Show notes
Jon and Ian discuss the history and economics of anesthesia delivery models. Ian overviews the various types of anesthesia care models, some of the historical context for the development of those models and explains how anesthesia providers can optimize the delivery of anesthesia care in terms of billing, efficiency and quality outcomes. We also discuss some of the challenges facing researchers in terms of gathering and interpreting “big data” on quality outcomes related to anesthesia care. If you’re interested in the behind-the-scenes story on anesthesia care in the United States, this podcast is a good place to start!
Ian Hewer, MSN, MA, CRNA is an Assistant Professor and the Assistant Director of the Graduate Nurse Anesthesia Program at Western Carolina University. He is a Fellow of the American Association of Nurse Anesthetists’ Journal Writing Fellowship Program and has published articles in the AANA Journal, the International Journal of Nursing Research and the Social Science Journal. Ian is currently pursuing his PhD at the University of North Carolina – Charlotte in Health Services Research with research focusing on the economics and outcomes of various anesthesia care delivery models.
Topics discussed:
* Types of anesthesia care models in the United States
* Types of specific billing modalities for anesthesia services and the implications for anesthesia care models
* The difference between medical direction and medical supervision and defining these terms in relation to billing & reimbursement verses standards of care of anesthesia providers
* What “opt-out” means in terms of reimbursement and CRNA practice autonomy
* Historical economic and political evolution & context of anesthesia care
* The challenge of gathering & interpreting anesthesia quality data
* Current trends in anesthesia quality research
* Ideas on structuring anesthesia care models for success in a future where healthcare must become more efficient and cost-effective while maintaining safety and high quality
* Suggestions for anesthesia providers in educating themselves on trends in healthcare economics
* Thoughts on CRNAs becoming doctorally prepared clinicians and how this evolution will influence anesthesia in the United States
Background information:
Kane & Smith’s 2004 article titled An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom, published in the 2004, vol 59 edition of Anaesthesia, provides a particularly in-depth review of the development of anesthesia in the United States. The types of anesthesia providers and models of practice are reviewed along with many of the key dates, legislation and publications that have influenced the anesthesia field in the United States over the last 100 years. Professor Hewer touches on many of these dates and developments and we encourage listeners to reference Kane (2004) for more detail.
Chronology of important dates in US anaesthesia (quoted from Kane, 2004)
1846 First anaesthetic administered
1847 American Society of Anaesthesiologists formed
1909 First formal Nurse Anaesthetist training program
1931 American Association of Nurse Anaesthetists formed
1932 Anaesthesia recognised as a medical Specialty by the American Medical Association
1960s Johnson administration healthcare reforms
1966 Medicare program allows anaesthesiologists to bill them directly for overseeing hospital-employed CRNAs as well as personally administered anaesthetics. Graduate Medical Education program
1980 Forrest study published
1981 Bechtoldt study published
Ian Hewer, MSN, MA, CRNA is an Assistant Professor and the Assistant Director of the Graduate Nurse Anesthesia Program at Western Carolina University. He is a Fellow of the American Association of Nurse Anesthetists’ Journal Writing Fellowship Program and has published articles in the AANA Journal, the International Journal of Nursing Research and the Social Science Journal. Ian is currently pursuing his PhD at the University of North Carolina – Charlotte in Health Services Research with research focusing on the economics and outcomes of various anesthesia care delivery models.
Topics discussed:
* Types of anesthesia care models in the United States
* Types of specific billing modalities for anesthesia services and the implications for anesthesia care models
* The difference between medical direction and medical supervision and defining these terms in relation to billing & reimbursement verses standards of care of anesthesia providers
* What “opt-out” means in terms of reimbursement and CRNA practice autonomy
* Historical economic and political evolution & context of anesthesia care
* The challenge of gathering & interpreting anesthesia quality data
* Current trends in anesthesia quality research
* Ideas on structuring anesthesia care models for success in a future where healthcare must become more efficient and cost-effective while maintaining safety and high quality
* Suggestions for anesthesia providers in educating themselves on trends in healthcare economics
* Thoughts on CRNAs becoming doctorally prepared clinicians and how this evolution will influence anesthesia in the United States
Background information:
Kane & Smith’s 2004 article titled An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom, published in the 2004, vol 59 edition of Anaesthesia, provides a particularly in-depth review of the development of anesthesia in the United States. The types of anesthesia providers and models of practice are reviewed along with many of the key dates, legislation and publications that have influenced the anesthesia field in the United States over the last 100 years. Professor Hewer touches on many of these dates and developments and we encourage listeners to reference Kane (2004) for more detail.
Chronology of important dates in US anaesthesia (quoted from Kane, 2004)
1846 First anaesthetic administered
1847 American Society of Anaesthesiologists formed
1909 First formal Nurse Anaesthetist training program
1931 American Association of Nurse Anaesthetists formed
1932 Anaesthesia recognised as a medical Specialty by the American Medical Association
1960s Johnson administration healthcare reforms
1966 Medicare program allows anaesthesiologists to bill them directly for overseeing hospital-employed CRNAs as well as personally administered anaesthetics. Graduate Medical Education program
1980 Forrest study published
1981 Bechtoldt study published