J U LY 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 7
that anesthesia, broadly stated, provided by one practitioner is safer than that
provided by the other (osmag.net/ZM2Yst).
The contention, as far as I can see, is really between the professional societies,
not actual practitioners. Today, the vast majority of anesthesiologists and nurse
anesthetists work together harmoniously as team members. In ambulatory anes-
thesia, which accounts for an increasingly large percentage of the revenue
earned by most anesthesia practices, these collaborations are particularly impor-
tant. Both parties are generally perfectly happy with the physician supervision of
CRNAs arrangement. I can't speak for all CRNAs, but the ones I know have little
interest in independent practice.
Why would the VA, a federal agency, want to consider independent CRNA
practice? The VA looks at the cost of anesthesia care and notices that CRNAs
are cheaper. End of story. Trying to figure out why independently practicing
CRNAs are cheaper is a little tricky in our twisted world of third-party payers.
Medicare and private insurers calculate the price of anesthesia in 15-minute
increments, a base unit pay modified by complexity, an anesthesia conversion
factor, a code that is seemingly changed daily, a 30-character password and a
secret handshake. That's not the case at the VA, where doctors and CRNAs are
salaried employees. At the VA, you have to pay a doctor more, no matter what
the billing looks like.
Med school matters
All sectors of the medical profession now have to prove their market value.
Doctors are more extensively (and expensively) educated, have more student
debt and are compensated accordingly. They have more clinical training hours
and know more about medicine than anyone else in the OR. This is actually a
critical point. Knowledge of medicine is what doctors go to medical school for
and what gives them broad powers of judgment that cut across procedure and
protocol. Doctors are the experts and therefore are uniquely and perhaps exclu-
