Anesthesia Deconstructed: Science. Policy. Realities.

Key Points:

1. Importance of the AANA to CRNA economy 
2. Proposed bylaw changes and resolutions
3. Support for Board Term Extension (Bylaw 2) (with caveats) and Virtual Business Meetings
4. Opposition to Board Expansion (Bylaw 3) and Automatic Leadership Succession (Bylaw 4)
5. Rationale behind each position

Summary: Joe shares his views on proposed AANA changes, advocating for longer board terms and virtual meetings while opposing board expansion and automatic leadership succession. He emphasizes the need for efficiency, cost-effectiveness, and flexibility in leadership.

Call to Action: Members encouraged to review proposal documentation and participate in the upcoming discussion in early August.

Next Episode: Tune in next week for more CRNA insights and industry updates.

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Summary

The conversation discusses three main changes proposed by the Leadership Identification Committee (LIC) for the American Association of Nurse Anesthesiology: increasing the number of directors from seven to nine, increasing the term for directors from two years to three years, and changing the progression of the president to a three-year term. The rationale behind these changes is to decrease turnover, increase the number of eligible people for executive positions, and provide more support to region directors. The conversation also addresses concerns about the time commitment for directors and the potential impact on decision-making, cost, and the role of the professional staff. The conversation explores the proposal to increase the number of directors on the board, extend the terms of the vice president and president-elect, and create continuity in executive leadership roles. The main themes discussed include the benefits of having more directors to support state leaders, the financial feasibility of the proposal, the potential risks of electing the wrong person into an important position, the need for continuity and experience in executive roles, and the importance of informed voting.  The conclusion is an editor's note, where our host, Joe Rodriguez, expresses his view after taking time consider the conversation.  

Keywords

AANA, association, Leadership Identification Committee, directors, term, turnover, executive positions, region directors, time commitment, cost, professional staff, board directors, executive leadership, continuity, experience, informed voting

Takeaways

• The proposed changes aim to decrease turnover, increase the number of eligible people for executive positions, and provide more support to region directors.
• Increasing the term for directors from two years to three years allows for more continuity and experience on the board.
• Expanding the number of directors from seven to nine helps to reduce the workload for region directors and aligns with the growth of the association.
• Concerns about the time commitment, decision-making, cost, and the role of the professional staff are important considerations in the discussion.
• The financial feasibility of the proposal was assessed and deemed affordable.
• There is a potential risk of electing the wrong person into an important position, but the board can address disruptive behavior and provide coaching to mitigate this risk.
• Having continuity and experience in executive roles can lead to better decision-making and representation of members' interests.
• Informed voting is crucial, and members should take the time to understand the proposals and make informed decisions.

Chapters

00:00
Introduction and Background of the Proposed Changes

02:51
Increasing the Term for Directors from Two Years to Three Years

10:14
Expanding the Number of Directors from Seven to Nine

18:09
Considerations and Approval of the Proposed Changes

31:16
Enhancing Support f

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Summary

The conversation discusses the topic of rural pass-through and its impact on the anesthesiologist shortage. It explores the idea of including physician anesthesiologists in rural pass-through and whether it would be an effective solution. The conversation also delves into the concept of shortage and how it can be addressed by utilizing anesthesia providers to their maximum potential. The importance of deregulation and allowing local experts to make decisions about anesthesia models is emphasized. The conversation concludes with a discussion on title misappropriation and the need for transparency in using the terms 'physician anesthesiologist' and 'nurse anesthesiologist'.

Keywords

rural pass-through, anesthesiologist shortage, physician anesthesiologists, CRNAs, shortage solution, utilization of anesthesia providers, deregulation, local decision-making, title misappropriation, transparency

Takeaways

• Including physician anesthesiologists in rural pass-through may not have a significant impact on the anesthesiologist shortage.
• Utilizing anesthesia providers to their maximum potential can help address the shortage.
• Deregulation and allowing local experts to make decisions about anesthesia models is crucial.
• Transparency in using the terms 'physician anesthesiologist' and 'nurse anesthesiologist' is important to avoid confusion.

Key Quotes 

• "Rural pass-through is about providing compassionate care close to home for rural facilities across rural America."
• "The idea here is to subsidize the ability for people to get care close to home and be economically efficient in doing it."
• "The shortage is artificial because of model selection and facilities."

Chapters

00:00
Introduction and Background on Rural Pass-Through

01:15
Understanding the Purpose of Rural Pass-Through

03:04
The Inaccuracy of the Article's Premise on Mitigating the Anesthesiologist Shortage

08:51
Utilizing Anesthesia Providers to Address the Shortage

19:22
The Importance of Deregulation and Local Decision-Making in Anesthesia Models

25:03
Addressing Title Misappropriation for Transparency in Anesthesia Care

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Summary

The conversation discusses the topic of out-of-hospital cesarean sections and the potential risks and implications. Dr. Matt Mazurek, a physician anesthesiologist and assistant professor of anesthesiology at Yale School of Medicine, provides insights and raises concerns about the definition of low-risk cesarean deliveries, the dangers of complications during and after the procedure, and the lack of resources and training in outpatient settings. The conversation also touches on the financial incentives and potential cherry-picking of patients by private equity-owned medical facilities. The need for increased access to obstetrical care and support for OBs in rural areas is highlighted as a more effective solution to address maternal morbidity and mortality rates. 

