Jump to content
mcvcrna

mcvcrna

Level 1 Trauma, ICU, Anesthesia
Member Member
  • Joined:
  • Last Visited:
  • 21

    Content

  • 0

    Articles

  • 1,390

    Visitors

  • 0

    Followers

  • 0

    Points

mcvcrna has 18 years experience and specializes in Level 1 Trauma, ICU, Anesthesia.

mcvcrna's Latest Activity

  1. mcvcrna

    "Anesthesiologists are gaming the system"

    jwk....I have to share this as well. I have several personal friends and colleagues who own substantial multi-million dollar anesthesia businesses around the country. I am talking about easily over 100 million in billing and over 100 facilities. Their success has been ALMOST exclusively predicated on eliminating MD/CRNA ACT model type practices who require stipends. Their achievements have resulted in less than 10% of their facilities needing to pay stipends. In the situations where they do require a stipend, it is less than 25% of what the facility had been paying utilizing the ACT model. These practices consist of CRNA only and in many instance MD/CRNA. The difference is, where MDAs are employed or requested for one reason or another, they are working in rooms. This saves money. The fact is, the CRNAs and the MDA that work in these practice also make much more money than they would in an ACT money. I don't care to disclose the amounts, but it is substantial...especially for the MDAs. I wonder why more MDAs wouldn't want this.....these guys are making a killing. The CRNAs do well as well. jwk....I understand your point about patient savings not being directly affected by this....or should I say the potential. However, as providers we can only do our part. If the facility does not pass on those savings onto the patients, then we need to look at what they are doing to drive costs up or down. Regardless, system costs need to be assessed globally not locally. Saving money, here and there, adds up to millions up millions of dollars. personally, I have no issue working with MDAs at all, but I don't think the ACT model is cost effective or necessary. I haven't personally worked with MDAs for the last 5 years but that doesn't mean I wouldn't...just not in an ACT model - I have a choice. Just my opinion.
  2. mcvcrna

    "Anesthesiologists are gaming the system"

