Marc Koch, MD, MBA, president and CEO of Somnia Anesthesia Services and an anesthesiologist, shares the following comments regarding the recent study by The Lewin Group, published in the Journal of Nursing Economics, that claims the certified registered nurse anesthetist-only anesthesia model is the most cost-effective anesthesia model for delivery.
Clinical roles
When discussing the delivery of anesthesia, the goal always is to have it administered by appropriately educated, trained and skilled personnel. That might be a medical doctor of anesthesia (MDA), who has completed four years of medical school and another four in residency, or a CRNA, a registered nurse who has had one year of experience in an acute care setting and also has completed a 24-36 month nurse anesthetist program. It is important to clarify that the CRNA is different from a registered nurse or licensed practical nurse. Similarly, MDAs are different from other MDs in that they have received specialty training. With that said, it is the MDA and/or the CRNA who should be administering potent anesthetics.
Anesthesia models
Staffing an anesthesia department involves a broad, sophisticated and involved approach that considers multiple variables: the state-specific regulatory environment, hospital culture, community in which the hospital is situated, the number of ORs and the acuity of cases. Generally speaking, when the objective is to achieve operational effectiveness in a hospital that has three or more ORs, a blended model employing a mix of MDs and CRNAs will provide optimal coverage and deliver value for the anesthesia spend. That value grows as the number of ORs increases. Conversely, using a blended model in a facility with a single OR wouldn't necessarily require the MD/CRNA mix; oftentimes it doesn't make financial or operational sense.
Cost
The compensation structure for the MDA and CRNA is different. Typically, anesthesiologists are compensated annually and receive perquisites, whereas the certified nurse anesthetist's compensation is hourly or based upon shifts. The difference in salaries can be likened to that which exists between private sector workers who hold BA degrees and those who have gone on for further study, to receive their MBA or PhD credentials.
While salaries may differ, certain compensating differentials are applied universally across the pay structures for both the CRNAs and MDAs. Depending on the circumstance, they may include sub-specialty training, the assumption of additional leadership or administrative roles, as well as the frequency and nature of on-call obligations.
Because anesthesia departments are complicated, in the end it takes sophisticated, long-tenured expertise to design the strategy and tactics that result in a durable and accepted anesthesia model that can safely and effectively deliver high-quality clinical care, minimize the cost of providing that care, identify and exploit new revenue streams, and result in optimal value.
Learn more about Somnia Anesthesia Services.
Clinical roles
When discussing the delivery of anesthesia, the goal always is to have it administered by appropriately educated, trained and skilled personnel. That might be a medical doctor of anesthesia (MDA), who has completed four years of medical school and another four in residency, or a CRNA, a registered nurse who has had one year of experience in an acute care setting and also has completed a 24-36 month nurse anesthetist program. It is important to clarify that the CRNA is different from a registered nurse or licensed practical nurse. Similarly, MDAs are different from other MDs in that they have received specialty training. With that said, it is the MDA and/or the CRNA who should be administering potent anesthetics.
Anesthesia models
Staffing an anesthesia department involves a broad, sophisticated and involved approach that considers multiple variables: the state-specific regulatory environment, hospital culture, community in which the hospital is situated, the number of ORs and the acuity of cases. Generally speaking, when the objective is to achieve operational effectiveness in a hospital that has three or more ORs, a blended model employing a mix of MDs and CRNAs will provide optimal coverage and deliver value for the anesthesia spend. That value grows as the number of ORs increases. Conversely, using a blended model in a facility with a single OR wouldn't necessarily require the MD/CRNA mix; oftentimes it doesn't make financial or operational sense.
Cost
The compensation structure for the MDA and CRNA is different. Typically, anesthesiologists are compensated annually and receive perquisites, whereas the certified nurse anesthetist's compensation is hourly or based upon shifts. The difference in salaries can be likened to that which exists between private sector workers who hold BA degrees and those who have gone on for further study, to receive their MBA or PhD credentials.
While salaries may differ, certain compensating differentials are applied universally across the pay structures for both the CRNAs and MDAs. Depending on the circumstance, they may include sub-specialty training, the assumption of additional leadership or administrative roles, as well as the frequency and nature of on-call obligations.
Because anesthesia departments are complicated, in the end it takes sophisticated, long-tenured expertise to design the strategy and tactics that result in a durable and accepted anesthesia model that can safely and effectively deliver high-quality clinical care, minimize the cost of providing that care, identify and exploit new revenue streams, and result in optimal value.
Learn more about Somnia Anesthesia Services.