Rocky Mountain State
Anesthesia Providers
(RMSAP)
Anesthesia Handbook
Updated February 2019
Rocky Mountain State Anesthesia Providers (RMSAP) was established in April 2018. Our vision is to
provide excellent anesthesia services for our patients while building and maintaining good
relationships with surgeons and colleagues to promote a positive work environment for our valued
providers.
This anesthesia group employs Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs)
who work together, under a medically supervised practice, to provide professional anesthesia services.
We have high expectations for our providers to not only meet the standards of anesthesia practice, but
to exceed them.
This RMSAP handbook is not a legal document, these are guidelines to help provide guidance. This
handbook will be updated from time to time as RMSAP evolves.
Welcome to RMSAP.
Hierarchy outline of RMSA (2019)
Keith Elliott MD, CEO/Managing Partner RMSAP
Mario Carmosino MD, CFO/Managing Partner RMSAP
North Colorado Medical Center (NCMC) and Mountain Vista Orthopedic Surgery Center (MVO)
Tim Westover MD, COO/Managing Partner RMSAP
McKee Medical Center (MMC) and Banner Fort Collins (BFC)
CRNA POD LEADERS
A POD - Ryan Beck CRNA
B POD - Jeff Fryer CRNA
C POD - Mitch Larson CRNA
RMSAP has also recognized the need for diversity and input from all employed providers. An Advisory
Board has been established. Physician and CRNA contributors will assist in managing and maintaining
a high level of excellence within the group. The Advisory Board will help guide practices to the latest
standards.
Current Board members (primary roles within Advisory Board):
Gayle Close MD (Education)
Juliet Erb CRNA (Handbook/Social/PR)
Julie Gaca MD (MVO liaison)
Erin Gayla CRNA (Burn Liaison)
Sara Geyer CRNA (Clinical consensus group-CCG Banner wide)
Peter Robbiano MD (CV liaison)
Jason Searcy CRNA (Pharmacy/Equipment)
Nick Weitenberner MD (Trauma)
Frank Hartley CRNA-RET.
OPEN POSITION -TBD
RMSAP provides anesthesia services at several hospitals and surgery centers in Northern Colorado.
While at these locations, it is imperative that we comply with and follow policy and procedures and
medical staff bylaws outlined by those facilities in addition to our standards.
These standards will not be mentioned in this handbook but are available at all facilities where RMSAP
services are provided. It is up to the provider to be familiar with these at the facilities where they
work. Banner Hospitals offer a list of policy and procedures on the Banner intranet. Please refer to
these for facility specific questions. Individual employee contractual agreements should also be
reviewed and will not be included in detail in this handbook.
We expect all providers to maintain necessary licenses to practice in the State of Colorado, as well as
obtain continuing education credits to fulfill credentialing requirements.
Administrative assistant: Jen Maroni. Please contact Jen with any issues with CME or
incentive/overtime pay.
Contact info: j [email protected]
Group address:
Rocky Mountain State Anesthesia Providers, PLLC
3604 Copper Spring Drive, Ft Collins, CO 80528
Email: [email protected]
No official phone number, although patients can call (855)654-5262 for billing estimates.
RMSAP WEBSITE: www.rmsanesthesia.com
Employee portal login: Provider
Password: Rmsa2019!
ABEO is our billing and practice management company.
Preferred contact with ABEO is:
Tim Ruse
[email protected]
469.277.3678
SAGE-Health benefits (KAISER)
Tim Hebert
1501 S. Lemay Ave. Suite 200
Fort Collins, CO 80524
Office: 970-484-1250
Cell: 970-566-1111
Fax: 866-265-7243
[email protected]
www.sageba.com
Those who need to make changes to the dependents portion of the health care policy (i.e. new baby,
divorce, etc) the employee must go into HRConnection (https://www.zywave.com/hrconnection/) to
report a life change event. The addition or removal of a family member needs to be done within 30
days. Contact Tim Hebert with Sage if help is needed to navigate this.
401K-Employees employed as 0.6 FTE or higher qualify for the group 401K through Cosner Financial
Group. RMSAP will match 4% after one year of employment.
