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The midlevel push to provide care autonomously
Posted on 5/1/17 at 6:21 pm
Posted on 5/1/17 at 6:21 pm
So I saw this article on one of my newsfeeds today, that is about a bill that the N.C. Association of Nurse Anesthetists is pushing that allows them to practice without the supervision of a physician (anesthesiologists). It reminded me of this other article I read a few weeks back about how optometrists are trying to push legislation that allows them to perform surgeries and procedures typically reserved for ophthalmologists. One of the main things cited by these groups is that this shift will save money. This is something that has been discussed previously in the context of routine preventative health care, but I think we can both agree the operating room is a bit of a different animal.
My question to you is as follows: are you ok with the minimum qualifications being lowered if that meant "cheaper care?" And for those who say yes, at what point do you draw the line? If you had a vote, what would you cast?
My question to you is as follows: are you ok with the minimum qualifications being lowered if that meant "cheaper care?" And for those who say yes, at what point do you draw the line? If you had a vote, what would you cast?
15
Posted on 5/1/17 at 6:30 pm to onmymedicalgrind
I'm curious how much actual caregiver salary impacts care costs
Posted on 5/1/17 at 6:37 pm to onmymedicalgrind
Yeah that's the ticket. Let's have a bunch of doped up nurse anaesthetists putting people under with no MD supervision. What could possibly go wrong?
Posted on 5/1/17 at 6:51 pm to Turbeauxdog
quote:
I'm curious how much actual caregiver salary impacts care costs
Not much, which is why I'm curious where the nurse anesthetist group in NC got the $477M in annual savings if they were allowed to practice independently number from.
Posted on 5/1/17 at 6:53 pm to LSUTigersVCURams
quote:
Yeah that's the ticket. Let's have a bunch of doped up nurse anaesthetists putting people under with no MD supervision. What could possibly go wrong?
Agreed, but to play devil's advocate, if your comfortable having a nurse anesthetist, should you not be allowed to "save money" (if thats even the case, mind you) and opt for one over an anesthesiologist for your procedures?
Posted on 5/1/17 at 6:53 pm to onmymedicalgrind
Do we really need an MD to do strep screens and sutures? How about prescribe birth control? So much of medical care is billing the hours to the highest level practitioner so that the hospital or clinic can get the most from Medicaid. The patient may only see a PA or NP but the doctor makes a note in their chart so that they can bill at 100% rather than 80%. After all, you have to have the MDs on staff so you have to pay them.
Posted on 5/1/17 at 6:56 pm to onmymedicalgrind
There are some really great CRNA's, NP's and PA's and there are some bad ones. Same with MD's, lawyers, dentists, etc...
Doubtful that a law like this will pass. If it did, there are some very high standards that have to be met to be able to perform in any of these roles. A lot of clinical hours as well as didactic studies.
Far as cost? Who really knows the truth there.
Doubtful that a law like this will pass. If it did, there are some very high standards that have to be met to be able to perform in any of these roles. A lot of clinical hours as well as didactic studies.
Far as cost? Who really knows the truth there.
Posted on 5/1/17 at 6:56 pm to onmymedicalgrind
I want to know what "autonomous" actually means.
Do they mean like the current pa/np model where they see the pt, write scripts, and tell the attending what they're doing?
Or do they mean legit autonomous?
I don't have a big issue with the former.
The latter won't save money. Big cost of this realm of care is malpractice insurance. Malpractice for an autonomous nurse is going to be higher than an MD, I'd imagine.
Do they mean like the current pa/np model where they see the pt, write scripts, and tell the attending what they're doing?
Or do they mean legit autonomous?
I don't have a big issue with the former.
The latter won't save money. Big cost of this realm of care is malpractice insurance. Malpractice for an autonomous nurse is going to be higher than an MD, I'd imagine.
Posted on 5/1/17 at 7:02 pm to kcon70
quote:
If it did, there are some very high standards that have to be met to be able to perform in any of these roles. A lot of clinical hours as well as didactic studies.
Hmmm.....so something like.....medical school?
