Frequently Asked Questions on Operating Room Efficiency and Anesthesia Staffing Models

by | Mar 27, 2020

As a full-service anesthesia management company, DPI fields many questions surrounding the various types of anesthesia staffing models and how they impact operating room efficiency. As anesthesia experts, we are committed to staying apprised of the latest changes in healthcare regulations that relate to anesthesia care to ensure our client facilities are experiencing maximum efficiencies that support their bottom line.

The most common anesthesia practice models are medical direction (one anesthesiologist medically directing four CRNAs), the medical supervision model (an anesthesiologist medically directing more than four CRNAs concurrently) and the CRNA-only model (commonly referred to as the QZ model). The collaborative team model generally refers to at least one anesthesiologist and any number of CRNAs who are personally performing and billing QZ.

At DPI, we utilize and value all of the above provider models based on the unique needs and goals of our client facilities. For our clients, we offer our recommendations and suggestions for the specific anesthesia staffing model that we believe will be the most efficient and cost effective for your facility.

The following questions on collaborative anesthesia team environments, CRNA independent practice, surgeon liability and collections are frequently received by our team:

FAQ #1: In a collaborative anesthesia team environment, what roles do anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) play?

A:  In a collaborative anesthesia team environment, the anesthesiologist will typically see all the patients preoperatively, be available for any needed assistance in the operating rooms, address any recovery issues and facilitate the operating room schedule. The CRNA will typically be personally performing the anesthetic in the operating room. Depending on the practice’s policy, there may be procedures that CRNAs are unable to perform based on the facility’s policies governing scope of practice.

FAQ#2: Can a CRNA practice anesthesia independently of an anesthesiologist at a surgery center or hospital?

A: In all 50 states, CRNAs are licensed and certified to practice independently of an anesthesiologist. There is a Medicare Part A requirement for a physician to supervise the case, but this physician does not have to be an anesthesiologist. Currently, there are 17 states that have opted out of the supervision requirement.  The November 13, 2001 rule allows states to “opt-out” or be “exempted” (the terms are used synonymously in the November 13 rule) from the Medicare Part A supervision requirement. This effectively eliminates any requirement for a physician to supervise a CRNA in these states.

FAQ#3: Is the surgeon liable for anesthesia if there is no anesthesiologist present?

A: Generally, a surgeon would only be held liable for direct orders given to the anesthesia provider. This applies whether there is an anesthesiologist assigned to the case or not. The surgeon normally would bear no responsibility for the anesthesia decisions and outcomes made by solely by the anesthesia personnel (anesthesiologists or CRNAs).

FAQ#4: Does the anesthesia company using an anesthesiologist and CRNA team-based approach collect more money from insurances and patients?

A: The amount billed is the same whether a case is performed by a solo anesthesiologist, solo CRNA or a team comprising an anesthesiologist and a CRNA. When an anesthesiologist and CRNA perform the case as a team, Medicare will split the payment equally between each provider. There are commercial payors who will reimbursement the same fee regardless of the case being personally performed by a CRNA or an anesthesiologist. However, there are also commercial payors that will reimburse less if the case is personally performed (QZ modifier) by a CRNA without an anesthesiologist.

FAQ#5: Can a CRNA bill directly for their services when performed independently of an anesthesiologist?

A: Yes. A CRNA can be reimbursed directly for personally performing all types of anesthesia care and related procedures to include invasive line placement and post-operative nerve blocks for pain management without any participation from an anesthesiologist.


DPI is a full-service anesthesia management company that provides anesthesia billing services to facilities in the states where we practice. When we enter a new state, we always confirm unique payor rates and specific billing procedures before we begin services. If you feel that your anesthesia staffing model is not supporting your bottom line, contact us today. It would be our privilege to help you maximize operating room efficiencies and reduce unnecessary costs.