Ryan Cosner
Cosner Financial Group
204 Maple St, Unit 104, Fort Collins, CO, 80521
www.cosnerfg.com
970-482-3922
COMMUNICATION GUIDELINES
Accepted communication channels for questions, suggestions and concerns, from RMSAP group
members.
CRNAs:
1. Speak with your Pod leader.
2. If the issue cannot be answered or addressed directly with your Pod leader then consult with
the regional Director to facilitate answers. NCMC and MVO, address Dr. Carmosino and MMC
and BFC, address Dr. Westover.
3. If it is a Board question/issue, please discuss it with your Pod leader to bring it to the Board.
4. Any day to day issues/schedule of the day can be addressed directly with the anesthesiologist
you are working with that day, or the Anesthesia In Charge (AIC).
Physicians:
1. Scheduling questions/issues can be discussed with your designated schedule maker.
2. System queries to be communicated to the Board.
3. Additional questions/issue not addressed by these two entities can be discussed with the
respective Director at that facility. NCMC and MVO address Dr. Carmosino and MMC and BFC,
address Dr. Westover.
PHYSICIAN PODS
Pod A: Primarily BFC with regional day shifts
Pod B: Primarily MMC with regional day shifts
Pod C: Primarily NCMC (on call)
Pod D: Primarily NCMC, with regional day shifts, minimal nights and weekends
Pod CV: Cardiac coverage
CRNA PODS
A: Mostly based at NCMC, shift work (8, 10, 12 hours), mostly days, approximately 32 vacation days
off/year, minimal weekends. Flex to B pod as needed. Option to op-out of OB.
B: Mostly based at MMC and BFC, Flex to NCMC on occasion. Peel-off system, call required.
Approximately 7 weeks off/year. OB required.
C: 8-24 hours shifts and 2- 8 hour shifts in 13 weeks. NCMC. Rare float to MMC or BFC. Variable time
off. OB required.
SCHEDULE
It is RMSAP’s intention to publish the work schedule 60-90 days in advance.
Dr. Weitenberner is in charge of physician schedule drafting and oversight.
CRNA schedule drafting will be completed by Pod Leaders.
Holiday schedules determined within individual Pods. Most likely determined at the beginning of the
year. 12 hour coverage on holidays. There will not be a Flex-8 shift on Holidays
RMSAP recognized holidays include:
New Year's Day
Memorial Day
Independence Day
Labor Day
Thanksgiving Day
Christmas Day
Minor holidays (potentially reduced staffing) include:
New Years Eve
The Friday after Thanksgiving
Christmas Eve
Physicians: AIC will make the daily schedule. 6h, 8h, 10h shifts will be assigned positions at MMC,
MVO, or NCMC according to schedule duration. Typically the 6h will be assigned d4 or m10, the 8h will
be assigned m10 or d4, and the 10h will be assigned d3 or v1. The 6h and 8h can make 1st and 2nd
assignment requests, respectively. Physicians may be floated from MMC or NCMC on slow days
(typically with advanced notification).
CRNAs: AIC will make the daily schedule. The relief schedule at NCMC is as follows: Incentive shift, 8hr
(group C), 8hr (group B), 8hr (group A), 10hr (group A), etc. The #3 from Pod B is the FIRST choice to go
to NCMC when needed.
In pod B #1 is first to go then will peel off in order. #6 and M24 can stay until 7pm.
In pod C there is a designated OR and OB CRNA. The OB CRNA can work in the OR as needed. Post call
day off. In house call.
As a courtesy, physicians or CRNAs should not leave early until all colleagues have received
breaks/lunch and Post Anesthesia Evaluations (PAEs) are caught up.
At NCMC, pre op orders will need to be done for the next day prior to early outs.
CLINICAL EXPECTATIONS
Physician and CRNA employees are expected to report to work within enough time to fully prepare for
their first case of the day. We strive for on-time starts everyday. Tardiness disrupts workflow and
increases the workload of fellow employees.
Example: 7am case start: In pre-op and anesthesia consent done by 6:45am.
