12 states down yeee haaaa

user69 · Jan 27, 2004

in the 12 states that are open, what is the premium that a CRNA can make? Does this allow CRNAs to jump up into the 400-600K range of an MD?

smiling_ru · Jan 28, 2004

Generally regardless of who provides the anesthetic (MDA or CRNA) reimbursement is the same.

This does not change with the opt out. The opt out is specifically a Medicare issue that relates to the HOSPITALS reimbursement for CRNA services. It's affect is only seen in hospitals with CRNA's who are their employees, and the hospitals ability to be reimbursed under Medicare part A.

The issue for us is that by having the supervision ruling, there is an appearance that supervision is preferred.

The ASA has used this requirement to scare surgeons into believing that they will be held liable for the actions of a nurse anesthetist if something goes wrong. This is one of the reasons there has been a push by the AANA to remove this ruling. It really has very little effect on the practice of most CRNAs.

So in answer to your question, again the reimbursement for anesthesia is the same. The MDA's making the salaies you quoted generally work with a group that has a lot of CRNA's. The CRNA's are not directly billing for their services, the group is. The MDA's are paid a higher percentage of the group income, so their salaries are higher. Not because their services were reimbursed at a higher rate, but because they are taking part of the money billed for CRNA services.

An MDA and a CRNA in sole practice in a similar environment will earn the same amount.

The following is the FAQ from the AANA website regarding the supervision ruling.

Q. Does the final rule change how nurse anesthetists currently practice or how nurse anesthetists are reimbursed under Part B of Medicare?

A. No. The rule does not change the requirements for practice or payment policies for nurse anesthesia services.

Q. Does the final rule change payment policies for hospitals, ASCs or CAHs under Part A of Medicare?

A. No. The Medicare conditions of payment remain the same as prior to November 13, 2001.

Q. Since the publication of the November 13, 2001, final rule, do hospitals, ASCs or CAHs have to do anything differently to meet the conditions of payment for anesthesia services provided by Certified Registered Nurse Anesthetists (CRNAs)?

A. No. If a hospital, ASC or CAH was Medicare approved and received payment for CRNA services prior to this ruling, then nothing new needs to be done.

Q. Is the requirement for physician supervision new as of November 13, 2001?

A. No. The rule retains a supervision requirement for nurse anesthetists in order for hospitals, ASCs and CAHs to receive Part A payment for anesthesia services. As always, the management of a patient's medical and surgical care continues to be the responsibility of a physician.

Q. Does the new rule prohibit states from opting out of the federal supervision requirement?

A. No. To the contrary, the rule allows state governors to opt out of the federal physician supervision requirement by meeting certain criteria. Specifically, the governor must:

consult with the state boards of medicine and nursing;

determine whether opting out would be consistent with state law; and

decide whether opting out would be in the best interests of the citizens of that state.

Once these criteria are met, the formal, written opt-out notification must be sent by the governor to the Centers for Medicare & Medicaid Services of the Department of Health and Human Services. The opt-out becomes effective upon submission .

Q. Does the new rule require nurse anesthetists to be supervised by anesthesiologists?

A. No. The rule does not require CRNAs to be under the supervision of anesthesiologists. Every state permits CRNAs to practice without anesthesiologist supervision. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) does not require anesthesiologist supervision either.

Q. Does Medicare (CMS) define or require hospitals to define "supervision"?

A. No. CMS does not define supervision, and hospitals are not required to define supervision. Defining supervision can create complicated compliance issues that many hospitals would prefer to avoid. See the following: Gene A. Blumenreich, JD, "LaCroix case," AANA Journal, Oct. 1997, Vol. 65, No. 5; and Denton Regional Medical Center v LaCroix, 947 S. W.2d 941 (1997). Further, the JCAHO does not define supervision or require such definition.

Q. Does the role of the supervising physician change when working with a CRNA?

A. No. The responsibility of the operating or diagnostic physician does not change based on who is providing the anesthesia. Typically, the physician:

determines whether a patient requires a surgical or diagnostic procedure;

requests that an anesthetic be administered; and

determines that the patient is an appropriate candidate for the planned procedure and anesthetic.

Q. Does the supervising physician need to be privileged in anesthesia?

A. No. The supervising physician is not required to have privileges to actually administer anesthesia.

Q. Is a physician or surgeon more liable when working with CRNAs?

A. No. Surgeons are no more likely to be held liable for the actions of nurse anesthetists than the actions of anesthesiologists. The courts have not found physicians and surgeons to be automatically liable for the actions of CRNAs, nor are physicians/surgeons immune from liability when working with anesthesiologists.

While physicians/surgeons commonly request nurse anesthetists to give anesthetics, CRNAs are accountable for their own actions. Courts generally do not look at the status of the anesthesia provider, but at the amount of control the physician/surgeon exercises over the anesthesia provider, regardless of credential.

Sole CRNA providers can bill and re

Berliner · Jan 28, 2004

Thank you so much for this information and all your work- I had been wondering about all these questions!