Anesthesia Deconstructed: Science. Politics. Realities.

Michael MacKinnon DNP FNP-C CRNA

This podcast will touch on issues ranging from clinical to politics of anesthesiology and take a balanced, realistic approach based on the evidence.

  • 29 minutes 56 seconds
    Did CMS Actually Miss an Opportunity To Reduce the Anesthesia Shortage?

    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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    19 July 2024, 11:00 am
  • 16 minutes 24 seconds
    Should C-Sections Be Performed on an Outpatient Basis? Florida is going to find out.

    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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    16 July 2024, 12:00 pm
  • 38 minutes 2 seconds
    RAISING ARIZONA Pt. 1: Arizona's Zero to Hero Story with Ali J. Baghai, CRNA, AZANA Past President and Guide Anesthesia | AzAS Managing Partner

    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:

    • Subscribe to our podcast for more insightful conversations on healthcare and anesthesia.
    • Visit our website for more information on CRNA advocacy and resources.


    Note to Listeners: Don't forget to leave us a review and share this episode with your colleagues and friends in the healthcare community! Your support helps us bring more valuable content to you.

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    9 July 2024, 12:00 pm
  • 6 minutes 28 seconds
    CRNAs: An American Innovation - Reflecting on Independence Day
    In this special July 4th episode, we explore the significance of American independence and its impact on the CRNA profession. We discuss the foundations of American governance and how these ideals have shaped our national identity. The episode presents two key messages: addressing current societal tensions and highlighting CRNAs as a unique American innovation in healthcare.

    The podcast emphasizes the exceptional position of CRNAs in the United States, noting their level of autonomy and economic freedom unparalleled in other Western societies. It traces the profession's success to decades of advocacy work and stresses the importance of continued effort in maintaining and advancing the field. The episode concludes by encouraging CRNAs and aspiring CRNAs to reflect on the benefits they've gained from both the American system of government and the tireless work of their predecessors, while enjoying the Independence Day celebrations.

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    4 July 2024, 3:00 pm
  • 31 minutes 12 seconds
    FTC Update With Simon Willman, JD and What It Means for Anesthesia Providers

    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 Rodriguez

    Resources Mentioned:

    • Becker's Healthcare article on the FTC vote.
    • The FTC's final rule on non-competes.

    Connect with Us:

    Disclaimer: The content of this podcast is for informational purposes only and does not constitute legal advice. Listeners should consult their own legal advisors for specific guidance related to their circumstances.

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    25 June 2024, 11:00 am
  • 13 minutes 56 seconds
    We Became The Top Anesthesia Podcast in the United States AND Episode Previews

    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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    14 June 2024, 8:00 pm
  • 20 minutes 25 seconds
    Mike MacKinnon is Back! Massachusetts Opt Out and What it Means vs
    Summary



    In this conversation, Joe Rodriguez interviews Michael McKinnon,  podcast founder, CRNA, and assistant program director at National University. They discuss two topics: the supervision clarification advisory opinion from the Arizona Board of Nursing and the opt-out of Medicare Part A physician supervision requirements in Massachusetts. McKinnon shares his perspective on these issues and emphasizes the importance of removing barriers to competition and promoting a level playing field in healthcare.


    Keywords



    CRNA, supervision clarification, advisory opinion, Arizona Board of Nursing, AA, opt-out, Medicare Part A, physician supervision, Massachusetts


    Takeaways



    • 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.
    Chapters



    00:00
    Introduction and Background of Michael McKinnon


    01:04
    Supervision Clarification Advisor Opinion in Arizona


    05:21
    Opposition to Anti-Competitive Legislation


    09:31
    Opting Out of Medicare Part A Supervision Requirements in Massachusetts


    12:20
    Impact of Opting Out on CRNAs and Service Line Management


    16:29
    Future Plans and Conclusion






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    7 June 2024, 2:00 pm
  • 19 minutes 6 seconds
    Should CRNAs supervise AAs? And, updates on DC, SC, TN, and the Pre-CRNA Market

    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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    4 June 2024, 2:00 am
  • 3 minutes 46 seconds
    Is it ethical to have pre-CRNAs pay for intro courses? And, where is our co-host?

    In this episode:

    • The CRNA Intro Market: We're going to explore this issue more deeply - we want to hear from you! 
    • How You Can Contribute: We want to hear from you! Share your experiences, questions, or advice about starting out as a CRNA. Your insights could be featured in upcoming episodes!

    Send Your Contributions: Reach out via email at [email protected] and write us or send us a voice memo (2 mins or shorter please). Join the conversation and help shape the future of our show!

    Subscribe and Stay Connected: Don't miss an episode—subscribe to our podcast on your favorite platform!

    Also, where the **** is Mike MacKinnon? 

    Your Host(s) Joe Rodriguez, CRNA -, bringing years of experience and a passion for anesthesia, and CRNAs -   right to your ears.

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    15 May 2024, 1:00 pm
  • 1 minute 10 seconds
    AANA Election Time!

    In this concise episode, Dr. Joseph Rodriguez, CRNA, shares a glimpse into his voting process during the recent elections. He reveals two of his four votes, choosing to keep the remainder confidential to maintain a positive election environment. Dr. Rodriguez emphasizes the importance of voting for candidates rather than against them, reflecting his commitment to promoting a constructive and supportive community. Tune in to hear which candidates earned his vote and why he believes in a selective sharing approach during elections.

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    8 May 2024, 5:00 pm
  • 43 minutes 57 seconds
    Navigating New Frontiers: NorthStar Anesthesia's Approach to Modern Anesthesia Challenges

    Introduction:

    • In this episode of "Anesthesia Deconstructed," we delve into the evolving landscape of anesthesia services with two leading figures from NorthStar Anesthesia: Randall Moore, DNP, MBA, CRNA, Chief CRNA, and Jim Roberts, MD, Chief Medical Officer. Together, they shed light on NorthStar's innovative strategies in navigating staffing shortages, private equity involvement, and the complexities of the post-No Surprises Act era.

    Guest Insights:

    • Randall Moore brings a wealth of experience in anesthesia management and clinical excellence, offering a unique perspective on the role of advanced practice anesthesia professionals in addressing current challenges.
    • Jim Roberts shares his insights from the viewpoint of medical leadership, emphasizing the importance of strategic partnerships and quality care in the face of industry shifts.

    NorthStar's Journey:

    • A brief overview of NorthStar Anesthesia, detailing its foundation, mission, and evolution into a leading national anesthesia services provider.

    Key Topics:

    1. Addressing Staffing Shortages: Strategies and initiatives employed by NorthStar to combat the ongoing staffing challenges in healthcare, particularly within anesthesia services.
    2. Private Equity and Corporate Investment: An examination of the role of private equity in healthcare, specifically in anesthesia services, and how NorthStar navigates these issues.
    3. Thriving Post-No Surprises Act: Discussion on the impacts of the No Surprises Act on anesthesia services, with a focus on NorthStar's adaptive strategies to ensure financial stability and patient satisfaction.
    4. Blueprint for Success: Insights into NorthStar's operational, clinical, and strategic methodologies that have positioned them for success in a rapidly changing healthcare environment.

    Why It Matters:

    • This episode offers a glimpse into the operational and strategic mindset of one of the leading anesthesia services providers, highlighting actionable strategies for navigating modern healthcare challenges. It serves as an invaluable resource for anesthesia professionals, healthcare administrators, and anyone interested in the intersections of healthcare policy, management, and clinical excellence.

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    15 April 2024, 11:00 am
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