    "countless articles read and numerous lectures given on the subject matter" [COLOR=#333333]First of all, both of these actions on my part include past and the most current research on the matter.....no where did I say this was my opinion only[COLOR=#333333]. My comments are not and never are predicated on anecdotal or emotional influences, but rather educated, sound deductions and interpretation of the most current data and research. "You assume that all groups that have MD's get stipends because they can't get paid enough from insurance and CMS payments alone. That is simply a false assumption" I never stated that ALL MD only or MD/CRNA practices take stipends....clearly, I state: "The cost-effectiveness is realized when stipend money necessary to sustain MDA only and MDA/CRNA groups is no longer required by the MAJORITY of CRNA practices" No where in that statement did I say ALL MDA or MD/CRNA groups require a stipend. However, I could of easily stated that the majority do. As of three or four years ago around 70-80% of MDA or MD/CRNA groups were relying on stipends. Since "the majority is only defined as [COLOR=#333333]greater than 50%, I don't think it is an unreasonable statement. I don't think you will find a more current statistical documented source that declares otherwise. In fact, I believe this stat came from you own organization, the ASA. "You and I both know that isn't true - there are CRNA groups or individual CRNA's that take stipends" I didn't say CRNAs don't take stipends: I stated: "However, MOST CRNA’s in business for themselves, are able to sufficiently realize their salary requirements exclusively from third-party payers and CMS reimbursement." Last time I checked MOST was not indicative of ALL. The statement stands true. "Your assumption that ACT practices require more personnel compared to a CRNA-only practice is an apples to oranges comparison. Yes, at least one MD will be required for four rooms in an ACT practice, but that MD does other things besides provide medical direction" [COLOR=#333333]Really? Apples and oranges. For 8 years I worked in an MD/CRNA model. When I started with the group the MDs and CRNAs were both in rooms, both covering OB, doing the blocks, answering the emergency intubations, putting in the lines, etc....and in a high acuity setting - ASA PS 3 pt were the norm. We had a 700/yr cardiac program as well. Over the 8 years we had gone from 20 providers to 90 providers. Granted this included added additional sites to our group. However, at our own facility (without out adding any additional rooms or starts), we went from 20 providers (13 CRNAs and 7 MDS) to 27 providers (16 CRNA and 11 MDs). Why? Because the merger of our group with other groups brought in a model where the MDAs no longer wanted to provide hands-on anesthesia. This meant we needed more bodies (CRNAs) to fill rooms and the MDs went on to only provide supervision. So now were covering the same number of starts with an additional 7 providers, 4 (more than half) were MDs. Are you trying to tell me this did not drive up cost? The numbers speak for themselves. Additionally, the blocks, epidurals, emergencies, lines, etc.......still all being done by everyone. And, I won't even get into the number of MDAs we hired in the entire group so that there would be enough coverage for them to take 10 weeks of vacation a year. And this is not just this group.....this is every group in this entire area, at least 10 weeks of vacation is the norm. This costs money too! "Here's the most important thing in your whole post - " I realize that this does not save the insurance carriers or CMS any money". Exactly the point I've been trying to make for a while. To the people who actually pay the bills, you're not cheaper than an MD." [COLOR=#333333] While I can appreciate your point, and it was not lost on my when I wrote it, I believe and tried to articulate that this cannot be the only consideration regarding this issue. The fact of the matter is, that despite groups like yours (which I personally believe are rare), the cost to necessary to provide adequate coverage/service must be looked at from a multitude of angles. The example I have provided from my own experience represents a more realistic trend of anesthesia practices beginning about 10 years ago - and that drives up cost. Its simple: if you add or employ more providers to do the job than is actually necessary, then cost will go up - its as simple as that. And because MDAs demand more compensation, you unfortunately drive up cost even more. I hate it for you...but that doesn't make it untrue. Personally, I wish we could just get over this ridiculous turf war. CRNAs have been providing quality, safe anesthesia for nearly 150 years. We only live life once....no trial run, no do overs, and to battle over this issue year after year after year is such a waste of time, money, and vital resources. s
  3. mcvcrna

    "Anesthesiologists are gaming the system"

    Thank you. I have learned to understand this issue through 15 years of experience as a CRNA, 9 years of political involvement to include state presidency, government relations Chairmanship as well as national level government relations committee involvement, countless articles read and numerous lectures given on the subject matter. I have worked in each of anesthesia models, not as just an employee but in leadership roles that dealt with this very issue. For the past 5 years I have owned and operated an independent CRNA practice. Understanding these issues has been essential for my success as well as the success of countless CRNA owned practices throughout the country. Citing references would be arduous to say the least given the fact that the knowledge I have gained over the subject matter has come through years and years of immersing myself in the available data and experiences of others and myself.
  4. mcvcrna

    "Anesthesiologists are gaming the system"

