How exactly does a surgeon "supervise" a CRNA?

Specialties CRNA

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I dont get it. A surgeon knows NOTHING about gas at all.

So I'm confused when I hear some CRNAs say that their "supervising physician" (in states that require a supervising physician) are the surgeons running the case.

Explain to me exactly how a surgeon can "supervise" or "collaborate" wtih a CRNA.

Specializes in Anesthesia.
If you had to place your bets, how much longer before the number of states that pass AA legislation eclipses the number of states that have opted out? The current score is 11 vs. 14.

Apples and oranges.

https://allnurses.com/forums/2379951-post17.html

!

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In all 50 States, CRNAs are legal independent providers.

So all 50 states have opted-out of the Medicare "supervision" rules?

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Specializes in Anesthesia.
So all 50 states have opted-out of the Medicare "supervision" rules?

Apples and oranges.

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So all 50 states have opted-out of the Medicare "supervision" rules?

The medicare opt-out has nothing to do with independent practice of a CRNA. It is a billing issue. In those states that have NOT opted out, a CRNA must be supervised in order to receive full reimbursement for MEDICARE cases they do. The supervising physician need not be an anesthesiologist. CRNAs are licensed to practice independent in all 50 states. The individual institutions then set their own policy and procedures that govern nurse anesthesia practice.

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Specializes in CRNA, Law, Peer Assistance, EMS.

GOOD LORD!:nono:

There are 5 different things being compared to each other, none of which has anything to do with the others.

First, the number of states that allow the tiny fraction of anesthesia providers known as Anesthesiology Assistants (AA's) to practice has nothing whatsoever to do with the "opt-out" from the medicare requirement for supervision. Whoever brought that up is an anesthesiologist happily acting the fool and childishly pretending to be a nurse in order to post nonsense on this board. Shame.

Second, the terms SUPERVISION and MEDICAL DIRECTION are terms that were coined by the American Society of Anesthesiologists and adopted by OMIG many years ago when Medicare and Medicaid were in their infancy and developing their reimbursement framework. The ASA hoped these terms would ensure that all Medicare and Medicaid patients would have to be supervised by an anesthesiologist in order for services to be reimbursed. Thus, these terms were/are ONLY useful and relevant for billing purposes. Many major insurance companies also use them to determine the rate they will pay for anesthesia services. For example, if an anesthesiologist is covering 3 CRNA's in 3 operating rooms (medical direction), he/she must be present in the room for induction and emergence and available at all times for emergencies, and check the room at regular intervals in order to be PAID. Whether he/she is there at all, is purely an institutional policy. If he/she wants to bill for the procedure then the above medical direction must take place. As i said, the anesthesia and the CRNA will carry on with or without him/her.

I'll say it once more. THESE TERMS RELATE TO BILLING ONLY! They have NO effect on liability for the surgeon, the CRNA, or the anesthesiologist. Each is responsible for his/her own actions. Supervision, or medical direction when applied to a surgeon/dentist/podiatrist working directly with a CRNA, is a nearly meaningless term. There is no legal definition that has been clearly defined in ANY state. The CRNA bills as NON-MEDICALLY DIRECTED since there is no anesthesiologist to split the fee. The surgeon DOES NOT choose or prescribe the anesthetic. If they DO, they become materially involved in the delivery of the anesthesia and both the CRNA and the surgeon immediately incur greater liability. The CRNA for letting a surgeon dictate the anesthesia, and the surgeon for butting in to an area in which he has no expertise.

The "opt-out" from supervision is about BILLING...PERIOD. And only Medicare and Medicaid billing at that. It has NOTHING to do with the manner in which anesthesia is delivered, or by whom....only who can bill for it. $$$$$$$$$:smiley_ab

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Specializes in Pain Management.
GOOD LORD!:nono:

There are 5 different things being compared to each other, none of which has anything to do with the others.

