Waste not, want not. Don’t dispose of your PCs… Repurpose.

Post Written by Brant Myers, Director of Operations for Excel Anesthesia

Part of my role at Excel Anesthesia is to maintain and manage the IT stuff around the office. Over the last year we have improved our workflow by changing some of the applications we use on a daily basis. As it happens, our old PCs just couldn’t keep up with these changes.

We were left with a choice.  We could upgrade our existing equipment, or buy new machines.

Fortunately, new PCs were not only outlined in our IT strategic plan last year, but also included in the budget.  We purchased and installed new PCs for our corporate office in 2013.  As a result, I have the task of making sure the old PCs are disposed of securely.  Based on my past experience, this is usually not an easy task and can be expensive. Part of the expense is making sure that data on the old machines is destroyed so that we maintain HIPAA compliance.

Connecting For GoodI know of local organizations that recycle old computer parts, but these PCs might still be useful to someone willing to take the time to rebuild them and install more memory (RAM).  As I was deciding the best course of action, got an email from my long-time colleague Rick Dean.  Rick and I had run into each other many times over the years at not-for-profit IT events.  We loved to “talk shop” and share our IT experiences. We’ve kept in touch over the years, mostly through LinkedIn, but it was his recent email that caught my eye.

Connecting For Good - Refurbishing ProgramRick is a founding board member of Connecting for Good, a not-for-profit organization dedicated to making sure that everyone has access to broadband Internet, regardless of their income. While Internet access is available at libraries, schools and other public institutions, they believe connectivity in the home is essential for all Kansas City families if they are to fully participate in our digital society.

Connecting to the internet requires a computer and an internet connection.  Their computer refurbishing program provides lower cost access to computer hardware.   This program was a perfect fit for our needs, and Connecting for Good will be getting all of our old machines.  Everybody wins, and we feel like we are doing a good deed instead of just recycling the old PCs!

Do you normally recycle your old machines?  Do you keep them in a closet to collect dust because you didn’t know what to do with them?  I hope this is a good for solution for you… please let us know!

What’s in a name? – CRNA, AA, Nurse Anesthetist or Anesthetist, the difference is significant.

JCBuisnessWhat’s in a name? CRNA, AA, Nurse Anesthetist or Anesthetist?

Warning! The pristine patient safety record that certified registered nurse anesthetists (CRNAs) have historically achieved is at risk.  Currently all reputable studies show; there is no difference in patient outcomes when CRNAs provide care to patients individually vs. CRNAs who provide care under the medical direction of an anesthesiologist, (Department of Health, 2005), (Dulusse & Cromwell, 2010), and (Newhouse, et al., 2011). Nowhere in these studies does it measure patient safety outcomes when utilizing Anesthesiologist Assistants (AAs). The publicized outcomes of these patient safety studies has been the primary reason why states are permitted to “opt-out” of the CMS requirement for CRNA supervision when billing for Medicare part A. Therefore, it is imperative that all data that is recorded in the patient electronic medical record be entered accurately and consistently when documenting the title or category of the healthcare provider performing the care.

Increasing numbers of hospitals and surgery centers have implemented some version of electronic medical record system to facilitate participation in health information exchange. While this is an important step in enabling providers to access and review their patient’s pertinent health information, it is also a powerful tool for reporting evidenced based outcomes.  With that in mind, it is imperative that the EMR/EHR systems include the ability for each provider to be categorized separately and consistently.  Otherwise, the data used for reporting outcomes will be compromised, leading to inaccurate conclusions, and potentially dangerous policy.

In the past two weeks we have encountered several instances in which different providers were lumped together in a single category when anesthesia services were recorded. One in particular involved a large, multi-location hospital in the Kansas City area. This hospital was in the process of training providers to utilize the new EMR software. During the training, one of the CRNAs tried to locate the field that correctly identified him as a CRNA but the software only offered either a combined field that listed AA/CRNA or the remaining field choice, Anesthesiologist. Neither of these is correct or accurate.

The effects of lumping different providers into a single category are:

1.  Distinction between CRNA and AA is blurred
2.  Integrity of the data is compromised
3.  Evidenced Based Safety Outcomes results are inaccurate
4.  Compromised CRNA safety record

In addition, we have recently encountered multiple bills in the Missouri House and Senate that if passed will require the adoption of some form of cloud based health information exchange. All these bills contain confusing, ambiguous, and inconsistent definitions of Health Care Providers, such as “nurse anesthetists” and “anesthetists” which refer to CRNAs and AAs respectively. Referring to AAs as anesthetists could blur the distinction between the two providers.

