AANA (NON) membership anyone?

Specialties CRNA

Published

This is for CRNAs only....Are any of you NOT members of the AANA? if not, why not? Please do not go on and on about how it is my prefessional organization protecting my scope of practice etc etc etc. I am asking those who are NOT members why they chose to opt out. Are any of you angry enough about the AANAs inaction and abandonment of its members RE the MBCRNAs program for recertification? Maybe it's refusal to admit overproduction is a problem and it's unwillingness to address the problem? Cost of membership vs benefits received?

I know I am NOT the only non AANA member. According to the annual survey, about 5% of us are not members.

Thanks

Vast was not the adjective to use. And I did say I heard a rumor about AAs in the military. It has been a long time since I was a 46M3. We did not have AAs. I do not keep up with military CRNA issues as it has nothing to do with me any more. That you for quashing the rumor I heard.

I am glad you are happy with the AANA. But I must repeat , I was looking for non- members. Nevertheless ,your comments are appreciated.

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Specializes in Anesthesia.

Maybe the reason why no non-members respond is that there are very few of them who bother with internet sites involving anesthesia. One of the people who I talked to recently reinstated her membership because of wanting to read the Journal and News Bulletin for clinical updates and professional matters. Also, I heard from a third party of one who let his membership lapse and also his that he got through AANA Insurance Services. Within a month he found himself in the wrong end of a lawsuit and is having to pay for an attorney to defend his actions. When questioned about why he didn't renew his membership, he said it was because of money. The guy makes well over $300,000 and he was fussing about paying $645. I bet he is rethinking his decision as he writes the retainer check to the attorney.

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Maybe the reason why no non-members respond is that there are very few of them who bother with internet sites involving anesthesia. One of the people who I talked to recently reinstated her membership because of wanting to read the Journal and News Bulletin for clinical updates and professional matters. Also, I heard from a third party of one who let his membership lapse and also his malpractice insurance that he got through AANA Insurance Services. Within a month he found himself in the wrong end of a lawsuit and is having to pay for an attorney to defend his actions. When questioned about why he didn't renew his membership, he said it was because of money. The guy makes well over $300,000 and he was fussing about paying $645. I bet he is rethinking his decision as he writes the retainer check to the attorney.

There are many places to get updates on clinical issues. Not so much professional issues. Unless you borrow someone's copy of the newsletter.

As for doing it to save money, nope. The story you heard, as apocryphal as it sounds is pure fantasy. Non members pay the same amount to renew certification through the NBCRNA as it would cost to be an AANA member . AANA members get a discount that makes the decision to be a member or not, economically a wash . Thank you for responding even though it was not what I was looking for.

Oh, and think about this , a provider earning 300Ka year and no ? That does not pass the smell test.

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I am not saying AAs in the military are a good thing. But it could be done if the need arises. CRNAs and MDAs could fill deployment positions in ATHs etc. In the case of the USAF. And CASH (?) , FSTs in the case of the Army. And an AA could be backfill at Conus MTFs.. Not everyone gets deployed. Nuclear weapons technicians , missile launch officers and many more come to mind. But again. All I heard was a rumor and by the strident nature of your response, I think you are more connected to the military than I am. As I said before, I don't follow military CRNA issues closely. Sounds like you do. Thank you for setting me straight on that.

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Duplicate post removed

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Specializes in CRNA, Finally retired.
AHHH NBCRNA... that makes all the difference in the world...I wil now rejoin the AANA.... Come on, I am sure there are syntactical errors you can also point out.

There is just nothing wrong with accuracy - especially for us.

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1. First and foremost AAs cannot serve in the military as anesthesia providers. All military anesthesia providers have to be able to deploy and work independently. That cannot be done with AAs. Only CRNAs and anesthesiologists can provide independent anesthesia care.

