Why do anesthesiologists make more than CRNAs?

[Mully]

Is it because they can bill multiple cases at the same time within ACT practices?

I've heard that reimbursement is the same for CRNAs or MDAs providing the anesthesia, is this true? In other words, if an independent CRNA performs the same case as an independent MDA, will they be reimbursed the same amount?

Thanks!

P.S. This is not a should MDAs/CRNAs make more than each other etc. etc. question. This is specifically about current practices with billing and cost of anesthesia.

[jwk]

The studies suggest no more than 2:1 d/t difficulties meeting TEFRA requirements.

I hate it when people fall back on "the studies". Perhaps if people who did "the studies" actually worked in a modern private anesthesia group practice, they could see how this is done. Otherwise, it's little more than fodder for those CRNA's banging the independent practice drum.

[wtbcrna, MSN, DNP, CRNA]

I hate it when people fall back on "the studies". Perhaps if people who did "the studies" actually worked in a modern private anesthesia group practice, they could see how this is done. Otherwise, it's little more than fodder for those CRNA's banging the independent practice drum.

Yeah, it is so awful to rely on research, but maybe that is one of the big differences between CRNAs and AAs. That study came from the ASA journal by the way...

Apparently, it isn't being done right or these ACT practices wouldn't be getting fined.

[wtbcrna, MSN, DNP, CRNA]

Ummmmm asking why a medical doctor makes more than an advanced practice nurse? How many years does it take to become an anesthesiologist? If a CRNA wants to get paid like an anesthesiologist then they should head on off to med school eh?

How long have you been a CRNA? If reimbursement was simply a matter of who went to school longer than MD/PhD would make more than MDs. When two providers provide the exact same service your answer is to pay more for the one more education.....

[lmdscd]

Sorry for late comment but just wanted to point out CRNA can and I know a few .Who own their practice and have the hospital contract then they can make more.

[US Army MAJ,CRNA]

Does a surgeon occasionally have to wait a couple minutes? Sure. We wait on them all the time, so that's really not a valid factor.

That is the definition of inefficiency…..it's also a little self righteous ….making the person responsible for you getting up in the morning to earn a living WAIT on you? Without them, you have no work, and it is just fine for you to make them wait on your royal highness?

Hilarious.

Our docs are actually working - covering their assigned rooms, present for induction and emergence, doing pre-ops, blocks, etc. On a typical OB shift, they'll put in 15 or more epidurals. Not a lot of down time.

Oh, so they do exactly what CRNA partners do in solo CRNA practices?

Only difference is I don't need my partner in the room sucking oxygen while I induce or extubate….I can hold my own tube, push my own drugs without someone wasting space and watching…..contributing absolutely nothing to the process.

[subee, MSN, CRNA]

I think you're trying to describe what is commonly known as a "collaborative" practice, and those are popping up here and there. However, in a collaborative practice, CRNA's and MD's don't have the same employer. If a CRNA assigns their billing rights to the group to collect AND is an employee of the group, that's not really a collaborative practice since an employer / employee relationship exists which means by definition they're not "independent". Or perhaps this group you describe is billing as medical supervision rather than medical direction.

I've worked in ACT practices for more than 30 years, and have been in what is now defined as a "medically directed" practice for more than 20. We make it work and we follow all 7 specifications of the TEFRA law. Does a surgeon occasionally have to wait a couple minutes? Sure. We wait on them all the time, so that's really not a valid factor. Perhaps the difference is that our anesthesiologists aren't consumed with non-clinical activities like crosswords and stock-picking which is the stereotypical anesthesiologist mantra of the stereotypical "we should be independent" CRNA. Our docs are actually working - covering their assigned rooms, present for induction and emergence, doing pre-ops, blocks, etc. On a typical OB shift, they'll put in 15 or more epidurals. Not a lot of down time.

And do you have to keep a patient asleep while waiting for the MDA to show up for extubation? The MDA is going in and out of all four rooms checking on the patients and showing up for all extubations? How do they do that when they are running 3 endoscopy rooms? I really find it hard to believe that they are meeting all of the Tefra requirements all of the time. I'm certainly not waiting for ANYONE to extubate a patient and I certainly extubate the biggest and the baddest. I remember before Tefra ... sigh. Tefra makes liars out of us all.

