Difference between medically directed and supervision


I am trying to find out if a difference between medically directed as opposed to supervision exist?

What are the implication of each?

Glad to hear any feed back

Brenna's Dad

394 Posts

First of all, it is the nurse practice act of each state that determines the elements of CRNA practice. It is my understanding, and several people more qualified than me have agreed, that no states require CRNA supervision by an anesthesiologist, only the request for services by a physician, dentist, podiatrist.

Thus, supervision and direction are only insurance billing terms, specifically Medicare billing terms. Although Medicare could care less whether the anesthetic is performed by a CRNA, an MDA, or both....to qualify for medical direction and thus secure 50% of the medicare billing, the anesthesiologist must meet the 7 TEFRA rules, ie. prescibe the anesthetic plan, be present for induction and emergence and immediately available, direct PACU care, direct no more than 4 rooms, etc. If the TEFRA rules are not met, then the MDA is "supervising" and will NOT receive 50% payment....what they do receive is not known to me.

Obviously, this arrangement is strange. Why would the CRNA give up 50% of their billing rights to an anesthesiologist, when they are doing most of the work? It is my feeling that the ASA has perverted these Medicare billing rules to imply that CRNAs must always be directed/ supervised and in my opinion have done a very good job at perpetuating this misconception. My apologies to my anesthesiologist colleges if this is mere conspiracy theory on my part...


140 Posts

Brenna, thanks.

I had done clinicals at one site where the MDA's basically wrote out the anesthetic plan. type of anesthesia, meds to be used and other details.This site the CRNA's are hospital employees while the MDA's are a private group.MDA works four rooms at a time.

At another site the MDA, did the pre-anesthetic assessment and made suggestions about how the anesthetic would go. But the CRNA decided the meds to be used and decided if the case called for lines or any other anesthetic adjuncts. This site the CRNA and MDA work for the same group.

MDA works two rooms at a time.

They still did their billing thing in both institutions. But at the second site CRNA's had more of a say in how they wanted to do the anesthetic. They looked at the MDA. I just was not sure if one of them uses medically direction and the other medical supervision or both were applied.

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