Each CRNA and physician is to carry an ASCOM phone for the day. Write your number on the board to
promote good communication within the group and for our nursing/surgical colleagues.
The second Thursday of each month usually is a “late start day” and is reserved for RMSAP meetings if
needed. Cases on this day usually start at 08:30 am. If no meeting is indicated there will be opportunity
for interesting case presentations, medication updates, and quality improvement reporting. An email
will notify employees of these meetings beforehand. It is expected that all employees participate as
able. Meetings should go no longer than 8 AM.
Anesthesia bridge line # to call into meetings: 1-515-604-9734, The prompts will ask for access
code. ACCESS CODE: 421913
If you are calling from the hospital phone you must first dial 9
PIN # for meeting lead only (to activate the conference): 5210
It is expected that the CRNA or physician for the case to complete the Post Anesthesia Evaluation (PAE)
on the patient that day before leaving their shift.
It is expected that all providers capture charges for the services they provide. Please be diligent and
accurate when billing for items, procedures, and supplies. Repeat offenders costing the group money
or participating in fraud will be addressed by ABEO and/or Directors of RMSAP.
NIGHT/WEEKEND CALL
Expectations for B pod CRNAs M24:
M24 will work a normal day shift in the OR
OB call 1900-0700 Monday-Friday at MMC and BFC.
M24 shift will cover OB at MMC and BFC weekends from 0700 on Saturday until 0700 on Monday
morning. Post call day off during the week. Weekend call is 48 hours with post call after the second
day.
#6 position for West side will be the last one to leave for the day and will end shift at 1900 that day.
In the event that there are simultaneous OB needs at both hospitals:
The M24 CRNA for the west side, prioritizes C/S (or other intraop OB case) first, then epidural, then TOLAC.
So if for example, there is a TOLAC at MMC with an in-house CRNA and a subsequent call for either a C/s or
epidural at the other facility, the MMC doc is to cover the in-house TOLAC responsibility until the work at BFCMC is
complete.
The doc on call at night and on the weekend is expected to cover OB in these instances. Communication is key.
If there is a case on-going in the OR that has the doc tied up...., please call the AIC for coverage options.
Remember the D1 is available until 9pm. After 9pm it is up to the AIC to arrange the coverage.
Weekend BACK UP first call is the Flex 8, and then the MD counterparts for that weekend. It is the
expectation that good communication between CRNA and Doc regarding TOLAC and CS patients.
Weekdays:
MMC physicians will cover OR cases starting at 1900 Monday through Friday. BFC physicians will cover
OR cases starting at 1900, Monday through Friday.
NCMC has designated CRNA for OB and OR 1900-0700 with scheduled MD.
Weekends:
MMC physicians will cover the OR Friday at 1900 through Monday morning at 0700.
BFC physicians will cover OR Friday at 1900 through Monday morning at 0700 .
CV MD to cover NCMC, with two CRNAs (one OR and one OB) and Flex 8 as backup, if needed.
For both MMC and BFC: If a case is covered by a CRNA and underway at 1900 and will finish by 1930, the
CRNA should finish the case. If the case will go well over 1900, the physician signed in can take over the
case. If an OR case will start after 1830, the physician should start and finish the case.
This standard will need to be trialled before a true guideline can be established. ABEO will be able to
provide more information, and more strict guidelines on case start times.
If needed, the weekend flex 8 CRNA covers OR cases from 9a-5p at NCMC. Coverage at NCMC takes
priority, however coverage at other facilities is possible.
Backup call: D1 will cover regional backup until 9pm (Mon-Fri). CV (or n2) will cover NCMC backup
after 9pm. MMC/BFC Night CRNA will be available to help with an OR case when requested by the night
anesthesiologist. All cases will be reviewed to determine the clinical necessity for the CRNA’s
participation. Examples could include but are not limited to, trauma and massive transfusion protocol
(MTP), difficult airway, and critical clinical situations requiring additional assistance.
It is the responsibility of the MMC/BFC physician to communicate potential backup needs with the
available staff. All facilities will have the NCMC AIC number listed as the backup coordinator, so this
phone must be carried at all times.