    Interesting discussion. However, I think it's missing to the key elements as to why CRNA's are more cost-effective than our MDA counterparts. A little long but its a complex issue. MDAs demand higher salaries than CRNA's. Unfortunately, the current reimbursement from commercial insurance carriers and CMS are not substantial enough to cover the MDA salary requirements. Thus, facilities must make up the difference. The range of stipends across the country can vary from $100,000 to even in the millions of dollars annually. However, most CRNA's in business for themselves, are able to sufficiently realize their salary requirements exclusively from third-party payers and CMS reimbursement. The cost-effectiveness is realized when stipend money necessary to sustain MDA only and MDA/CRNA groups is no longer required by the majority of CRNA practices. While I realize that this does not save the insurance carriers or CMS any money, the savings are realized by the facility by not having to pay for the stipend. Ideally, these savings should be passed on to the patient. But that's another discussion. In situations where the CRNA is employed by the facility, the lower salary requirements further enhances the cost savings by the facility employing those CRNA's. The number anesthesia providers required to staff the ACT model is greater than that needed to staff the ACT model. Commonsense dictates that if it takes five providers (MDA/CRNA) to accomplish the same service as four providers (CRNAs) can accomplish, then more money will be required to meet the same need. If the reimbursement is the same for both providers, which in most instances it is, one could argue that the same amount of money is just split between providers and no increased cost. However this thought process undermines the most essential consideration - it cost more money to employ five providers than four providers and thus 20 providers versus 16 providers. The additional four providers (MDAs), in the latter scenario, would result on an increased salary demand of about $1-$2 million annually. This money has to come from somewhere. If the reimbursement stays the same regardless of the number providers then the money has to be made up somewhere, once again this typically this is made up by the facility in the form of a stipend. Since MDA only model typically also requires increased reimbursement, the short fall again needs to be made up. CRNA only models rarely need stipend monies - a CRNA billing for themselves with a reasonable case load can easily generate $200 - $300/annually. Please keep in mind that the working premise is predicated on the current blending of model practices across the country, M.D. only, MD/CRNA (Directed model), and CRNA only billing for themselves or being salaried by a facility. If all practices billed solely for themselves and did not rely on stipends from the facilities the disparity in cost-effectiveness between providers would be diminished. However, this would also result in MDA's realizing less money for their services and thus leveling the playing field for anesthesia provider income - something the MDAs are none to happy about - which I am sure most of wouldn't be.
  5. mcvcrna

    Looking for a CNM in Virginia

    I'm a CRNA looking for a Va CNM to ask a question to. Please post here if you fit the description and don't mind providing me with a little information. It is about Anthem reimbursement. Thanks.
  6. mcvcrna

    Help me Help me!!!!!! (CRNA prerequisite courses!)

    You've already received some good advice on this thread. Nothing to ignore so far. Every CRNA school varies in their requirement for organic chemistry for admission. Some have you take it after your in. Regardless, organic is alway highly preferred. Even though my program required us to take organic in anesthesia school, even if you already had it, it really paid off to have already had the course earlier. Physics is a toss up as well for admission. Some do some don't. It wasn't required to get into my program but my mammalian physiology course was the same course that the med students and PhDs had to take and required pretty in-depth knowledge in the application of physics. I had to get a physics book and teach myself during that course. The syllabus/handout alone was approx. 900 pages. Laced with physics. Obviously, I recommend that as well. I think, as previously mentioned, it can be hard to take these courses during your actual nursing program training which is really rigid. If you are going to take them you will have to do it sooner more than later. Good for you for already developing a plan involving so much at such a young age. Its a long road but worth it. Remember, sacrifice now or sacrifice later--but you will sacrifice.
  7. mcvcrna

    Do CCRN scores matter?

    That's a good point. Many times the interview process is fluid in motion. We only have a limited amount of time to determine whether you would be a viable candidate to succeed in an extremely rigorous, financially draining, and self sacrificing endeavor. You would be surprised how hard this is. It's not just what is on the paper. I would always go home with a headache. Your point is taken and many times in an effort to balance an equation the interviewer must rely on other tidbits of information to make a more educated assessment. That is why there are so many factors involved in determining who gets in and who doesn't. I am sure you have heard the line that a GRE score, a standardized test, is not always determinant of academic success. This is true. However, applying a multitude of measurements is an effort to build a pattern of success representative if the applicants probability of success is paramount.
  8. mcvcrna

