CRNA independent states

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Hi all. As a prospective SRNA, I was hoping someone could tell me which states nurse anesthetists are allowed to practice independently in. (Or which states they cannot, whichever is the shorter list).

Thanks,

Elyse

The states won't opt back in. It doesn't make sense (logistically or financially) for them to do so. Why stretch their medicaid/medicare dollars to pay MDAs more when they've been paying CRNAs less to get the same job done for years. Besides, the states that opted out did so in the first place because most MDAs are not willing to relocate to practice in certain (especially rural) areas where they know they won't make a ton of money. The legislators would never have allowed opting out if they weren't convinced that it is a safe and advantageous thing for citizens of those states. This is one part of the battlefield where $$$ speaks louder than politics, and the physicians are not unaware of this.

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The states won't opt back in. It doesn't make sense (logistically or financially) for them to do so. Why stretch their medicaid/medicare dollars to pay MDAs more when they've been paying CRNAs less to get the same job done for years. Besides, the states that opted out did so in the first place because most MDAs are not willing to relocate to practice in certain (especially rural) areas where they know they won't make a ton of money. The legislators would never have allowed opting out if they weren't convinced that it is a safe and advantageous thing for citizens of those states. This is one part of the battlefield where $$$ speaks louder than politics, and the physicians are not unaware of this.

MD's don't get the same financial incentives through Medicare for small hospitals that CRNA's do. If the hospital does less than 800 cases a year, some of the professional anesthesia services can be covered under Part A, allowing the hospitals to pass through their expenses and enabling them to utilize CRNA's. MD's on the other hand are only covered under Part B, period. They are paid the Medicare rate only. At $15-20 a unit, it wouldn't even cover the true costs of most anesthetists. But if you can add in additional money through Part A, it works out better. Of course that only applies to CRNA's, not MD's. That's why you see more CRNA's in rural hospitals. You actually get paid MORE than an MD would. So much for your CRNA's are cheaper argument.:chuckle

As for opting IN, stay tuned, because it will happen...

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Well then, thank goodness for CRNA's. Without them Those small rural

communities might not have any local surgery option. As you said

why would an MDA practice there and not get paid. :stone

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i was under the impression that crnas could only bill 75% of what an anesthesiologist bills through medicare and this was the financial bonus for using crna's, jwk maybe you could post a link to a medicare site on billing, i'll start looking now.

d

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I don't know how it works for CRNA's who are in their own independent practice but for those that work for a hospital this is what I was told. I was told that hospitals hire both CRNA's and MD's because they can bill Medicare for two providers for each patient as long as there are two signatures on the chart. This is also what I have been seeing. The MD goes around and signs his/her name on the chart without even seeing the patient or having anything to do with the case. And people wonder why Medicare is so high for the elderly population. The hospitals are taking advantage of the Medicare system. The MD's are the ones driving up the cost of health care, not CRNA's. When you have a hospital paying $300,000 or more a year for each anesthesiologist to sign charts and then sit around and play on the computer that drives up the prices, not CRNA's who are actually taking care of the patient.

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Specializes in Anesthesia.
...... When you have a hospital paying $300,000 or more a year for each anesthesiologist to sign charts and then sit around and play on the computer that drives up the prices, not CRNA's who are actually taking care of the patient.

http://www.gaspasser.com/animal%20farm.html

deepz

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Specializes in Anesthesia.
.......At $15-20 a unit, it wouldn't even cover the true costs of most anesthetists. .....That's why you see more CRNA's in rural hospitals......

Such a comedian!

!

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i was under the impression that crnas could only bill 75% of what an anesthesiologist bills through medicare and this was the financial bonus for using crna's, jwk maybe you could post a link to a medicare site on billing, i'll start looking now.

d

I'll be the first to admit I'm no expert on Medicare payments. I think this applies when the hospital is paying the CRNA, not the CRNA doing direct billing. Hospitals get reimbursed based on their costs, and in smaller hospitals doing less than 800 cases a year, they can get special consideration for CRNA's doing the case. This same pass-through arrangement doesn't apply to MD's. Let's be honest - rural CRNA's can't make a living off of a lap chole that might pay

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Such a comedian!

!

Glad you liked it - wait till the opt-in's start - you'll like that even more.

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Well said.

yoga crna, Imdscd, deepz, chattypattycrna2b, and others I've missed,

Thank you for your replies and for keeping your cool with me. It seems that there's a lot of strong feelings so it always feels like I'm playing with fire around here.

Yoga crna, well, I wouldn't call those physicians arrogant. Confident but not arrogant. If you've met them, they're quite nice. And yes, they do appreciate nurses watching their backs. I know that nurses are responsible for their own actions and I know there's a lot of interdependence between doctors and nurses. Anesthesia aside, if a nurse sees something odd, they'll notify the physician. However, isn't it still the physician that ultimately determines the medical management of the patient?

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Specializes in Anesthesia.
......isn't it still the physician that ultimately determines the medical management of the patient?

Perhaps some med schools still teach patient care as if it were a wheel with the physician at the center. But the modern day actual clinical practice places the PATIENT at the center. We are all spokes on that wheel, working together.

.

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Perhaps some med schools still teach patient care as if it were a wheel with the physician at the center. But the modern day actual clinical practice places the PATIENT at the center. We are all spokes on that wheel, working together.

.

What an AWESOME analogy! I never heard it put quite that way, and it is very descriptive. I am definitely using this one in future discussions/writings. Thanks deepz!

loisane crna

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