Keywords
out-of-hospital cesarean sections, risks, complications, low-risk deliveries, resources, training, financial incentives, private equity, access to care, maternal morbidity, maternal mortality

Takeaways

• Defining low-risk cesarean deliveries is challenging and depends on various factors.
• Complications during and after cesarean sections can be life-threatening, especially in outpatient settings.
• The financial incentives of performing cesarean sections may lead to an increase in unnecessary procedures.
• Investing in more OBs and supporting them financially is crucial to improve access to obstetrical care in rural areas and reduce maternal morbidity and mortality rates.

Key Quotes

• "OB is still very dangerous, both in the OR and postoperatively"
• "It's much more common and more likely to happen in this particular group. So do we really want to gamble with people's lives in this setting?"
• "It has happened and it's happened to younger, healthier patients out of the blue."

Chapters

00:00
Introduction and Background

01:23
The Challenges of Defining Low-Risk Cesarean Deliveries

06:01
The Financial Incentives and Potential Risks of Outpatient C-Sections

08:20
Improving Access to Obstetrical Care in Rural Areas

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Episode Summary: In this episode, Joe Rodriguez talks with Ali Baghai about his journey and impact as a CRNA in Arizona. Ali shares his experiences in CRNA advocacy, the evolution of anesthesia practice in Arizona, and his role in significant legislative changes. They also discuss the nuances of owning an anesthesia business and life in Arizona.

Highlights:

Introduction

• Joe Rodriguez introduces the episode and welcomes Ali Baghai.
• Brief discussion about the uniqueness of Ali's name and CRNA role.

Ali's Background

• Ali shares his background, including his early involvement in CRNA politics.
• Discusses his time as state president and the changes in Arizona's CRNA landscape since 2009.

Initial Involvement in CRNA Advocacy

• Ali's journey from student representative to board member.
• The transformation of Arizona's job market and practice landscape for CRNAs.

Key Meeting in 2012

• Joe and Ali reminisce about a pivotal meeting in 2012 with other CRNA leaders.
• The decision to aim for opt-out and the creation of the political action committee (PAC).

Legislative Success Stories

• Ali's experience with legislative processes and passing key bills.
• The significance of Senate Bill 1336 and the Surgeon Immunity Law.

Opt-Out Success

• Discussion about Arizona becoming an opt-out state.
• The ripple effect of Arizona's opt-out status on other states.

Dental Anesthesia Regulation

• Ali's involvement in dental anesthesia regulation since 2019.
• The challenges and outcomes of the new rules for pediatric safety and provider registration.

Business Ownership in Anesthesia

• Ali's perspective on owning an anesthesia business.
• The challenges and rewards of being a business owner in the healthcare field.

Arizona Living

• Ali shares his love for living in Arizona, comparing it to his hometown of Boston.
• Highlights of Arizona's climate, outdoor activities, and overall lifestyle.

Closing Remarks

• Joe thanks Ali for his contributions to the CRNA community and the state of Arizona.
• Final thoughts on the importance of advocacy and leadership in healthcare.

Key Takeaways:

• The importance of CRNA advocacy and policy changes in improving anesthesia practice.
• The impact of legislative victories on CRNA practice and patient care.
• The challenges and rewards of owning an anesthesia business.
• The unique lifestyle and opportunities in Arizona.

Guest Information:

• Ali Baghai - CRNA, former state president, and key advocate for CRNA practice improvements in Arizona.
• Joe Rodriguez - Host, CRNA, and managing partner in an anesthesia group.

Call to Action:

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Episode Summary: In this episode, Joe Rodriguez welcomes back Simon Willman, Esq., former in-house counsel for one of the largest orthopedic groups in the country. They discuss the Federal Trade Commission's recent vote to ban non-compete agreements and its implications for healthcare professionals and practice owners.

Key Topics Covered:

