An MDA who does a case gets the full fee for the case. Lets say he gets $25 per unit. The minimum number of units per case is 3 so he gets $75 just sitting down to do the case. Then he gets 1 unit per 10 minutes of anesthesia time. That is time in the OR. Very rarely would he get less than 2 units for time, so he gets a minimum of $125 for a quick little case.
Now lets assume he has three AAs or CRNAs under him and he pays their salary. Now he can get three times as much pay. So he now can pull in $375 during the same time period. If he can pay the CRNAs and AAs less, he gets more. So IMO the CRNAs and AAs who work for MDAs are going to not only see payment to the MDA less, they are the ones who are going to have to make up the difference. You will see a very large movement of CRNAs and AAs as their pay gets cut at one place and they look for another place, only to find the pay being offered is less.
However many CRNAs work in solo and/or rural positions. They get the anesthesia payment. Since they can not supervise, they get only the rate for doing the case themselves.
Now the real problem. You get more pay for doing a lot of quick cases than you do for one long case. Surgeons who are slow are not going to be liked very much. So there will be a push for the surgeon to work faster, even if they are not capable of it. Also, if a surgeon gets X dollars for removing a gallbladder and the hospital gets Y dollars for the same procedure, they are going to want to go for the fastest cheapest way to do it. So forget the 90 minute scope chole, they are just going to slice and dice and have it done in 20 minutes. We will see a decline in the care because post op loss of work will not be factored into the issue. The patient is going to need longer to recover.
This is not a CRNA or AA or MDA issue, it is a quality of care issue. We all together need to be on the same page and not diverting attention with attacks on each other. The bottom line is patient care. Evaluate the Obama plan based upon impact on the patient.
