out of the same pot of money from Uncle Sam. Resident reimbursement issues for anesthesiology relate to parity with other medical and surgical specialties and has/had nothing to do with money for nurse anesthesia training.

There's a big difference between the two. Residents, although in training, are employees of their departments or hospitals. SRNA's on the other hand are students earning a degree. Physician residencies in all specialties depend primarily on patient/insurance payments to pay the bills. Anesthesia residencies are treated different than other specialties. Nurse anesthesia programs depend primarily on tuition payments from their students, and on top of that, their services are billed to the insurance companies. It's apples and oranges.

The ASA is not going to make the proposals to deal with training of SRNA's. That's the AANA's job. The agreement supposedly was that each organization would support the other's request for changes in reimbursement - it was never the intent for the ASA to ask for SRNA money any more than it was for the AANA to ask for more money for anesthesia residencies. That's the job of the respective organizations. Each organization was to put forth their own proposal which the other would support. The ASA made their proposal. The AANA never made theirs - they just slammed the ASA's proposal because it didn't include SRNA's (and why should it?????). And of course this is when ThoughtBridge collapsed.

Maybe you haven't seen the final letters from the ASA and AANA as they pulled out of ThoughtBridge. I have. Although pointed and specific, the ASA's letter was still very professional and business-like. The one from the AANA was anything but. The ASA was interested in collaboration before, but getting stabbed in the back has ruined that for the forseeable future. But for the AANA and CRNA's to oppose the bill for no other reason than to get back at the ASA is petty and juvenile.

MmacFN · May 19, 2006

jwk

Nicely written. I am not knowelgeable enough about the issues to really comment, ill leave that for the experienced CRNAs. I would like to ask some questions though as you seem to have spent time reading the appropriate resources.

1) Your points about money comming from two different pots makes sense. However, if the ASA is asking for public money to increase MDA residency slots and they are justifying that with an "anesthesia provider shortage" argument, I can see why the AANA would be upset. The argument would appear dismissive of the CRNAs whom currently are in about equal numbers to the MDAs; ergo also in shortage. If the goal was to increase providers, then wouldnt it be more prudent to argue for using the same money to train twice the CRNAs? I know the argument isnt pro ASA, im just playing devils advocate.

2) I may be wrong, but i dont believe there is any public money reimbursement or support for SRNAs. Since there is a shortage why would the AANA be advocating the ASAs proposal to increase MDA slots while there is already a disparity between the two in regards to incentives to hospitals for training?

3) I cant speak to the ThoughtBridge thing. Where can i read about it?

4) The issues of backstabbing are nasty, but when isnt the poliics of money? It wasent that long ago the ASA fought to call anesthesia the sole practice of medicine. This would effectively end the CRNA profession or limit it to a handmaiden job. How would that have been helpful to the "anesthesia shortage" or contribute to patient care? Some would see that as the ultimate backstab. Who would trust someone after that?

Again, i am not versed in the absolute history other than that found in watchful care and the legal transcripts from the cases between the ASA and AANA. What I see, as an outsider looking in, is a battle for and about money and turf. This is a minor battle but one which could set a ball rolling. One that suggests:

"The government recognizes the anesthesia shortage and by their actions (if this bill passess without any amendment for SRNAs), endorses the ASA and Anesthesiologists as the solution to this problem."

Dont worry, im not under any illusions that the AANA is altruistic either, im just suggesting that a joint bill would be the only option if this one gets defeated as is. Maybe that would help place both groups at the same table?

Nitecap · May 19, 2006

Here's my understanding of the issues - I'm sure if I'm incorrect, someone will let me know.
Resident reimbursement and SRNA reimbursement are separate issues. They're not paid out of the same pot of money from Uncle Sam. Resident reimbursement issues for anesthesiology relate to parity with other medical and surgical specialties and has/had nothing to do with money for nurse anesthesia training.
There's a big difference between the two. Residents, although in training, are employees of their departments or hospitals. SRNA's on the other hand are students earning a degree. Physician residencies in all specialties depend primarily on patient/insurance payments to pay the bills. Anesthesia residencies are treated different than other specialties. Nurse anesthesia programs depend primarily on tuition payments from their students, and on top of that, their services are billed to the insurance companies. It's apples and oranges.
The ASA is not going to make the proposals to deal with training of SRNA's. That's the AANA's job. The agreement supposedly was that each organization would support the other's request for changes in reimbursement - it was never the intent for the ASA to ask for SRNA money any more than it was for the AANA to ask for more money for anesthesia residencies. That's the job of the respective organizations. Each organization was to put forth their own proposal which the other would support. The ASA made their proposal. The AANA never made theirs - they just slammed the ASA's proposal because it didn't include SRNA's (and why should it?????). And of course this is when ThoughtBridge collapsed.
Maybe you haven't seen the final letters from the ASA and AANA as they pulled out of ThoughtBridge. I have. Although pointed and specific, the ASA's letter was still very professional and business-like. The one from the AANA was anything but. The ASA was interested in collaboration before, but getting stabbed in the back has ruined that for the forseeable future. But for the AANA and CRNA's to oppose the bill for no other reason than to get back at the ASA is petty and juvenile.

Have not seen the letter. When did this thought bridge fallout occur. I have material claiming an ASA-AANA meeting Feb 13th where they didnt even have mediators present. They discussed the movie "Awake" and set fouth some protocols for each side to continue communication. These included the presidents of each contacting each other monthly to discuss evolving issues, creation of a training manuel for future ASA-AANA leader on the how tos and protocols of running these meetings ect. So as of Feb. seems as though there is some cmcn occuring. It even went as far to set meetings for Oct. 2007 and March 2007. They agreed to meet at least 2 x per yr and more if both sides agree to meet.

The AANA should also intro a bill granting similar wishes as the ASA's. This way each could give support to the other and you could ensure one side wouldnt stab the other in the back. AANA knows they cant trust ASA and Im sure ASA has mutual feelings about us. A mans word is garbage when it comes to political agendas, we all pretty much know that. Not sure if I would turn my back on the bill lobbying against it directly yet if consulted I prob wouldnt support it. On one note my training facility and dept you be pulling in much more money much of it prob being dumped back into the program possibly. Yet on the other hand why have all these SRNA's when we can increase the number of residents which will bring in 50% more than the SRNA. That is the AANA's worry. Not that the ASA's agenda is a direct move against the AANA, but that by increasing reimburstments for residents will lead to many SRNA slots being cut and replaced with residents. I mean its common sense that a group would want 100% reimbustment as opposed to 50%. Money drives everything and just that fact would def. effect SRNA training in the long run.

No i dont expect the ASA to intro a bill for CRNAs, yet the CRNA leadership must make a move that will be in the best interest of the profession and its growth. Supporting this bill that undoubtly gives programs ,that have a fixed number of positions, to increase the number of residents for monetary reasons will effect SRNA training.

JWK your telling me if a program has 30 residents and 15 SRNA that program would just totally pass up the opportunity to in a sense double their reimbustments all the way around by replacing the SRNA's with residents. Come on of course they would. Hey if I was an anesthesiologist or Business man that managed the practice it would be a no brainer. It would also effect staff CRNA positions that work at academic facilities with residents. I mean why pay the staff CRNA 150k for 100$ reimbustment when you can pay the resident 50-60k and get the same reimbustments. Though they can supervise 4 CRNA's to 2 residents the large difference in pay may be worth it depending on how busy the facility is and how many attendings there are.