Ocean Views

A blog by Jan Mannino and invited guests

This new endeavor, Anesthesia Business Academy is the fulfillment of my dream to educate CRNAs and SRNAs in the business and economics of anesthesia. It is for all CRNAs, no matter their practice setting or time in the profession.

Elsewhere on the website, anesthesiabusiness.com, you will find information on what services we are offering. Please understand two things, this is a new endeavor where growing pains are part of the process and we will be evaluating and improving our products and services. Please feel free to make suggestions.

Imagine anesthesia practice in early 1960 and you will see operating rooms with no electrical equipment, because the primary anesthetic agents, ether and cyclopropane were explosive. Thiopental (Pentothal) was a relatively new intravenous agent and the anesthetic techniques rarely included the use of opiods. (Perhaps we are seeing history repeat itself with the new techniques of opiod free anesthesia.) There were no monitors, ventilators, and many cases were done with mask anesthesia, instead of an endotracheal tube.

That is when I entered the anesthesia program at St. Francis Hospital in Pittsburgh, PA. Eighteen months later, I received a diploma, passed my boards and became a CRNA. Through the years, anesthesia changed; I moved to Washington, DC and then to Southern California. Education was important to me, so I received my BS in Anesthesia at George Washington University and a JD (law degree.) I never practiced law, mostly because, in my opinion, I was the happiest in the operating room doing anesthesia.

A wonderful opportunity came my way in 1984, when plastic surgeons were doing more procedures in their office operating rooms and wanted general anesthesia. I joined another CRNA and we set up an office anesthesia business. Another opening came my way, a few years later and I became the owner of an ambulatory surgery center, giving me another perspective on business.

While I practiced in the various models of employment and supervision/direction through the years, clearly I was the happiest in my own practice. I made more money and am not ashamed to admit that fact and had control over my anesthesia techniques and patient care.

Around the same time, I was elected to the AANA Board of Directors and moved up the chain to become President in 1987-88. Little did I realize that having experience of a CRNA business owner would be so important during my AANA tenure. In 1986, AANA was successful in getting legislation passed for CRNAs to receive Medicare direct reimbursement. In my presidency year, we worked with the federal government in developing the Medicare fee schedule for CRNAs. In a later post, I will go into greater detail about the process and obstacles. The end result was good for us and, in my opinion, opened the door for CRNAs to open their own business and make their own money. No longer, were we bound by employment models, where our anesthesia skills made money for hospitals or physician anesthesiologists groups. We now had choices.

The anesthesia world changes as the healthcare market changes and CRNAs must be at the table for those changes. Someone is making the decisions that we have to live with and I strongly believe we must be part of the process.

I am a proud member of the AANA and will continue to promote our organization as the primary advocate for nurse anesthetists. Anesthesia Business Academy is not meant to replace the AANA, but to enhance the education of CRNAs in business practices and economic principles. We hope to work with AANA on many of our upcoming projects.

If any of you would like to write a blog for the Academy, send me an email and we will talk.

Final note: I have retired from clinical anesthesia and am setting up the Academy from my home office overlooking the Pacific. With my dog Annie (named for anesthesia,) my Mac computer and the lovely view I hope to continue to be a force in our profession.

–Jan Mannino. January 8, 2018




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