Pre-Session: State-Level Updates from Louisiana, Maryland, and Pennsylvania 

1. Introduction:
   • Welcome and introduction of Simon Willman, Esq.
   • Background on Simon's experience with Health Outcomes Performance Company and Core Orthopedics.
2. FTC's Vote to Ban Non-Competes:
   • Overview of the FTC's recent vote to ban non-compete agreements.
   • The timeline for the ban going into effect (120 days post-publication).
   • Legal challenges from the U.S. Chamber of Commerce, the Business Roundtable, the Texas Association of Business, and the Longview Chamber of Commerce.
3. Implications for Healthcare Professionals:
   • Simon's insights on how the ban might affect providers and practice owners.
   • Potential benefits for healthcare providers who can move freely between employers.
   • Concerns for business owners regarding the impact on enterprise value and capital investments.
4. Details of the FTC's Final Rule:
   • Summary of the key points of the final rule.
   • Explanation of the difference between non-compete and non-solicitation agreements.
   • Potential legal interpretations and challenges ahead.
5. Non-Competes vs. Non-Solicitation:
   • Breakdown of how non-solicitation agreements differ from non-competes.
   • Discussion on whether non-solicitation agreements might serve as a backdoor to enforce non-competes.
6. Legal Considerations and Advice:
   • Practical advice for healthcare providers dealing with non-competes.
   • The importance of understanding the legal landscape and potential court interpretations.
   • The potential costs and implications of legal challenges.
7. Federal vs. State Jurisdiction:
   • Explanation of how the jurisdiction might shift from state to federal courts.
   • The impact of this shift on enforcement and legal proceedings.
8. Sale of Business Exception:
   • Discussion on the exception for bona fide sales of businesses.
   • How this exception might apply to equity owners and business transactions.
9. Final Thoughts and Advice:
   • Simon's final comments on the significance of the FTC's rule.
   • Advice for healthcare providers and practice owners navigating this evolving legal environment.
10. Outro:
    • Joe and Simon wrap up the discussion.
    • Teaser for the next episode.

Key Quotes:

• "If I'm in your audience's shoes as providers and as practice owners, I think this is significant and I don't think this is just pure speculation." - Simon Willman
• "Everyone should have a right to earn a living, I think." - Joe Rod

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Summary

The podcast, Anesthesia Deconstructed, has become the number one anesthesia podcast in the United States (Apple Podcasts - subsection: Medicine) due to its focus on deconstructing issues and having thoughtful and respectful conversations. The host, Joe Rodriguez, discusses his involvement in the The Nurse Anesthesiologist Facebook Group (TNAG)  and the importance of creating a space for sharing ideas and discussing issues. He addresses a screenshot from another Facebook group that accuses him and others of monopolizing information platforms. Rodriguez clarifies his involvement and highlights the diversity of perspectives in the group. He also previews upcoming episodes on topics such as FTC banning non-competes, CRNA advocacy, interprofessional collaboration, and the CRNA-friendly environment in Arizona.

Keywords

anesthesia podcast, deconstructing issues, respectful conversations, Facebook groups, sharing ideas, diversity of perspectives, upcoming episodes, FTC banning non-competes, CRNA advocacy, interprofessional collaboration, CRNA-friendly environment, Arizona

Takeaways

• Anesthesia Deconstructed is the number one anesthesia podcast in the United States due to its focus on deconstructing issues and having thoughtful and respectful conversations.
• Creating spaces like the TNAG group allows for the sharing of ideas and discussions on anesthesia-related issues.
• Rodriguez clarifies his involvement in the group and highlights the diversity of perspectives and respectful conversations that take place.
• Upcoming episodes will cover topics such as FTC banning non-competes, CRNA advocacy, interprofessional collaboration, and the CRNA-friendly environment in Arizona.

Titles

• Previewing Upcoming Episodes: FTC Banning Non-Competes, CRNA Advocacy, and More
• Creating a Space for Sharing Ideas: The Neuroscientist-Anesthesiologist Facebook Group

Sound Bites

• "Anesthesia Deconstructed: The number one anesthesia podcast in the United States."
• "Wanting to have really good and thoughtful conversations, and trying to do it in a respectful way."
• "Creating a place where people can share ideas and discuss issues without constant attacks."

Chapters

00:00
Introduction and Podcast Success

01:26
The Importance of Thoughtful and Respectful Conversations

07:59
CRNA Advocacy: Empowering Anesthesia Professionals

08:29
Interprofessional Collaboration: Enhancing Patient Care

11:43
Arizona: A Model for CRNA-Friendly Regulatory Environment

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• Removing barriers to competition and promoting a level playing field in healthcare is important.
• The supervision clarification advisor opinion from the Arizona Board of Nursing allows CRNAs to supervise other health professionals.
• The opt-out of Medicare Part A physician supervision requirements in Massachusetts eliminates the perception of supervision and reduces liability concerns for CRNAs.
• The opt-out also simplifies contract negotiations and promotes collaboration between CRNAs and surgeons.
• CRNAs should have the opportunity to choose the model of care that best suits their practice and the needs of their patients.
• More states should consider opting out of Medicare Part A physician supervision requirements to improve access to care and increase provider options.

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Episode Date: Monday, June 3rd

Welcome to Anesthesia Deconstructed!

In this episode, we cover:

Segment 1: Pre-CRNA Market Update

• Impact of late-stage capitalism on mentorship and professional development.
• Feedback from current nurse anesthesia residents/students.
• Questioning “Guaranteed Success” and the high cost of prep programs.

Segment 2: Key Legal Updates

• South Carolina and Maryland Associations’ successes in preventing restrictive rules.
• TANA’s loss of the term “anesthesiology.”
• DC’s HORA Act removing collaboration requirements for CRNAs.

Segment 3: Arizona Board of Nursing Update

• New authority for CRNAs to supervise other professionals 
• Discussion on ensuring competence and the debate around supervision and education.

Stay informed on the latest developments in anesthesia with us!

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