Anesthesia-in-USA-4-2011
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
H&HN may, 2003
Mississippi State Medical Crisis
• Dr. Paul Mace of GMH, a general surgeon,
the liability premium reached $170,000/year. • In Yazoo City, 14,550 residents, no practicing obstetrician • In Mississippi, lawyers are allowed to sue physicians without their patients’ knowledge
• CMS: Centers for Medicare & Medicaid Services
(a federal agency) • HCFA: Health Care Finance Administration, it is the old name for CMS • CMS determines the conversion factor (CF, 转换因子) for all medical specialties.
Relationship between MDs and CRNAs
Relationship with CRNA
• Congressman Jim Nussle (R-IA) introduced the
Anesthesia Service Protection Act of 1999 (HR 804) to end physician supervision for CRNA • Safe Seniors Assurance Study Act by David Weldon (R-FL) asks HCFA to conduct a study to look into the difference in mortality and morbidity between MD and CRNA
An Overview of Anesthesia Practice in USA
Manpower of anesthesia service in USA (人力资源)
• • • • •
ASA membership: 44,000/2010; 38,501/2003 Total anesthesiologists: ?? Total anesthesia residents: 1200-1300/year Total CRNA in USA: 35,052 in 2004 ? In 2010 Total AA in USA:
Dr. Karen Domino, ASA Newsletter, 2003, 67(6):6
Malpractice insurance: what is the solution?
• A national cap to limit the award for • • • •
medical lawsuits. Change the lottery mentality. Significantly cut the lawyers’ profit potential even they win. Government restricts Medicare/Medicaid patients from suing government facilities Train perfect physicians they won’t make any mistakes
H&HN may, 2003
Mississippi State Medical Crisis
• MS lost 40% of its doctors in the last 10
years • Jefferson County has only 9740 residents, they have 21000 plaintiffs from 1995-2000 • 51 out of 82 counties in Mississippi face doctor shortage
Fighting with government HCFA(CMS)
ASA Bulletin: “Regarding governmental affairs, the more you take part in, the less government will take part of you”.
Dual players: Anesthesiologist and politician
• Andrew Harris: Congressman (U.S.), R-MD
formerly State Senator • Tom George: Senator, R-MI • Kyle Janek: Senator, R-TX • Sam Page: State Representative, D-MO
Fighting with government HCFA(CMS)
Why CF is important?? CF determines health care providers’ reimbursement for Medicare/Medicaid patients. How is CF determined??
Anesthesia Practice in US:
The workforce, political, Financial and Professional Considerations
.
美国麻醉科医师的人力资源, 政治, 经 济和职业考量
Henry Liu (刘恒意), M.D. Associate Professor of Anesthesiology Director of Cardiothoracic Anesthesiology Associate Director of Research Tulane University Medical Center New Orleans, Louisiana
Fighting with government HCFA(CMS)
• CF is based on many factors:
physician’s work physician’s expenses malpractice premium geographical location, etc
(Resource-based Relative Value Scale (RBRVS))
MD and CRNA employment pattern
• • • •
MDA only group: 26% MDA employs CRNA: 41% Facility employs CRNA: 19% Hybrid: 14%
Comparison of annual production of CRNA and MD gradutes
Scope of Anesthesia Practice
• • • • • •
Traditional anesthesia Critical care medicine Acute and Chronic pain management Office-based anesthesia services Transesophageal echocardiography Intraoperative laboratory diagnosis
Surgical mortality and anesthesia provider--Dr. Silber’s study
Surviving Medical Malpractice
Surviving Medical Malpractice
• The University of Nevada Medical Center closed its • • • • •
trauma center for 10 days in 2003 Houston’s Spring Branch Medical Center no longer delivers babies Thomas Jefferson University’s Methodist Hospital in Philadelphia closed Labor & Delivery Unit In New Jersey, 65% of the hospitals say their doctors are leaving Surgeons in WV, IL, NJ, PA, MS have walked off their job Orlando Regional Medical Center will lose its Level One Trauma Designation
ASA Newsletter, 2003, 67(6):2
CR来自百度文库A
• Must have R.N. certificate • Master’s degree • At least one year critical care, respiratory,
or ER experience • Total training time: 2.5 years
2500
2000 Total annual gradutes
1500 Series1 1000 Series2
500
0 1 2
Political considerations
.
(麻醉科医师的政治考量)
Fighting with government (与政府打交道)
Fighting with government CMS(HCFA)
Anesthesia education
• One year “clinical base year” training plus • • • •
three years’ clinical anesthesia training Clinical competence review ABA written examination ABA oral examination Anesthesia subspecialty fellowship training
CF
• 2010: National average CF: $21.5696 • 2011: $21.0515, decreased 2.4%
Conversion Factors in some areas
• • • • •
Highest in Alaska: $29.22/unit Lowest in Puerto Rico: $15.71/unit Los Angeles: $18.51/unit Louisiana: $17.67/unit National average: $17.50/unit
AA
Currently 18 states allow AA to practice: Alabama, Colorado, District of Columbia, Florida, Georgia, Kentucky, Michigan, Missouri, New Hampshire, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Texas, Vermont, West Virginia, Wisconsin
Malpractice insurance
• Professional liability insurance premium for
anesthesia practice: The average is $21,351/year ($7,216—$124,598), in 2003, Florida has the highest premium
Mississippi State Medical Crisis
• Dr. Paul Mace of GMH, a general surgeon,
the liability premium reached $170,000/year. • In Yazoo City, 14,550 residents, no practicing obstetrician • In Mississippi, lawyers are allowed to sue physicians without their patients’ knowledge
• CMS: Centers for Medicare & Medicaid Services
(a federal agency) • HCFA: Health Care Finance Administration, it is the old name for CMS • CMS determines the conversion factor (CF, 转换因子) for all medical specialties.
