Outpatient Surgery Magazine

Work-Life Balance - January 2017 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/771120

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Stop Paying for Medical Direction of CRNAs Nurse-only anesthesia would save billions and improve OR efficiency. A CRNA is stationed in each of your 4 ORs. Patients and sur- geons are ready to go. But only 1 of the 4 cases can proceed. The holdup? The attending anesthesiologist can't start 4 rooms at once. But he can oversee 4 cases at once. And he can bill twice as much for medical direction as opposed to performing the anesthetic himself (he'd receive 50% of each of 4 medically directed anesthetics as opposed to 100% if he did one himself) — all thanks to a ridiculous reimbursement scheme for anesthesia services that should be abol- ished. When billing for medical direction of CRNAs, anesthesiologists must complete 7 magic steps to qualify for payment — from performing a pre- anesthetic examination and evaluation, to monitoring the course of anesthesia administration at frequent intervals. Medical direction can set the day on a trajectory of inefficiency and needlessly rising costs. In an ASC, you'll have to pay staff overtime because rooms run later and you'll have to track down surgeons to finish dictations because they had to leave in a rush. Costs increase, but your revenues do not, because you only get a fixed facility fee. In the hospital OR and HOPDs, the unbundled, charge-master charges for OR time are $80 per minute (still the most common form of charg- ing for OR time). The costs are astronomical regardless of how you do the math. The anesthesiologists' own literature, without caveat or dis- claimer, says so, even at 1:3 medical direction; the cost and waste is even higher at 1:4. We'd save billions just by reducing OR time pay- ments incurred while waiting for an anesthesiologist to meet the 7 steps (osmag.net/wm7osf), start the case and avoid fraud. Anesthesiologists are highly skilled and valued members of the OR team, but their value is severely diminished when they're relegated to 1 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 7 Point Jay Horowitz, CRNA

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