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Messages - pavulon

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Practice Issues & Concerns / PACU fentanyl dosing recommendations for peds
« on: December 02, 2010, 05:38:11 pm »
While unusual, we will give some fentanyl to peds in PACU.  The pediatricians have involved themselves in our PACU orders (I know, I know) and want to put a 30-60 minute leash on redosing as a printed recommendation.  I've indicated that we typically will put a 5-10 minute leash on redosing and that there is no fentanyl in PACU pyxis (it would have to be obtained from us).  The pediatricians have asked for a source for our recommendations (theirs came from Harriet Lane).  I can't say I have one.  Anyone have ad source for PACU peds fentanyl in print?
Thanks!
Scott

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Technology / Re: Your Own Electronic Record ?
« on: November 28, 2010, 06:22:37 pm »
does this system allow the use of a tablet type PC?

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Practice Issues & Concerns / Re: anesthesia policy and procedures
« on: May 18, 2010, 09:58:04 am »
Well...my $0.02 is that there are hospital "policies" and then there are anesthesia professional practice guidelines.  I like guidelines in that variables  requiring alterations in practice can generally be accommodated.  I've not seen many policies that allow for discretion.  Further, it has seemed to me that policies generally protect the hospital not people working at the hospital.  Who has time to look at a policy/procedure manual when it's all turning to mud??  Too frequently, some clipboard will use it against folks after the fact.  As always, your mileage may vary.

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Business Topics / Re: Buying into a CRNA group
« on: May 09, 2010, 06:49:48 am »
I can agree to all of that. 

My point is that there are a fair number of positions that are over-sold and a fair number of people that under-sell their skills (clinical, interpersonal, common-sense...).  Jumping into a tough situation without full disclosure from all invovled is a bad deal for everyone.  In a perfect world, folks lay down ALL of their cards before contracts get signed.  I think most people expect MDAs to play angles on CRNAs.  Unfortunately, there are a lot of CRNAs willing to do the same to fellow CRNAs.  Hard feelings from the very start is a recepie for disaster.

No underlying messages.  Just observations made by me and to me by fellow class-mates (a guy in Oregon), some partnerships I've watched fall apart and my experiences hiring a few guys (into a hospital-employed sitaution) over the past years.

Best to all and thanks for the discussion and respective positions,
Scott

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Business Topics / Re: Buying into a CRNA group
« on: May 07, 2010, 08:00:41 am »
I simply stated an opinion and related my experiences.  It seemed to me that the thread's original poster was seeking those from people...I could be wrong.

Not to be full-on Capt. Obvious but there are others things to consider too.  A rural practice may be a place that few people are willing to consider.  Or, the practice may be new, unstable, disorganized or simply slow.  Or, the person already there may be a jerk.  Or.... .

Any of these suboptimal situations may result in an owner having to make concessions to get help and/or grow and/or lose their contract. 

Lastly, I'd think that the majority of CRNAs bring plenty to the table...some might bring more than the person(s) already in place...which may be a great deal for everyone.

In the end, it's not only the owner that's taking a big chance.  Plenty of folks have jumped into a bad spot that was sold to them as "all good". 

Best.
Scott Buskerud, CRNA

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Business Topics / Re: Buying into a CRNA group
« on: April 19, 2010, 07:39:02 am »
I would say that all of it is negotiable and will depend upon what the current folks want/need/are willing to take and what the new member(s) is/are bringing to the table and willing to pay.  Also, the new person may want to consider what it is that he/she is "buying", what it is that they will "own" and what they will have to sell if they leave or it all goes south.

Not that long ago, I had an MDA contact me trying to "sell" me his practice in a small town in which he was a single provider competing with a group.  He had another job in a town about 100 miles away when I spoke to him.  In the end, he simply left town and that was the end of his sale.


Quote from: bdemko on March 04, 2010, 09:35:22 pm
Your question is somewhat unclear.  Did you expect to become an owner of a business for free?  The group went to the effort of creating a work situation and laying the ground floor for what can be a lucrative situation if properly managed.  You will obviously need to get some "skin in the game".  The skin can come in the form of extra responsibility, extra work or money.  In my experience it will take all three.