First, the number of states that allow the tiny fraction of anesthesia providers known as Anesthesiology Assistants (AA's) to practice has nothing whatsoever to do with the "opt-out" from the medicare requirement for supervision. Whoever brought that up is an anesthesiologist happily acting the fool and childishly pretending to be a nurse in order to post nonsense on this board. Shame.

Second, the terms SUPERVISION and MEDICAL DIRECTION are terms that were coined by the American Society of Anesthesiologists and adopted by OMIG many years ago when Medicare and Medicaid were in their infancy and developing their reimbursement framework. The ASA hoped these terms would ensure that all Medicare and Medicaid patients would have to be supervised by an anesthesiologist in order for services to be reimbursed. Thus, these terms were/are ONLY useful and relevant for billing purposes. Many major insurance companies also use them to determine the rate they will pay for anesthesia services. For example, if an anesthesiologist is covering 3 CRNA's in 3 operating rooms (medical direction), he/she must be present in the room for induction and emergence and available at all times for emergencies, and check the room at regular intervals in order to be PAID. Whether he/she is there at all, is purely an institutional policy. If he/she wants to bill for the procedure then the above medical direction must take place. As i said, the anesthesia and the CRNA will carry on with or without him/her.

I'll say it once more. THESE TERMS RELATE TO BILLING ONLY! They have NO effect on liability for the surgeon, the CRNA, or the anesthesiologist. Each is responsible for his/her own actions. Supervision, or medical direction when applied to a surgeon/dentist/podiatrist working directly with a CRNA, is a nearly meaningless term. There is no legal definition that has been clearly defined in ANY state. The CRNA bills as NON-MEDICALLY DIRECTED since there is no anesthesiologist to split the fee. The surgeon DOES NOT choose or prescribe the anesthetic. If they DO, they become materially involved in the delivery of the anesthesia and both the CRNA and the surgeon immediately incur greater liability. The CRNA for letting a surgeon dictate the anesthesia, and the surgeon for butting in to an area in which he has no expertise.

The "opt-out" from supervision is about BILLING...PERIOD. And only Medicare and Medicaid billing at that. It has NOTHING to do with the manner in which anesthesia is delivered, or by whom....only who can bill for it. $$$$$$$$$:smiley_ab

Good information and...best smiley icons EVER!

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and

(3) determine that the patient is an

appropriate candidate for the procedure

and anesthesia

a surgeon has absolutely zero business doing this. its the same thing as asking a family practice doctor whether his patient is a good candidate for brain surgery without talking to a brain surgeon first.

deciding whether a person is appropriate candidate for anesthesia is something only an mda or crna can do. are you telling me that surgeons are capable of deciding what kind of anesthesia a pt can get? thats absolute garbage. mdas dont go up to surgeons and ask them "hey doc do you mind if i use geta for this pt?"

this is the way it should work: crna comes to eval the pt preop. crna chooses the anesthesia plan. crna writes the orders for the anesthesia plan. crna runs the case solo. crna monitors the patient at all times and has sole authority, without consulting the surgeon, to cancel the case if the pt becomes unstable.

now, the "rules" that somebody posted above dont fit that scenario. it says the surgeon has to order the anesthetic and has to sign some of hte anesthesia-related documents. thats insane for a surgeon to "order" a drug when he doesnt even know the basics for how it works!

the only thing the surgeon should be doing is writing the op note. the domain of anesthesia belongs solely to mdas and crnas.

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supervision, or medical direction when applied to a surgeon/dentist/podiatrist working directly with a crna, is a nearly meaningless term.

so you are claiming that its impossible for a surgeon to be liable for a crna's error, even when the state law explicitly states that some kind of "supervision" is required?

i dont doubt that its a very rare occurrence, but its not as open and shut as you say. if what you said was true, then no surgeon would ever be sued for anything that happens in terms of bad anesthesia outcomes unless they "interfered" with the anesthesia plan by changing orders or sedation protocols.

the surgeon does not choose or prescribe the anesthetic.

that doesnt match with the link above that somebody posted:

the centers for medicare & medicaid

services (cms) do not define or

specify how to prove supervision.