[jwk]

And do you have to keep a patient asleep while waiting for the MDA to show up for extubation? The MDA is going in and out of all four rooms checking on the patients and showing up for all extubations? How do they do that when they are running 3 endoscopy rooms? I really find it hard to believe that they are meeting all of the Tefra requirements all of the time. I'm certainly not waiting for ANYONE to extubate a patient and I certainly extubate the biggest and the baddest. I remember before Tefra ... sigh. Tefra makes liars out of us all.

In an efficient and well-organized practice, this just isn't a problem.

[wtbcrna, MSN, DNP, CRNA]

In an efficient and well-organized practice, this just isn't a problem.

Funny that isn't what has been reported in the ASA's medical journal.

[jwk]

Funny that isn't what has been reported in the ASA's medical journal.

Academic practices are a poor comparison to a well-run private practice.

[wtbcrna, MSN, DNP, CRNA]

Academic practices are a poor comparison to a well-run private practice.

Research and recent CMS litigations for billing against ACT practices do not support your argument. There is not a possible way for anyone to be in multiple rooms at one time, so how is that you're MDAs are able to start all the morning cases simultaneously without delays?

[jwk]

Research and recent CMS litigations for billing against ACT practices do not support your argument. There is not a possible way for anyone to be in multiple rooms at one time, so how is that you're MDAs are able to start all the morning cases simultaneously without delays?

Who said anything about being in multiple rooms at one time? Of course that's not possible, but that's not the requirement. The requirements in the immediate operative period are that the MD is present for induction, emergence, and checks in at intervals during the case. Like I said - a well run private practice is far different from an academic one. How long do your inductions take? Many of our cases are 10 minutes from in-the-room till incision, and only a couple minutes of that are induction and intubation. Maybe you've never worked in a busy private practice, so you can't really comprehend how it's done because the only thing you know is what you've read from studies or heard about it from someone at the AANA that's more interested in politics than actual patient care. Want to see how it's done? I can probably arrange a free tour for you.

We stagger our OR starts in the mornings, anywhere from 6:45 to 7:45. Maybe in your hospital all surgeons show up at the same time, on time, but that's not the reality in most places. 99% of the delays in our facilities are surgeon or hospital-caused. Surgeon late, surgeon disappears after induction to go make roudns, surgeon overestimates his skills and runs long, surgeon didn't order appropriate pre-op labs/EKG, patient didn't show up for pre-assessment prior to surgery so their pre-op took longer, OR doesn't have the right equipment or implants, etc. Surely you see some of these same things in your hospital.

[wtbcrna, MSN, DNP, CRNA]

Who said anything about being in multiple rooms at one time? Of course that's not possible, but that's not the requirement. The requirements in the immediate operative period are that the MD is present for induction, emergence, and checks in at intervals during the case. Like I said - a well run private practice is far different from an academic one. How long do your inductions take? Many of our cases are 10 minutes from in-the-room till incision, and only a couple minutes of that are induction and intubation. Maybe you've never worked in a busy private practice, so you can't really comprehend how it's done because the only thing you know is what you've read from studies or heard about it from someone at the AANA that's more interested in politics than actual patient care. Want to see how it's done? I can probably arrange a free tour for you.

We stagger our OR starts in the mornings, anywhere from 6:45 to 7:45. Maybe in your hospital all surgeons show up at the same time, on time, but that's not the reality in most places. 99% of the delays in our facilities are surgeon or hospital-caused. Surgeon late, surgeon disappears after induction to go make roudns, surgeon overestimates his skills and runs long, surgeon didn't order appropriate pre-op labs/EKG, patient didn't show up for pre-assessment prior to surgery so their pre-op took longer, OR doesn't have the right equipment or implants, etc. Surely you see some of these same things in your hospital.

Actually,I have worked in a variety of settings. I have probably have worked in more states and practices in my short time as a CRNA versus all your time as an AA and that doesn't include other countries. I would like to see an independent on site surprise audit of your billing, because there has yet to be an ACT that follows all the TEFRA rules at a 4:1 ratio or even a 3:1 ratio.

You are going to keep saying it is possible and I'm going to stick with my experience and the research and say it isn't possible to be 100% compliant with TEFRA rules at those ratios. We are at impasse.