Posted on 5/1/17 at 7:04 pm to CC
quote:
Do we really need an MD to do strep screens and sutures?
I already mentioned the role midlevels could prob play in PCP clinics. As far as sutures go, usually the surgeons PA/NP/resident does those anyway.
quote:
The patient may only see a PA or NP but the doctor makes a note in their chart so that they can bill at 100% rather than 80%.
Well if an MD supervised the care and discussed with the NP/PA, that should be noted and billed for. If he did not physically see the patient but says he did, thats fraud.
Posted on 5/1/17 at 7:20 pm to onmymedicalgrind
If you mean by doing 4 years of residency, then possibly a year as a fellow then no. But, for a lot of medical care, midlevels are perfectly able to competently provide. Specialty diagnoses and surgeries are of course best suited for an experienced MD.
There are a lot of prior military that have gone the mid level route. Some are at an age where getting into med school and residence are just not feasible.
There are a lot of prior military that have gone the mid level route. Some are at an age where getting into med school and residence are just not feasible.
Posted on 5/1/17 at 7:20 pm to onmymedicalgrind
Well shite. I read "midlevel" as "medieval".
Was expecting to see blood letting, frog hairs, witches brew, etc.
Was expecting to see blood letting, frog hairs, witches brew, etc.
Posted on 5/1/17 at 7:22 pm to kcon70
like, I have no issue with a trained midlevel with a fair amount of clinical hours following a simple protocolized approach for low-risk patients and surgeries (laparoscopic gallbladder removal in an otherwise healthy 30 yo male) as long as an MD is signing off on the protocol for use during the surgery and agreeing its "low risk".
But I want a highly trained expert who appreciates the nuance between propofol and ketofol manning the trauma bay for GSW, etc
But I want a highly trained expert who appreciates the nuance between propofol and ketofol manning the trauma bay for GSW, etc
Posted on 5/1/17 at 7:27 pm to kcon70
quote:
But, for a lot of medical care, midlevels are perfectly able to competently provide.
I've already conceded that this might be true, which is why I specifically centered this discussion around those that might be operating on your eyeball, or keeping you alive during said operation.
Posted on 5/1/17 at 7:31 pm to Tiguar
quote:
like, I have no issue with a trained midlevel with a fair amount of clinical hours following a simple protocolized approach for low-risk patients and surgeries (laparoscopic gallbladder removal in an otherwise healthy 30 yo male) as long as an MD is signing off on the protocol for use during the surgery and agreeing its "low risk".
Meh I still have an issue with it. Anesthesia is essentially hours of boredom, seconds of terror. I've been in many an OR where something started going awry on the other side of the curtain and the first thing that happens is the CRNA calls her attending in there ASAP. Theres too much at stake on a second to second basis in an operating room to have a nurse manning it independently without a backup anesthesiologist within shouting distance. This isn't an office or clinic setting.
Posted on 5/1/17 at 7:34 pm to onmymedicalgrind
Understand that. I believe for any major surgery, even what may seemingly be minor but performed on organs such as eyes, should be left to the adequately trained Physician.
Posted on 5/1/17 at 7:36 pm to kcon70
quote:
believe for any major surgery, even what may seemingly be minor but performed on organs such as eyes, should be left to the adequately trained Physician.
What is an example of a non-major surgery your OK being done by a non-phyician?
Posted on 5/1/17 at 7:50 pm to onmymedicalgrind
Bean counters in Washington and insurance board room already deciding what is medically necessary.
Aren't you a progressive? You couldn't see this coming when costs must be cut in order to treat everyone for all manner of conditions, lifestyle and otherwise?
Aren't you a progressive? You couldn't see this coming when costs must be cut in order to treat everyone for all manner of conditions, lifestyle and otherwise?
Posted on 5/1/17 at 7:51 pm to onmymedicalgrind
Like a previous post mentioned, laceration repairs, I&D's and other minor procedures. Nothing that would warrant general anesthesia and such.
Posted on 5/1/17 at 7:53 pm to onmymedicalgrind
To OP's question, "No".
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