In current laws and statutes, the term anesthetist has referred to CRNAs for decades, if not centuries. CRNAs and AAs are entirely separate providers with completely different training, education and experience.  CRNAs have an extensive healthcare background and a pristine patient safety record.  CRNAs have a bachelor’s degree in nursing, several years’ experience in intensive care performing direct patient care as a registered nurse, and a Master’s Degree and or Doctoral Degree specializing in anesthesia. CRNAs are also Advanced Practice Registered Nurses (APRNs) and are certified by a nationally recognized certifying body. CRNAs are qualified to make independent judgments and are able to practice without an anesthesiologist in all aspects of anesthesia.  In many states, CRNAs are completely independent of any physician supervision. CRNAs are able to bill Medicare, insurance companies and patients directly, and receive direct reimbursement for their services.  CRNAs have been providing care for over 150 years and have had many years to establish this incredibly high patient safety record.  In fact, there are approximately 32 million anesthetics administered to patients every year by CRNAs (Missouri Association of Nurse Anesthetists, 2011).

AAs, on the other hand, have only been providing service for approximately 45 years. There has been inadequate time and inadequate patient volume to establish a proven safety record, whether good, bad, or otherwise. Because of this, it is important to be vigilant and mindful when entering the title/credentials of the medical professional providing the care in order to maintain the sterling reputation of our profession and the integrity of our patient safety record. I prefer the CRNA safety record to accurately continue to reflect, as it should, to only those services provided by CRNAs. Marketing companies focus on the term “Branding” when trying to promote a product or service.  In the business industry, the best way to promote an inferior product is to make the product “seem” like it is the same as an established, superior product. So long as the public thinks it is the same, they will think they are getting a good deal. CRNAs are in danger of losing our branding. By merging our profession with that of another, we risk diluting our safety record and could soon be perceived by the public, and the policy makers, as the same.

As CRNAs, what can we do to promote and protect our own professional branding?

  • Be vigilant.  As our hospitals and surgery centers begin to implement EMRs, we need to ensure our designated provider field lists only CRNA and not nurse anesthetist, not anesthetist, and certainly not AA or any combination thereof.  If you see this and cannot get it changed, then inform your state association of the AANA.
  • Introduce yourselves appropriately to everyone as Certified Registered Nurse Anesthetists, or CRNAs.  Politely correct anyone who might incorrectly refer to you as tech, an anesthetist, a nurse without qualifying your advanced degree, or even a nurse anesthetist.
  • Support your state association and get involved. There are diplomatic methods to educate our co-workers without appearing combative in the workplace.
  • Get proactive at the federal CMS level and spearhead requirements for
specific roles/titles of providers when submitting claims involving
PQRI on the CMS EMR. There will soon be emerging standardized form fields for reporting data consistently in these health information exchange software programs.

If we could be at the table so to speak with the programmers working through CMS, Medicaid expansion, and the ACA, we would be in a position to protect THE INTEGRITY OF OUR DATA SUBMISSION and our specific practice. It’s imperative we lead the initiative. Otherwise we will be swallowed up in the system. Goodness knows, we saw first-hand with the ACA “roll-out” how well the initial programming went!

Most importantly, remember who we are and be proud of our profession. Be willing to educate others about our practice. Let’s work together to develop a pragmatic approach to ensuring our provider designation remains intact. This is our Practice!  Let’s get busy taking care of it!  Feedback is welcome.

Dulisse, B. & Cromwell, J. (2010). No harm found when nurse anesthetists work without supervision by physicians. Health Affairs, 29 (8).
Newhouse, Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., et al. (2011). Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review. Nursing Economic$, 29(5), 230-251.
Newhouse, R., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., et al. (2011). Advance Practice Nurse Outcomes 1990-2008: A Systematic Review. Nursing Economic$, CNE Series, 21.

Staff Profile: Jenny West – Practice Coordinator

Jenny West

Jenny West Profile PhotoTime With Company: Since August 2009
Position: Practice Coordinator

How Jenny Started Working for Excel: 
Jenny was working in Corporate Woods in 2008.  Her boss interviewed with Excel Anesthesia and decided it wasn’t a fit, but she thought Jenny would be.  Jenny met with Excel Anesthesia and knew right away that it was the right environment for her.  Jenny said, “Excel is a more friendly work environment and I love that.”