Call rooms are available for physicians and CRNA at all three facilities. If you are in need of a call room
and one is not available contact the nursing house supervisor to find you a bed.
House Supervisor Numbers
NCMC 970-810-6556
MMC 970-820-6027
BFC 970-821-4200
CRNA call room door codes
NCMC: 4th floor call room code 396, OB call room badge access.
MMC: Room 333, code 3524, call room near OR, code 3524
BFC: Anesthesia office, badge access
OB EXPECTATIONS
CRNAs are expected to be aware of the labor deck patients and obstetrical OR cases for the day.
It is expected that that CRNA performs a pre-procedural anesthesia history and physical (H&P) for OB
patients. The CRNA completes procedural notes, nursing and medication orders, and medication
administration record (MAR) documentation. Seek additional physician consultation as needed.
Physicians should be notified by the CRNA if going to C-section.
The CRNA will periodically check the status of the labor patient with an epidural and document face to
face time accordingly. The CRNA will update supervising physician on any potential high risk patients.
Post-op and post-epidural patients must be seen the day following anesthesia services.
Home call response time must meet American College of Obstetrics and Gynecology (ACOG) guidelines.
BREAKS
While we make every effort to give our providers breaks, staffing and OR constraints may limit
availability. To the best of our ability, the CRNA is typically entitled to one morning break (not to
exceed 15 min) and a lunch break (not to exceed 30 min). In the event that a CRNA works past 3pm, an
additional afternoon break (not to exceed 15 min) is possible. Please make every effort to take self
breaks on days when cases are “late start” and during downtime. Physicians should be in
communication with their CRNA team for the day, and available for breaks when all CRNAs are in
rooms.
Nursing mothers: RMSAP supports breastfeeding mothers. A reasonable effort will be made to provide
breaks to our nursing colleagues, as needed. Please contact security to gain badge access to the
lactation room at each facility if you are in need of this accommodation.
CELL PHONE SECURITY
Any employee of RMSAP who uses cell phones or any other electronic device to access or store
RMSAP information such as email, or confidential information must have the phone password
protected. The phone must also have the “find phone” feature enabled so that in the event the phone
is lost or stolen, it can be tracked and/or erased. Any employee who receives or stores company
information on their phone or electronic device consents to this policy.
E-MAIL/INTERNET USE POLICY
All computer users are obligated to use these resources responsibly, professionally, ethically, and
lawfully. All communications composed or sent through the Company’s systems must be written in a
professional manner, regardless of the mode in which the correspondence is transmitted. This includes
messages sent outside RMSAP and all internal communications.
• Sending, receiving, downloading, displaying, printing, or otherwise disseminating material that is
sexually explicit, profane, obscene, harassing, fraudulent, racially offensive, defamatory, or otherwise
unlawful.
• Disseminating or storing commercial or personal advertisements, solicitations, promotions,
destructive programs (that is, viruses or self-replicating code), non-business related matters or
any other unauthorized material.
• Using or copying software in violation of a license agreement or copyright.
• Violating any state, federal, local or international law.
HARASSMENT
RMSAP is committed to providing a work environment free of sexual or any form of unlawful
harassment or discrimination. Harassment or unlawful discrimination against individuals on the basis
of age, race, color, sex (including pregnancy, childbirth, and related medical conditions), sexual
orientation, genetic information, religion, national origin, citizenship status, age, disability, military or
veteran status, or any other status protected by applicable law is illegal and prohibited by RMSAP
policy. Such conduct by or towards any employee, customer, vendor or anyone else who does business
with RMSAP will not be tolerated. Any employee who violates this policy will be subject to disciplinary
action, up to and including termination of his or her employment. To the extent a customer, vendor or
other person with whom RMSAP does business engages in unlawful harassment or discrimination,
RMSAP will take appropriate corrective action.