Relationship between MDs and CRNAs
Relationship with CRNA
• Congressman Jim Nussle (R-IA) introduced the
Anesthesia Service Protection Act of 1999 (HR 804) to end physician supervision for CRNA • Safe Seniors Assurance Study Act by David Weldon (R-FL) asks HCFA to conduct a study to look into the difference in mortality and morbidity between MD and CRNA
An Overview of Anesthesia Practice in USA
Manpower of anesthesia service in USA (人力资源)
• • • • •
ASA membership: 44,000/2010; 38,501/2003 Total anesthesiologists: ?? Total anesthesia residents: 1200-1300/year Total CRNA in USA: 35,052 in 2004 ? In 2010 Total AA in USA:
Dr. Karen Domino, ASA Newsletter, 2003, 67(6):6
Malpractice insurance: what is the solution?
• A national cap to limit the award for • • • •
medical lawsuits. Change the lottery mentality. Significantly cut the lawyers’ profit potential even they win. Government restricts Medicare/Medicaid patients from suing government facilities Train perfect physicians they won’t make any mistakes
H&HN may, 2003
Mississippi State Medical Crisis
• MS lost 40% of its doctors in the last 10
years • Jefferson County has only 9740 residents, they have 21000 plaintiffs from 1995-2000 • 51 out of 82 counties in Mississippi face doctor shortage
Fighting with government HCFA(CMS)
ASA Bulletin: “Regarding governmental affairs, the more you take part in, the less government will take part of you”.
Dual players: Anesthesiologist and politician
• Andrew Harris: Congressman (U.S.), R-MD
formerly State Senator • Tom George: Senator, R-MI • Kyle Janek: Senator, R-TX • Sam Page: State Representative, D-MO
Fighting with government HCFA(CMS)
Why CF is important?? CF determines health care providers’ reimbursement for Medicare/Medicaid patients. How is CF determined??
Anesthesia Practice in US:
The workforce, political, Financial and Professional Considerations
.
美国麻醉科医师的人力资源, 政治, 经 济和职业考量
Henry Liu (刘恒意), M.D. Associate Professor of Anesthesiology Director of Cardiothoracic Anesthesiology Associate Director of Research Tulane University Medical Center New Orleans, Louisiana
Fighting with government HCFA(CMS)
• CF is based on many factors:
physician’s work physician’s expenses malpractice premium geographical location, etc
(Resource-based Relative Value Scale (RBRVS))
MD and CRNA employment pattern
• • • •
MDA only group: 26% MDA employs CRNA: 41% Facility employs CRNA: 19% Hybrid: 14%
Comparison of annual production of CRNA and MD gradutes
Scope of Anesthesia Practice
• • • • • •
Traditional anesthesia Critical care medicine Acute and Chronic pain management Office-based anesthesia services Transesophageal echocardiography Intraoperative laboratory diagnosis
Surgical mortality and anesthesia provider--Dr. Silber’s study
Surviving Medical Malpractice
Surviving Medical Malpractice
• The University of Nevada Medical Center closed its • • • • •
trauma center for 10 days in 2003 Houston’s Spring Branch Medical Center no longer delivers babies Thomas Jefferson University’s Methodist Hospital in Philadelphia closed Labor & Delivery Unit In New Jersey, 65% of the hospitals say their doctors are leaving Surgeons in WV, IL, NJ, PA, MS have walked off their job Orlando Regional Medical Center will lose its Level One Trauma Designation
ASA Newsletter, 2003, 67(6):2
CR来自百度文库A
• Must have R.N. certificate • Master’s degree • At least one year critical care, respiratory,
or ER experience • Total training time: 2.5 years
2500
2000 Total annual gradutes
1500 Series1 1000 Series2
500
0 1 2
Political considerations
.
(麻醉科医师的政治考量)
Fighting with government (与政府打交道)
Fighting with government CMS(HCFA)
Anesthesia education
• One year “clinical base year” training plus • • • •
three years’ clinical anesthesia training Clinical competence review ABA written examination ABA oral examination Anesthesia subspecialty fellowship training
CF
• 2010: National average CF: $21.5696 • 2011: $21.0515, decreased 2.4%
Conversion Factors in some areas
• • • • •
Highest in Alaska: $29.22/unit Lowest in Puerto Rico: $15.71/unit Los Angeles: $18.51/unit Louisiana: $17.67/unit National average: $17.50/unit
AA
Currently 18 states allow AA to practice: Alabama, Colorado, District of Columbia, Florida, Georgia, Kentucky, Michigan, Missouri, New Hampshire, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Texas, Vermont, West Virginia, Wisconsin
Malpractice insurance
• Professional liability insurance premium for
anesthesia practice: The average is $21,351/year ($7,216—$124,598), in 2003, Florida has the highest premium