nevertheless, having the supervising

physician sign certain anesthesia

orders, evaluations, or records may

be the simplest way for the asc or

hospital to confirm that supervision

has occurred.

it is omic's understanding that

the role of the treating physician, in

relation to the provision of anesthesia

services, is to (1) determine whether

a patient requires the surgery or

diagnostic procedure, (2) request

that anesthesia be administered, and

(3) determine that the patient is an

appropriate candidate for the procedure

and anesthesia. therefore, it is

not uncommon for the treating

physician to be asked to sign perioperative

orders for anesthesia, sedation,

and anxiolytic drugs and to co-sign

the pre-anesthesia evaluation conducted

by the nurse anesthetist in

addition to signing the record of

the operation prepared by the circulating

nurse as well as the dictated

operative report.

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Specializes in Critical Care, Emergency.
You are totally and absolutely correct here.

By the way, how does propofol work?

works on GABA receptors (as do all but one of the induction agents, ketamine). also acts on chloride channels to help prevent them from repolarizing.

hence, a nice relaxed state.

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Specializes in Anesthesia.
......A surgeon has absolutely zero business doing this. Its the same thing as asking a family practice doctor whether his patient is a good candidate for brain surgery without talking to a brain surgeon first.......

Again, apples and oranges. Simply put, anesthesia is not surgery. If you wish to understand anesthesia as it has been practiced in America for over 120 years, you could start here:

http://www.gaspasser.com/unique.html

I find your dogmatic attitude to be curious. If you have an axe to grind with CRNAs perhaps you belong on an Anti-CRNA site, not Allnurses.

?

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Specializes in Critical Care, Emergency.

a surgeon has absolutely zero business doing this. its the same thing as asking a family practice doctor whether his patient is a good candidate for brain surgery without talking to a brain surgeon first.

deciding whether a person is appropriate candidate for anesthesia is something only an mda or crna can do. are you telling me that surgeons are capable of deciding what kind of anesthesia a pt can get? thats absolute garbage. mdas dont go up to surgeons and ask them "hey doc do you mind if i use geta for this pt?"

this is the way it should work: crna comes to eval the pt preop. crna chooses the anesthesia plan. crna writes the orders for the anesthesia plan. crna runs the case solo. crna monitors the patient at all times and has sole authority, without consulting the surgeon, to cancel the case if the pt becomes unstable.

now, the "rules" that somebody posted above dont fit that scenario. it says the surgeon has to order the anesthetic and has to sign some of hte anesthesia-related documents. thats insane for a surgeon to "order" a drug when he doesnt even know the basics for how it works!

the only thing the surgeon should be doing is writing the op note. the domain of anesthesia belongs solely to mdas and crnas.

actually, you are not correct.

when surgeons talk to their patients prior to coming to the hospital, they will explain what they anticipate will take place, such as geta or regional.

now, the day of the procedure can vary.

anesthesia will see the pt and decide what might be best in their eyes.

but if it is known that the surgeon prefers or wants geta, that can be the way it goes. period.

yes, because the surgeon wants it that way.

now, am i saying this is ok?

not always.

now, as far as the anesthetic and the surgeon not knowing anything.

that's wrong also (to a point).

i have worked with several that, well, have a fair idea of what goes on behind the curtain.

now, they don't know the moa like we do, and i'm sure they don't know what a mac of anything is (probably), but you have to take into consideration that most surgeons have been around for awhile and have seen/heard alot.

i'm not defending that surgeons should be doing the anesthetic ordering and all, but i think they know more than you think.

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Oh please!!! I don't need supervision by either an anesthesiologist or surgeon. Before some of you answer, please be sure of your facts. Go to http://www.aana.com for information on this topic.

Surgeons don't want to/don't know how to/don't know anything about anesthesia.

I know I am new here, but I wish only CRNAs would reply to these legal and practice topics. It seems like misinformation has a way of multiplying until someone presents the facts.

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