2. The AACN (American Association of Colleges of Nursing) made the recommendation that APNs move to a clinical doctorate as an entry into practice. The NP credentialing body have not supported the move to entry level DNP for NP as of yet. The AANA did not make the move to a clinical doctorate to align with NPs. The move to an entry level clinical doctorate by the CRNA community was to make our curriculum consistent with the amount of credit hours being taught, and to help make CRNAs more consistent leaders in EBP/EBM. This is nothing new as CRNAs have went from OJT, to certification, to Bachelors, to Masters over the span of 150 years.

3. The AA fight is hardly a forgone conclusion. Medicare just eliminated one of the billing modalities that AAs had been using, and requiring billing for AAs to be only billed as medically directed. As medical billing becomes more complicated and every dollar is accounted for ACT practices are going to become more scrutinized. It has already been proven that the majority billing done in ACT practicing do not meet the TEFRA requirements. The ACT system will either change or die out leaving a lot of AAs without jobs.

1) You are correct - AA's do not currently serve in the military - but that can be changed with the stroke of a pen. Surely you recognize that civilian and military standards/guidelines/rules/regulations are entirely different animals. I can tell you there most certainly is interest in having AA's in the military judging from the discussions I've had with military anesthesiologists.

2) The move from OJT to masters did not take 150 years. As recently as the mid 80's, CRNA's were still receiving "certificates in nurse anesthesia" and there are currently many thousands of practicing CRNA's with no degree whatsoever.

3) Medicare didn't eliminate anything. Nothing changed. AA's have always been medically directed. And ACT practices are still thriving throughout the US. My group has hired 50 anesthetists in the last two years due to expansion of our practice. Job placement is still virtually 100%, at least for AA's, and probably close to that for CRNA's who are smart enough to leave the overproduced CRNA markets like Florida. Not sure where you get the idea that it has been "proven" that the majority of billing done in ACT practices doesn't meet TEFRA requirements. Wishful thinking perhaps - I know there is an organized campaign for CRNA's to act as whistleblowers against their employers. You have data to back up your claims of fraudulent actions?

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I do not work with AAs , however, they are in several local hospitals. The interesting thing about the hiring of AAs was, despite the " Sturm Und Drang" no CRNA left any of those practices in protest. I heard a lot of " I'll quit " talk when it was first introduced.

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There is just nothing wrong with accuracy - especially for us.

Thank you. I did not realize that.

But let me restate that I am looking for CRNAs who are not AANA members.

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Specializes in Anesthesia.
1) You are correct - AA's do not currently serve in the military - but that can be changed with the stroke of a pen. Surely you recognize that civilian and military standards/guidelines/rules/regulations are entirely different animals. I can tell you there most certainly is interest in having AA's in the military judging from the discussions I've had with military anesthesiologists.

2) The move from OJT to masters did not take 150 years. As recently as the mid 80's, CRNA's were still receiving "certificates in nurse anesthesia" and there are currently many thousands of practicing CRNA's with no degree whatsoever.

3) Medicare didn't eliminate anything. Nothing changed. AA's have always been medically directed. And ACT practices are still thriving throughout the US. My group has hired 50 anesthetists in the last two years due to expansion of our practice. Job placement is still virtually 100%, at least for AA's, and probably close to that for CRNA's who are smart enough to leave the overproduced CRNA markets like Florida. Not sure where you get the idea that it has been "proven" that the majority of billing done in ACT practices doesn't meet TEFRA requirements. Wishful thinking perhaps - I know there is an organized campaign for CRNA's to act as whistleblowers against their employers. You have data to back up your claims of fraudulent actions?

1. There is no plan to have AAs in the military, because they are useless to the military. AAs cannot deploy, they cannot do call by themselves, they cannot work outside of anesthesia etc. It is not a simple matter of signing something to make AAs a viable entity in the military. There are only a few bases that could even support an ACT practice where AAs could work. There would have to be a separate scope of practice just for AAs in the military. A scope of practice change in the military is not a simple matter of a military decision either this is highly charged political debate that takes place inside and outside of the military.