Bruce Demko

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Business Topics / Re: billing for ultrasound assisted block placement
« on: April 18, 2010, 05:18:51 pm »
well....we "get to" input the electronic billing for our services.  WE've been instructed to use a CPT number and charge for U/S guidance (CPT 76942, ultrasonic guidance for needle placement....)  which is not the same as the CPT and charge for the nerve block itself (CPT 64415).  We bill both.  I'm wondering what accounts for the differences and which is preferred.

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Business Topics / Re: billing for ultrasound assisted block placement
« on: April 14, 2010, 06:52:34 am »
Hi Dennis!

We bought a GE logiqE.  We bought because we were told that the machine will only need software updates to remain current (although I'm sure that will eventually change).  At the time, we couldn't get the sonosite folks to make the same claim.  At this point the machine has been completely reliable. 

All 4 of us have attended the AANA peripheral nerve block workshop.  The workshop I attended convinced me to push for a machine.  The remaining 3 CRNAs attended within the last year.  All of us found it to be valuable but there are other workshops out there that I've heard good things about as well.  In the beginning, I found it most beneficial to take the time to sit and scan yourself, others and to sit in on any block I could.

When we received our machine, we were allowed a day with a GE sonagrapher to learn the basics of the machine.  I suspect other companies do the same.

Best!
Scott

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Business Topics / Re: billing for ultrasound assisted block placement
« on: April 13, 2010, 05:03:30 pm »
Since begining this thread in late 2008, we have been using our machine at every opportunity and have been able to get the billing sorted. 

For me, it would be difficult to go back to landmarks for block placement.  U/S imaging has made me abandon my nerve stimulator for 90% of blocks, minimized block placement times (rarely does it take more than 5 minutes from begining to end for any block we do), minimized patient objections or discomfort, maximized success and practitioner satisfaction.  To date, we have not experienced a single complication from a block and I can't remember the last time a block "failed."  In short, U/S imaging makes me feel bad for many of the patients we blocked before getting the machine.  The only drawback I can see is the bill we submit to patients...it's a bit embarassing to me but I'm a hospital employee and don't have much influence on billing.

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Practice Issues & Concerns / Re: Day off after call
« on: February 24, 2009, 05:51:13 pm »
post-call is first off...unless the dept. director is post-call...then it's business as usual

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Practice Issues & Concerns / Re: Wasting narcotics
« on: February 24, 2009, 05:48:28 pm »
We waste narcs in the sharps (generally).  I'm a bit confused by sending them back to pharmacy though...do people really think that is some sort of assurance that there are no problems?  It seems to only add another unnecessary step and further drain manpower.  In my opinion, diverting any med we use would be so simple it's unreasonable to delude ones self into thinking that such sending stuff to pharmacy (they could also divert....or sell you down the river) solves anything.

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Business Topics / billing for ultrasound assisted block placement
« on: December 06, 2008, 07:12:45 am »
Group,

We recently pushed hard for purchasing an US unit to help us place blocks.  We were successful in getting the machine and it has been a great asset to us in placing successful interscalene, axillary, femoral and popliteal blocks quickly, safely and w/ minimal patient discomfort.   From that perspective, I think the machine has paid for itself already.

However, we are struggling with getting the US component of the block reimbursed.  Anyone having good results w/ US guidance payments?

Thanks,
Scott Buskerud
Medford, WI

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Practice Issues & Concerns / Re: Chaotic Operating/Anesthesia Environment
« on: August 17, 2008, 06:00:37 am »
Pack it up and leave before the house of cards folds (it seems inevitable by your description) and you're left flat-footed w/out a job.  The MDAs "timing" your tunover are showing their hand...they are showing non-support.  Imagine the non-support ($$$ and time you will be out) they will show you when they lose the contract or turn to vapor when they dis-band.

Also, the LT that says it's no better elsewhere hasn't been taking any gigs in rural america.

Good luck!!

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