"Anesthesiologists are gaming the system"

[wtbcrna, MSN, DNP, CRNA]

http://thehill.com/blogs/congress-blog/healthcare/309183-anesthesiologists-are-gaming-the-system

To make this whole issue even more absurd are two recent studies published in the journal "Anesthesiology," the official publication of the ASA, and "Anesthesia & Analgesia." In one, communications with "supervising" anesthesiologists were evaluated revealing that less than 2 percent of such communications originated from those being "supervised" in the OR. In the other, the authors revealed significant lapses in the ability to meet the accountability rules as the number of "medically directed" CRNAs increased - lapses which occurred 99 percent of the time! The study also identified a 22-minute delay when anesthesiologists try to meet the guidelines in order to properly bill for medical direction. With Medicare anesthesia provider reimbursement at a rate of $1.43 per minute, and perhaps millions of such delays every year, the waste of Medicare dollars adds up very quickly, even when the criteria can be met. But this is only a small part of the inherent economic fiasco. While patients waits for an anesthesiologist, the standard Operating Room charges are also accumulating at a rate of $25-50 per minute!

The solution to this problem is exquisitely simple. The president, via his HHS Secretary, must eliminate reimbursement for medically directed anesthesia claims other than those incurred when teaching students or residents. All anesthesia professionals privileged to relieve pain and suffering should actually administer anesthetics. As a society we simply cannot afford to have highly trained anesthesiologists, whose residencies are financed by taxpayers, "supervising". If a procedure requires multiple anesthesia providers due to surgical acuity or complexity, the current regulations provide for full reimbursement. The system currently incentivizes inefficiency without any gain in quality or safety, and potentially pays for services not rendered. This change eliminates the waste of millions or even billions of taxpayer-supported health care dollars and the submission of fraudulent claims. This would force anesthesia departments to become more efficient and allow all Americans to receive the same high level of care as our military heroes.

[jwk]

Just so everyone is clear, this is from an opinion blog from The Hill. It would be much like posting an item on a forum such as allnurses.com. It is NOT a fact-based article or a piece of investigative journalism.

[loveanesthesia]

It is much more difficult to have something published in The Hill than on allnurses.com. On here anyone can say about anything. The opinions published on The Hill blog are reviewed prior to posting.

[wtbcrna, MSN, DNP, CRNA]

Yes, the overall theme is opinion piece and should be obvious to everyone reading it. What is not an opinion is the articles that were referenced showing that ACT practices are often not meeting the TEFRA requirements and being sued when they are found to have committed billing fraud. This is going to be a more common theme that shows up more and more. Medicare has already stated it will be looking more at billing fraud r/t not meeting TEFRA billing requirements.

The ASA and AANA both have opinions that the current system of billing for ACTs does not work, but both have different ideas on how the ACT system should be fixed. ASA wants a relaxing of TEFRA billing requirements, and the AANA wants ACTs practice of supervision to be eliminated. The AANA version would save the hospitals and public money where the ASA version would would cost more and allow for actual decreased amount anesthesiologists being "immediately" available.

IMO ACTs are going to change. How they are going to change is still up for debate, but I doubt they will go away. The ASA is too powerful, and way too much money is involved to see ACTs go completely away.

[platon20]

One of the comments on the thread caught my attention:

"90% of CRNAs work under doctors. If you eliminate that billing, then that means 90% of CRNAs are now unemployed."

If this is true then it is a problem. If anesthesiologists cant make money off of CRNAs, then many CRNAs in the big cities where the gas docs are clustered are going to lose their jobs.

[manusko]

One of the comments on the thread caught my attention:

"90% of CRNAs work under doctors. If you eliminate that billing, then that means 90% of CRNAs are now unemployed."

If this is true then it is a problem. If anesthesiologists cant make money off of CRNAs, then many CRNAs in the big cities where the gas docs are clustered are going to lose their jobs.

CRNAs can bill for services without an anesthesiologist.

[jwk]

CRNAs can bill for services without an anesthesiologist.

But a LOT of places won't hire them without anesthesiologists. If they exist at all, hospitals routinely doing big cases - and I mean open heart, major vascular, major peds, major neuro - are going to have anesthesiologists. Surgeons and patients demand it.

[wtbcrna, MSN, DNP, CRNA]

One of the comments on the thread caught my attention:

"90% of CRNAs work under doctors. If you eliminate that billing, then that means 90% of CRNAs are now unemployed."

If this is true then it is a problem. If anesthesiologists cant make money off of CRNAs, then many CRNAs in the big cities where the gas docs are clustered are going to lose their jobs.

In general CRNA or anesthesia providers do not work alone. Many states require that CRNAs work with a Surgeon, Podatrist, Dentist, or physician of some sort. It is a requirement in 34 states (I think) that CRNAs have to work with one of the latter to be able to bill Medicare. There is however only one state, I think, that requires CRNAs to work with anesthesiologists.

In other words that 90% has nothing to do with billing and anesthesiologists.

[wtbcrna, MSN, DNP, CRNA]

But a LOT of places won't hire them without anesthesiologists. If they exist at all, hospitals routinely doing big cases - and I mean open heart, major vascular, major peds, major neuro - are going to have anesthesiologists. Surgeons and patients demand it.

Would you like to provide proof of that?

There are CRNAs doing every type of anesthesia case there is. There are hospitals that have independent CRNAs providing all these type of cases with or without anesthesiologists present.

By the way the American Hospital Association does not support ACTs either.

[jwk]

In general CRNA or anesthesia providers do not work alone. Many states require that CRNAs work with a Surgeon, Podatrist, Dentist, or physician of some sort. It is a requirement in 34 states (I think) that CRNAs have to work with one of the latter to be able to bill Medicare. There is however only one state, I think, that requires CRNAs to work with anesthesiologists.

In other words that 90% has nothing to do with billing and anesthesiologists.

No surgeon = no anesthesia - pretty simple concept.

[gobluern]

No surgeon=no surgery. Very simple concept

[nomadcrna, DNP, CRNA, NP]

And this would be incorrect.

I do anesthesia all the time for ER providers, family practice providers, cardiologists etc.

Not always a surgeon.

No surgeon=no surgery. Very simple concept