Second OpinionsCRNAs vs Anesthesiologists in ASCs

CRNAs vs Anesthesiologists in ASCs

We are a 1-OR ophthalmology ASC. We currently use only anesthesiologists, who bill the patients directly for their services. We would like to switch to a CRNA only for our anesthesia provider. We would bill the patient and pay the CRNA directly. I'm doing some research on whether this is allowed. It looks like the reimbursement is far less, and I see that some insurance companies will not pay for the CRNA unless they are supervised by an anesthesiologist. Our state does not require this supervision in ASCs. What experience have others had with this?

Started by: Susan Pedersen (Director, Surgical Services/Director of Nursing) at July 6, 2016 (12:05 pm)

Comments and Responses

 

CMS does not require supervision of CRNAs in any state in order to bill. CMS also pays the same anesthesia fee for a CRNA or anesthesiologist. I am not sure which state you are in, but 40 states have no or have never had "supervision" rules for CRNAs. I have worked for years at a cataract center without an anesthesiologist, no issues. In fact, they have never had anesthesiologists and they have been open for decades. Either practitioner should be able to handle cataract cases independently.

Lisa Mueller (Anesthesiologist/Nurse Anesthetist) at August 15, 2016 (10:30 pm)

Thanks for the great responses. Money is not the issue at all. I am aware of the billing practices and fee splitting. Right now our center has a lot of costs associated with anesthesia supplies, meds, emergency cart, equipment only they use, etc. We pay for these and are not reimbursed in any way, The anesthesiologist gets the whole fee and pays for none of these things. I am not arguing any one side, just pointing out that it is not necessarily a huge profit maker as it may seem. There are a lot of factors. Thanks everyone, for your opinions.

Susan P. (Director, Surgical Services/Director of Nursing) at July 11, 2016 (4:52 pm)

Thanks for the great responses. Money is not the issue at all. I am aware of the billing practices and fee splitting. Right now our center has a lot of costs associated with anesthesia supplies, meds, emergency cart, equipment only they use, etc. We pay for these and are not reimbursed in any way, The anesthesiologist gets the whole fee and pays for none of these things. I am not arguing any one side, just pointing out that it is not necessarily a huge profit maker as it may seem. There are a lot of factors. Thanks everyone, for your opinions.

Susan P. (Director, Surgical Services/Director of Nursing) at July 11, 2016 (4:52 pm)

Thanks for the great responses. Money is not the issue at all. I am aware of the billing practices and fee splitting. Right now our center has a lot of costs associated with anesthesia supplies, meds, emergency cart, equipment only they use, etc. We pay for these and are not reimbursed in any way, The anesthesiologist gets the whole fee and pays for none of these things. I am not arguing any one side, just pointing out that it is not necessarily a huge profit maker as it may seem. There are a lot of factors. Thanks everyone, for your opinions.

Susan P. (Director, Surgical Services/Director of Nursing) at July 11, 2016 (3:44 pm)

Thanks for the great responses. Money is not the issue at all. I am aware of the billing practices and fee splitting. Right now our center has a lot of costs associated with anesthesia supplies, meds, emergency cart, equipment only they use, etc. We pay for these and are not reimbursed in any way, The anesthesiologist gets the whole fee and pays for none of these things. I am not arguing any one side, just pointing out that it is not necessarily a huge profit maker as it may seem. There are a lot of factors. Thanks everyone, for your opinions.

Susan P. (Director, Surgical Services/Director of Nursing) at July 11, 2016 (2:06 pm)

Medicare and OIG turn a complete blind eye to supervision rules and allow massive billing fraud where you can blatantly use MD codes to bill and collect full MD rates even when a CRNA is used and then turn around and split the fee by giving pennies to the CRNA and keeping the rest. ASCs have been flaunting these rules with impunity as there is neither the will not the resources to enforce these rules. Technically however both are illegal. CRNAs need direct supervision with the MD signing off on each patient ( not remotely) and being physically available at induction and emergence and for emergencies. CRNAs will tell you that their Nursing Board allows remote " collaboration" over a phone but that is not kosher by State law. Fee splitting is also illegal as it promotes and incentivises abuse of anesthesia resources.

jay dayal (Anesthesiologist/Nurse Anesthetist) at July 7, 2016 (6:18 am)

If I am going to be anesthetised, I would prefer a Doctor giving the anesthesia. I am not saying that CRNAs are bad anesthetists, but the Anesthesiologists have more years of schooling and experience. Money shouldn´t be the issue!!
R Orozco

R. Orozco (Anesthesiologist/Nurse Anesthetist) at July 6, 2016 (9:20 pm)

I provided anesthesia services to a two room ASC for 23 years, 100% of the time without an MDA. GYN, ENT,GI, Pulmonary,Ortho,Gen surg. Peds. Well trained CRNA's need no supervision, same as well trained MDA's don't need supervision. Jim Dredla CRNA

Roger Meimen (Anesthesiologist/Nurse Anesthetist) at July 6, 2016 (5:38 pm)

Don't know why that posted 3 times. Sorry folks.

Susan P. (Director, Surgical Services/Director of Nursing) at July 6, 2016 (5:35 pm)

Thanks for all the helpful responses. John, my motivation is not money. If that ends up being a side benefit, so be it. I have worked extensively with CRNA's and Anesthesiologists for years in critical situations. I would trust my life to the vast majority of CRNA's I have met. I find them easy to work with, and it seems overkill to bring an Anesthesiologist in for moderate sedation in a cataract surgery. I believe in saving my patients money. I am exploring the options and appreciate all feedback.

Susan P. (Director, Surgical Services/Director of Nursing) at July 6, 2016 (5:34 pm)

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