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CRNA Court Victory is a Win for Rural Hospitals

John Commins, for HealthLeaders Media, March 28, 2012

As for the California ruling, it's hard to see how this could end up differently. Many rural hospitals are running on razor thin margins. Medicare and Medicaid are trimming reimbursements, and private plans have adopted zero tolerance toward cost shifting. The hunt for savings is prompting hospital administrations to reexamine every aspect of care delivery, as they should.  

Again, if there is no conclusive evidence to show that patients receive substandard care or are placed at greater risk under CRNAs, rural hospitals that provide bread-and-butter surgical procedures should not have to pay considerably more for the services of an anesthesiologist.

Anesthesiologists commanded top compensation during a robust economy. Like many other professionals, however, they may have to readjust their expectations. Perhaps it is time for them to make compensation demands that are more compatible with the market.

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John Commins is a senior editor with HealthLeaders Media.

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2 comments on "CRNA Court Victory is a Win for Rural Hospitals"


16788087 (3/29/2012 at 2:25 PM)
excellent comment by Barry. I would like to add, one thing often overlooked in the conversation about utility/cost of 'CRNA vs. Anesthesiologist' is much of the value add that physician anesthesiologists can bring to the 'service' of anesthesia that nurses, by definition, cannot. Examples being; most MD Anesthesiologists are well trained and experienced with providing ultrasound guided regional anesthesia, training and experience in acute post op pain management, ability to act as a physician consultant with deep understanding of the wide breath and depth of disease states, training and experience in the use of ultrasound for cardiac evaluation, training and experience in managing a patients' preoperative evaluation, and thus saving dollars and improving outcomes. There are many functions anesthesiologists, trained and encultured as physicians, can perform that nurses, by their training and culture cannot, is not within their scope of practice, or are not comfortable with. The challenge for the specialty of anesthesiology, and especially for older generation anesthesiologists, is to show our value perioperatively and OUTside of the operating room. As noted, precision medicine is making the technical practice of anesthesiology to be a lower level function as compared to how anesthesia was practiced decades ago-thus, O.R anesthesia is being disintermediated away from needing physicians. However, there is much within the purvue of Perioperative medicine that physician anesthesiologists are uniquely qualified to do, and should step up to do, so as not to make this specialty obsolete.

Barry W. Brasfield, M.D. (3/28/2012 at 6:31 PM)
The relationships between anesthesiologists and CRNAs represent what Clayton Christiansen ("The Innovator's Prescription")would classify as a "disruptive innovation": anesthesiologists, through research and training, have rendered anesthesia care so safe that it is virtually impossible to statistically demonstrate any difference in the "quality of care." Therefore, provision of anesthesia is no longer an "intuitive" medical service, but a "precision" medical service. The marketplace will continue to adjust to this development over the next decade or more...