Roles and Responsibilites:
Jenny is responsible for scheduling the CRNAs at our client facilities, supports the credentialing effort for our CRNAs, and manages our billing company partner for patient and insurance claims.

Brant had this to say about Jenny’s work at Excel:
Jenny  has consistently exceeded expectations in almost all areas of her job. She is extremely dependable and always willing to fill in where and when help is needed. She sets expectations of her self higher than Excel would expect and always strives for perfection. Jenny’s positive impact on the day to day operations of Excel are easily identified. She sets the job performance standard for all other staff. Excel is lucky to have her as part of the team.

Jenny West - Signature SnapshotsWhat Does Jenny Do in Her Spare Time?
Spending time with her family, especially her 13 year old daughter, Lauren.  She loves getting craft and recipe ideas from pinterest.  She also has a creative sign business where she takes pictures of real world items and puts them together to spell a word or phrase (an example is the “FAMILY” image to the right.  Very cool.)

March 7th – MoANA Town Hall Meeting

KCPlazaJoin us for any part of our informative Happy Hour session on the Plaza to discuss important legislative issues directly impacting our profession.Regardless of when you can arrive, it is important for us to remain connected and united. MoANA understands the issues that are currently affecting our practice and needs your voice, your involvement, and your support!! Take time out of your busy work week to unwind while meeting and socializing with other CRNAs in your region. Discover ways in which you can help. Together we have strength.

Brio Tuscan Grille , 502 Nichols Road , Kansas City, MO 64112 816.561.5888

March 7, 2014
5:00-6:00pm- Unwind and Socialize
6:00-7:00pm- Pres. Rob Walsh, MBA, MS, PhD, CRNA

Download the Flyer here.

Full page


Jean Covillo Testifies to Support Recent APRN Bill

An important bill was introduced to the house recently that affects APRNs (Advanced Practice Registered Nurse).

Jean Covillo was asked by MOANA to testify in support BillTestifyHearingof the bill. (Yes,Jean has been to the Missouri Capitol twice, in as many weeks, in the month of February). Senate Bill 700/House Bill 1481, APRN Barrier-free Collaborative Practice Legislation Collaborative Practice Arrangements (CPA) are outlined in State Statute 334.104, RSMo.

Current law states a physician may enter into a collaborative practice arrangement with an advanced practice registered nurse. The collaborative practice arrangement must be in writing and contain a list of items, such as complete names, addresses, telephone numbers, specialty board certifications, AND the manner of collaboration between the collaborating physician and the advanced practice registered nurse.

The CPA outlines how the physician and APRN will engage in collaborative practice consistent with each professional’s skill, training, education, and competence. The proposed legislation deletes the “geographic proximity” required for a CPA. In rules, that mileage restriction is 30 miles in an urban setting, and 50 miles in a rural setting. The proposed language states the physician and APRN will maintain “effective electronic communications”.

Currently, any rules and regulations regarding collaborative practice arrangements must be jointly promulgated by the Board of Nursing and the Board of Healing Arts. This proposed legislation would remove joint rulemaking for everything except rules regarding controlled substance prescriptive authority.

The following is an excerpt of Jean’s Testimony
Although CRNAs are exempt from collaborative practice agreements, as fellow APRNs we are supportive of any legislation that will allow our APRN colleagues the ability to practice their profession to the full extent of their education, training, and experience.

Like CRNAs, many APRNs provide healthcare service to the rural counties in Missouri, many of which qualify as Health Professional Shortage Areas. Without APRN services, many patients would either be forced to travel many miles from their local healthcare facility or fore go treatment entirely. As you can imagine, this is a very real concern for the rural hospitals and clinics, the healthcare professionals committed to providing this care, the patients, and our fellow Missouri citizens.

My role in testimony is to support legislation that will afford our citizens better access to care by permitting APRNs to practice to the full extent of their education and training. The Missouri Association of Nurse Anesthetists (MoANA) fully supports this proposed legislation.

