4
CRNA
Scope of practice
Care Models
1) Medical doctor of anesthesia
2) Certified registered nurse anesthetist
3) Anesthesia care team
Laws & Regulations
1
Medicare requires CRNA to be supervised by a physician to be reimbursed
Rules & Regulations
2
In 2019 federal government enacted opt out law
Quality of Care
Quality of Care
Quality Between Care Models
According to research data presented by Coomer, there is no indication that one care model is of better quality
Quality Between Care Models
Safety
Risk Associated with Anesthesia
- 1990 the CDC conducted a research project on the mortality and morbidity of anesthesia
- according to Hoyem, 2 per 1,000 inpatient procedures and 4 per 10,000 outpatient procedures
Cost Difference of Care Models
Cost
CRNA
CRNA
- The most cost effective
- lower salary, $183,008
- medicare reimburses 100%
Care Team
Care Team
- medicare reimburses 50% for ratios of less than 1:4 MDA to CRNA
- The more CRNA in the team the more cost effective it is
MDA
MDA
- The most costly
- in medicare reimburses 100%
- salary is higher $383,200
Relationships Between CRNA & MDA
Interpersonal Relationships
One of the most commonly experienced ethical issues among CRNA is conflict with MDA.
Why
surveys showed that “in a state that did not require physician supervision of CRNAs reported that 36% of CRNAs never collaborated with anesthesiologists and 20% of CRNAs collaborated with an anesthesiologist on every patient” (Boyd)
Why
There is a over lap in job roles. This can lead to loss of profession identity. They thought that doctors are superior than nurses is a contributor as well.
References
References
Boyd, D. (2017). Certified Registered Nurse Anesthetist Working Conditions and Outcomes: A Review of the Literature. AANA Journal, 85(4), 261–269.
Coomer, N. M., Mills, A., Beadles, C., Gillen, E., Chew, R., & Quraishi, J. A. (2019, March-April). Anesthesia Staffing Models and Geographic Prevalence Post-Medicare CRNA/Physician Exemption Policy. Nursing Economics, 37(2), 86+. Retrieved from https://link-gale-com.ezproxy.uwsp.edu/apps/doc/A584728002/AONE?u=stevens&sid=AONE&xid=5e8af89e
Hoyem, R. L., Quraishi, J. A., Jordan, L., & Wiltse Nicely, K. L. (2019). Advocacy, Research, and Anesthesia Practice Models: Key Studies of Safety and Cost-Effectiveness. Policy, Politics, & Nursing Practice, 20(4), 193–204. https://doi.org/10.1177/1527154419874410
Salary.com, S. (2020, May 28). Anesthesiologist Salary in Wisconsin. Retrieved June 19, 2020, from https://www.salary.com/research/salary/alternate/anesthesiologist-salary/wi