    CRNA vs AA

    He's an AA.
  9. mcvcrna

    CRNA resume.........Opinions please

    Just emphasize the importance, to your nurse manager, of her recommendation. In the program where I have served on the admissions committee, all the data were weighted. Overall GPA, science GPA, organic and statistics grade, references, personal statement, GRE scores(divided up and overall, interview, and so on. So, if you have one from a nurse manager it receive two additional points. If you get one from a CRNA it received an additional point. The CRNA doesn't have to know everything about you. Getting one from one you follow is best but one from a CRNA that recognizes that you are a conscientious nurse will help as well. Also important is this little known unwritten rule--your references should be from people who you know will rate you well. You have the control over who you pick--pick people that will reflect you positively, not critically. This sound strange but think about it. Commonly, applicants will get a reference from someone they respect or who is perceived as a 'raising the bar' practitioner-usually an MD in my experience. Unfortunately, the applicant is the only one who knows this, so if the reference reflects only 'good' and 'very good' and not much in the way of 'superior', the points for that reference go down. Their 'very good' might be great in your book but the paper doesn't change that. If the 'references' are weighted at 10-20% of your application you just compromised that percentage. Keep in mind that every program has a different way in which they select applicants. Each programs philosophy may emphasize different aspects of your skills and apply them as they see fit to judge your ability to succeed. However, I have tried to be more common sense with my advice and feel my paradigm is probably more indicative of the process than not. Hope this helps. Good luck. Remember, following a CRNA will alway, always help and will never hurt. If you haven't, I would.
  10. mcvcrna

    Do CCRN scores matter?

    If your really concerned and need some information to alleviate your stress--call the program and ask what their position is on the issue of score. My bet is they will say pass/fail and that asking about the score was an aberration. However, if you do make the call--let us know what they say. I would be interested in what they tell you whether I am right or wrong.
  11. mcvcrna

    CRNA vs AA

    That ain't nothing--I know numerous colleagues making over 200K and personally know several making over 300K. Opportunity is out there--you have to go find it. Without a doubt, areas in which AAs work tend to experience some salary depression. Not all, but many. There could be many reasons for this to occur.
  12. mcvcrna

    Do CCRN scores matter?

    I still think that is the exception. Fact is, it might be preferred but by far most schools don't require having a CCRN. So your score, albeit interesting for the person asking, it is not a standard admissions requirement. Anecdotal accounts are exactly that-anecdotal. Encouraging someone to retake their CCRN because their score might be lower is unnecessary. As an admissions committee member, I always looked for their CCRN, but our committee never asked for scores. More than half the applicants didn't even have their CCRN. Although it makes you more competitive--it is only one piece of a large puzzle.
  13. mcvcrna

    CRNA resume.........Opinions please

    Looks great! I second the recommendations made about your references. It's best to have one from your nurse manager and another RN you work with. A character/motivation reference from a CRNA you followed is always good as well. The MD reference is debatable. When I have served on an admissions committee and see an MD reference I question the intent of the reference--is it supposed to impress me, are you sure you don't want to go to med school? I want to know what your peers think or another CRNA think about you. Just food for thought....
  14. mcvcrna

    Anesthesia Program Rankings 2008

    VCU #1. You know it!!!!:bowingpur
  15. mcvcrna

    Do CCRN scores matter?

    Having your CCRN definitely works in your favor. However, I have never heard of anyone asking for the score. I would consider it a pass/fail scenario. If someone volunteered their score that was strictly their own decision. Most of the requirements are weighted in varying degrees depending on what school you apply too. Having the CCRN gets you the weight for that particular consideration.
  16. mcvcrna

    CRNA vs AA

    Hands down CRNA is the way to go. You can play that 'most CRNAs don't work independently" all you want. The fact is we can--you can't. That isn't a crack on AAs--it's just a fact. And in reality, AAs never will. Fact is, there are 37,000 CRNAs--half the anesthesia work force. How many AAs are there? 1700? Why would you want to play on a team with only 1700 players? Do you really think it's a contest? Come on. The AANA is one of the top 10 recognized organizations on Capital Hill--your going to compete with our organization? Get real. Give it another 50 years--then maybe. This is not our fault--its just the way it is. We worked hard to get to this point. I can't believe you would try to downplay our profession. Face it--AA is a runner up scenario. Your comments cement my feelings. AAs should be trying to befriend us not alienate us.