MoANA Lobby Day 2014 – Lobbying for CRNAs


Jean Covillo, owner of Excel Anesthesia, attended the 2014 MOANA Lobby Day in Jefferson City on February 5, 2014.  It was a day to talk to lawmakers about issues affecting CRNAs

MOANA held a reception on Tuesday evening which drew a large turnout of legislators. Although the official “Lobby Day” was cancelled due to heavy snow fall, we (the 5 MoANA Members who were able to arrive ahead of the weather) continued with Lobby Day nevertheless. With so few of us in attendance, we had to cover a lot of ground to ensure we visited as many legislators as we could.

It was definitely an eye opening experience.  We were there to educate our representatives about the role that CRNAs play in providing quality healthcare rather than discuss any upcoming legislation.  We were pleased that the Senators and Representatives that took time to meet with us were open to hearing what we had to say.

Happy Valentine’s Day from Excel Anesthesia!

Happy Valentines Day from Excel AnesthesiaHappy Valentine’s Day from Excel Anesthesia!  It is finally getting warmer in Kansas City, so we hope that you take advantage of the opportunity to go out for a nice dinner or evening on the town with the important people in your life. 

Open Table LogoHopefully, you already have reservations for dinner, but if not, you could check out Open Table for a list of 54 Kansas City restaurants that have Valentine’s Day specials.  Visit Open Table to reserve a table at your favorite spot.  If you happen to read this article after Valentine’s Day, we still recommend trying out Open Table to make dinner reservations… it is a great service that costs nothing!

Brant and his wife Cassandra are going to go to Fogo de Chao on the plaza.  They received a Fogo de Chao gift card from the partners at Excel Anesthesia during the holidays and are looking are forward to their dinner at the Brazilian steakhouse!  Jenny and Chris are going to Cheesecake Factory.  Yum!

Staff Profile: Brant Myers – Director of Operations

Brant Myers

Brant Myers PHOTOTime With Company: Since April 2013
Position: Director of Operations
LinkedIn Profile Link: http://www.linkedin.com/in/brantmyers

Brant met Jean during an on-site support visit while working for Umbrella Managed Systems, a KC based IT service provider. She appreciated his calm, intellectual demeanor and his knack for explaining complex technical processes in an easy to understand, straightforward manner.

Brant wears many hats when working for Excel Anesthesia. He is responsible for our information technology ranging from vendor management, user support and system maintenance. Brant also works directly with Jean on new initiatives for the expanding practice. He is involved in the marketing efforts through the website and various social media applications, as well as general managerial oversight of the company office staff.

Brant is definitely not your stereotypical “IT” guy. He has a delightfully outgoing personality and a knack for providing technical explanations for those of us who just want to know what button to push to either make it work or mute the alarm!

When not at the office, Brant spends time with his wife, son and daughter. They love traditional family pastimes like board games, cards and watching movies. Brant is taking Tae-Kwon-Do with his son and is a soccer dad for his daughter. Brant enjoys playing golf whenever he finds time between playing handyman around the house and tinkering with Macs, iPods and iPads. He’s a geek for sure and a big fan of all things Apple.

We are very happy and fortunate to have Brant on the Excel Anesthesia team!


What is a CRNA?

Certified Registered Nurse AnesthetistCRNAs are the core of Excel’s business.  We are often asked, “What exactly is a CRNA?”. The acronym is not commonly known outside the healthcare industry, but if you’ve ever had a medical procedure requiring anesthesia, there’s a good chance that you’ve taken advantage of CRNA services.

The Certified Registered Nurse Anesthetist (CRNA) is one of the four Advanced Practice Registered Nurses (APRN) roles. CRNAs provides the full spectrum of patients’ anesthesia care and anesthesia-related care for individuals of all ages, across all recognized levels of acuity, including persons with immediate, severe, or life-threatening illnesses or injury. This care is provided in diverse settings, including hospital surgical suites.

Read more

Happy New Year from Excel!

Happy New Year 2014The holidays were a quiet time at Excel. There was no official office party this year but there were treats in the form of popcorn tins and truffles sent to the office by our CRNAs! Jenny and Brant brought in homemade candies and cookies, some of which have yet to be eaten. Don’t worry, they WILL get eaten, but we are trying to pace ourselves.

Thanks to all those who contributed to our holiday cheer with treats and well wishes.

We are looking forward to 2014 with excitement and a renewed enthusiasm. We are positioned for growth this year and expect to be adding new clients in the first few months. We hired a new CRNA who will be starting in February and have hired new office staff as well (look for more detail about them in future posts!)

Read more