"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."
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.