mw2150

I am a solo CRNA in a small critical access hospital with one OR. We don't have an endoscopy suite and many of the RNs and doctors for that matter at my facility are not comfortable with 'conscious sedation' so anything sedation-related is turfed to me (ER, GI, procedures, etc.). I have been working on training them to get them more comfortable but it is taking time. I know that there is typically a facility charge and a separate physician charge on scopes. If an RN completes the sedation, is that charge usually included in the facility charge or can the hospital bill separately for 'RN conscious sedation' or is there no reimbursement whatsoever for any type of sedation (RN, CRNA, or MD) on ASA 1 or 2 patients? When I worked in bigger hospitals, we also only did scopes on sick patients or those deemed difficult to sedate. The gastroenterologist prefers to have a CRNA on all of his GI cases and prefers propofol sedation for many different reasons - quicker room turnaround, quicker recovery times, less nausea, patient comfort, etc. Administration wants me in on all scope cases to keep the doctor and patients happy, regardless of whether or not we are reimbursed. I just wanted to see if it was possible to get any reimbursement for my services, even if it is billed as an RN. Because right now we're not getting anything. Thanks again in advance.

I was hoping that some CRNAs or SRNAs can provide me some insight on a very important topic. I know that this isn't a new thing, but I just found out that Medicare will not reimburse for anesthesia/sedation for colonoscopies or EGDs for ASA 1 or 2 patients - only ASA 3 and above. Since many of the commercial insurances attempt to mirror Medicare, many of the major commercial players will not reimburse for ASA 1 or 2 patients either. I have a good friend who is a CRNA who works full-time in a very busy outpatient endoscopy center and I asked him what they did and he said that they do a ton of scopes every day on majority ASA 1 and 2 patients. He said that because they are able to turn the rooms over so quickly using propofol, that the sheer volume of patients they do every year more than makes up for not getting reimbursed for anesthesia services, so they just end up eating the anesthesia cost. Since we are not doing hundreds of scopes a month, what are you CRNAs doing for EGD and colonoscopy billing, especially those of you in the hospital? I know that there may potentially be some instances in which commercial payers and Medicare may reimburse on ASA 1 and 2 patients - (difficult to sedate, sleep apnea, etc.) but even that is a pretty gray area. Do any of you know whether or not insurances reimburse for "RN conscious sedation"? I'm just tired of providing such a great, safe service to patients and not getting reimbursed for any of it. I would love to see the law makers and insurance company personnel get their scopes done with no sedation - I'm sure they would change their mind pretty quickly. Thanks in advance for any help or insight.

I was just wondering if any of you had any information on the CRNA market in Las Vegas. I'm getting really close to graduation and would love to get back there but I've researched quite a bit and have come to the conclusion that MDs seem to have a stronghold of the anesthesia market. Most of the big anesthesia groups are all MD and cover most of the hospitals in the area (Vegas, Henderson, etc.). I remember seeing a fair amount of CRNA jobs several years ago, the majority of which were surgical center positions, but now even those are nearly non-existent. Does anybody know of any hospitals or surgical centers that even utilize CRNAs anymore? Any help would be greatly appreciated. Thanks in advance!

*knows - oops!

I've found a couple of groups that I know utilize CRNAs: http://www.mercyships.org/ http://ismission.org/ http://www.paxjoliet.org/missions/Medical.html http://www.ima-missions.org/ I'm sure there are many more - so if anybody know of them, please feel free to post. Thanks.

I was wondering if anyone knows if it is possible for CRNAs to do Medical or Surgical humanitarian service missions to third world countries due to licensing issues. I know that Anesthesiologists are able to go but I wasn't sure what the issues would be for CRNAs. Do they have to be accompanied by an Anesthesiologist or could they perform on their own? I completed a medical service mission as an RN and didn't have any problems and I would love to be able to do surgical missions as a CRNA but wasn't sure if it was possible. Any help? Thanks in advance.