2. Show me the numbers where there are still thousands of practicing CRNAs with just certificates in anesthesia. The point is that CRNAs continue to develop with times from OJT, to licensing, mandatory educational requirements for cases, certification, Bachelor, Masters, and now practice doctorates.

3. TEFRA rules are not met the majority of the time according to some magazine article in some peer review journal called "Anesthesiology". Only allowing AAs to bill for medical direction eliminates any loopholes for AAs being billed at a higher rate without having to follow TEFRA rules.

http://www.asahq.org/For-Members/Advocacy/Washington-Alerts/FY13-HHS-Inspector-General-Workplan-to-Include-Review-of-Personally-Performed-Anesthesia-Services.aspx

Medicare is aware that billing under TEFRA rules is often false.

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1. There is no plan to have AAs in the military, because they are useless to the military. AAs cannot deploy, they cannot do call by themselves, they cannot work outside of anesthesia etc. It is not a simple matter of signing something to make AAs a viable entity in the military. There are only a few bases that could even support an ACT practice where AAs could work. There would have to be a separate scope of practice just for AAs in the military. A scope of practice change in the military is not a simple matter of a military decision either this is highly charged political debate that takes place inside and outside of the military.

2. Show me the numbers where there are still thousands of practicing CRNAs with just certificates in anesthesia. The point is that CRNAs continue to develop with times from OJT, to licensing, mandatory educational requirements for cases, certification, Bachelor, Masters, and now practice doctorates.

3. TEFRA rules are not met the majority of the time according to some magazine article in some peer review journal called "Anesthesiology". Only allowing AAs to bill for medical direction eliminates any loopholes for AAs being billed at a higher rate without having to follow TEFRA rules.

FY13 HHS Inspector General Workplan to Include Review of Personally Performed Anesthesia Services

Medicare is aware that billing under TEFRA rules is often false.

You should read what you provide links for - that's a link to an item on the ASA website Anesthesiology has two articles regarding "medical direction" - one is the Silber study that I'm sure you're familiar with, and the other is a letter to the editor regarding the Silber study. If you can show me something in Anesthesiology that indicates "TEFRA rules are not met the majority of the time", by all means - show me.

Again - since the billing concept of "medical direction" was introduced by CMS, AA's have always been billed for in that manner. You do realize that the "AA" modifier for Medicare billing does not mean Anesthesiologist Assistant, but actually means personally performed by an anesthesiologist, right? There's no confusion on our part about this - perhaps it's just wishful thinking on your part.

If you look at the entire CMS document you are referring to, there are a large number of things the OIG is looking at - they want to save a buck EVERYWHERE, not just with anesthesia. Your claim that "Medicare is aware that billing under TEFRA rules is often false" is also wishful thinking on your part, and is the subject of much interest and promotion of whistleblower actions by CRNA's and their organizations.

As far as AA's in the military - their scope of practice and level of direction/supervision would be determined by the branch of the service that uses them. They would be under the medical corps, not the nurse corps (thankfully). I have no idea how many military units use anesthesiologists throughout the world, but under current concepts of medical direction, anywhere there is an anesthesiologist there could conceivably be an AA.

Certificates in nurse anesthesia were granted well into the 1980's as I recall, perhaps even into the 90's. The masters degree requirement didn't come along till well into the 90's. That means a lot of CRNA's who got their certificates in the 80's while they were in their 20's would only be in their 50's now. There are a number of them still working in my own group. I don't know the percentage still working, but even if you assume 10% of the AANA membership, that still means more than 4,000 individuals. I know, you look on them as lesser beings than those who actually have a degree, but they're still doing a fine job, and in most cases can dance circles around their younger degreed counterparts.

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Specializes in Anesthesia.

JWK only physicians belong to the medical corps in the military. That is just another thing you have no clue about. The only corps that AAs could belong to would be the BSC which is the same one as PAs. I don't need to sit and prove that the majority of ACT practices do not meet TEFRA requirements it is a known fact, if you feel it is not you can refute with skills taught in AA school on utilizing research/EBM.

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