AANA Candidate Forum is Up & Running

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The AANA Candidate Forum, an elusive but continually improving venue for Candidates and Members to interact, is up and running. Questions and Responses are coming in and you might be surprised with some of the Questions and Responses.

A glimpse at some of the questions:

What does the Vice President actually do ?

What happens if NBCRNA is replaced ?

What will you do if you lose ?

What sets you apart ?

Whom do you represent ?

Although you’ll catch glimpses of profiles and sound bites on Face Book or Listservers, the AANA Candidate Forum is the only “neutral site” sponsored by AANA that encourages direct interaction. Don’t let your questions remain unasked, become an informed voting member. You just might find it empowering !

VA Inspector General on CRNA Supervision

VA Office of Inspector generalExecutive Summary
The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection to determine the merit of an allegation regarding the Anesthesia Section at the Dayton VA Medical Center, Dayton, OH. A complainant alleged that because of poor oversight by the Anesthesia Section Chief, Certified Registered Nurse Anesthetists (CRNAs) responded to consults and performed preoperative assessments without proper review by physician anesthesiologists. We did not substantiate the allegation that the Anesthesia Section Chief did not provide oversight to CRNAs. We found that all CRNAs were properly credentialed and privileged to perform their assigned duties within the scope of their licenses. In addition, the Anesthesia Section Chief assigned a preceptor anesthesiologist to assess each CRNA twice each month through observation and chart review of specific anesthesia procedures. We made no recommendations.
VA OIG CRNA supervision report

Anesthesia as the “Insidious Creep”

The CreepAs we continue our discussion of anesthesia bundling, a recent White Paper was brought to my attention by a CRNA colleague.

Truven Health Analytics has chosen anesthesia services as the culprit in their White Paper Can New Payment Models Stop the “Insidious Creep?” The Case of Colonoscopies  (You can download the pdf directly from Truven by clicking on this red lettered title).

This White Paper references New York Times articles, selective research and (my favorite) the author’s personal experience, to highlight the cost, increasing popularity, potential danger and questionable necessity of having anesthesia for a colonoscopy.

Selecting a study “from the Industry” where it is hypothesized that deep sedation, “because of impairment in patient response, this technique also has the potential for greater likelihood of adverse events.”  The author ending the paragraph with the conjecture, ” This finding suggests that this trend not only results in a significant increase in costs with no real benefit to the patient, but a possible increase in the risk of complication.” How in the course of one paragraph does a hypothesis become a finding ?

The next paragraph,

“In the current Fee For Service market, this creeping patient expectation for deep sedation cannot be stopped. The patient readily defers to the physician’s insistence that the deep sedation is necessary, since it is covered by insurance and, ‘I deserve the best care available.’ This patient tells all of his friends that the experience was not nearly as bad as he feared and that it was certainly due to the effects of anesthesia. Word spreads and patients insist that their physician follow this ‘best practice’. “

Truven Health Analysis

” I speak from personal experience when I say that a screening colonoscopy is not a pleasant experience. But it’s really not that bad. Its ‘bark is worse than its bite’. The preparation is actually much more unpleasant and the insertion of the IV is more painful than the procedure under conscious sedation.”

Impact of New Payment Models

“Will either of the proposed new payment models, bundled payment or the accountable care organization (ACO), impact this insidious trend represented here as the rapid increase in anesthesiologist participation for simple colonoscopy procedures ??

The concluding sentence in the White Paper,

The role of the Accountable Care Organization in assuring that utilization rates are appropriate and consistent with the population’s needs requires that the organization establish and manage compliance with evidence based guidelines.” 

Although newspaper sensationalism, hypothesis and personal experience make for a compelling storyline, ignoring the numerous “industry” studies describing the benefits of anesthesia, neglecting patient satisfaction, improved compliance etc, illustrates the bias of the White Paper and fails to measure up to criteria necessary to establish evidence based guidelines.

It is up to the anesthesia professions to respond to these biased reports masquerading as “findings” and “evidence based guidelines”. We must make sure the rest of the story is told by us, our patients and the physicans that value the services we provide for the gastroenterology procedures.

Dennis Gundersen, CRNA

www.CRNAbiz.com