Prohibited Conduct
Sexual or other unlawful harassment or discrimination includes any verbal, physical or visual conduct
based on sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, race,
color, genetic information, religion, national origin, citizenship status, age, disability, military or
veteran status, or any other legally protected basis if:
1. Submission to such conduct is made either explicitly or implicitly a term or condition of an
individual’s employment or engagement;
2. Submission to or rejection of such conduct by an individual is used as a basis for decisions
concerning that individual’s employment or engagement; or
3. It creates a hostile or offensive work environment.
Sexual harassment includes unwelcome sexual advances, requests for sexual favors and lewd, vulgar or
obscene remarks, jokes, posters or cartoons, and any unwelcome touching, pinching or other physical
contact. Other forms of unlawful harassment or discrimination may include racial epithets, slurs and
derogatory remarks, stereotypes, jokes, posters or cartoons based on race, national origin, age,
disability, marital status or other legally protected categories. Prohibited harassment might also be
transmitted using RMSAP’s electronic communications system, or through other online conduct.
Complaint Procedure
Employees who feel that they have been harassed or discriminated against, or who witness any
harassment or discrimination by an employee, contract worker, customer, vendor or anyone else who
does business with RMSAP, should immediately report such conduct to their supervisor, any other
member of management. Do not allow an inappropriate situation to continue by not reporting it,
regardless of who is creating the situation. No employee, contract worker, customer, vendor or other
person who does business with this organization is exempt from the prohibitions in this policy. In
response to every complaint, RMSAP will conduct an investigation and, if improper conduct is found,
take appropriate corrective action.
DRUG AND ALCOHOL TESTING
RMSAP reserves the right on any occasion to test for alcohol or illicit drugs at any time. A positive test
will be followed by a second more sensitive test to verify. A second positive test is grounds for
immediate termination. RMSAP reserves the right to terminate any employee who violates this policy.
CME-CONTINUING MEDICAL EDUCATION
CRNAs
$2000/year for a 1.0 FTE
$1200/year for 0.6 FTE
American Association of Nurse Anesthetists (AANA) dues, American Medical Association (AMA) dues,
and all licensing will come out of CME allocation.
CME reimbursement forms and instructions will be provided in the anesthesia offices at NCMC and
MMC. CME reimbursement paperwork will be submitted in the marked lime green bins in the
anesthesia offices at NCMC and MMC (not BFC). All paperwork will be faxed to ABEO at the end of the
month with CME reimbursement reflected the following pay period.
Physician CME and business-related reimbursement will be deducted pretax from the month's
compensation.
Physicians and CRNAs are responsible for retaining all documentation and ensuring compliance with
IRS regulations governing deductions of CME expenses. Meals are not reimbursed due to incomplete
tax deduction criteria. However, travel, lodging, and conference fees are reimbursed, anywhere in the
United States.
CME expense allotment does not carry over from year-to-year.
If a 90 day notice of resignation of employment has been submitted or an employee has been given a 90
day notice of termination of employment, CME expenses will no longer be reimbursed.
Sixteen (16) Trauma credits PER YEAR need to be fulfilled by each provider of RMSAP (even if you do
not regularly go to MMC). This is a State requirement for MMC. It can be almost any CE that can relate
to Trauma that can be used to fulfill this requirement. ACLS/PALS included. Nick Weitenberner is your
contact for questions on this requirement.
SICK CALLS
While we all know that sick calls come at the most unexpected times, they also have potential for abuse.
Please make every effort to work the shift you are scheduled for.
If you cannot make it to work, it is expected that you call the AIC where your shift is scheduled as soon
as possible. Email your Pod Leader as well.
NCMC 970-810-4844
MMC 970-820-6121
FOCO 970-821-4280
CRNAs - It is expected that you will try to find coverage for the shift you are missing. Missed shifts will
typically be reassigned if alternative coverage is not arranged. Please check with Pod leaders for
specific requirements.
Physicians - If a shift is missed and uncovered, you will not be paid for the shift. Coverage is expected.
Any provider that misses 3 or more shifts, within 6 months, will be required to meet with RMSAP
leadership to review employment options.
Injury or extended illness will be evaluated on a case by case basis. Missed shift coverage will be
determined by the Pod leader and manager for the location you are scheduled to work. This may result
in working a previously arranged vacation to make up for the days missed for injury or illness.
SEPARATION OF EMPLOYMENT
As a reminder, the contract has a 90 day notice from both sides, without cause. Refer to your
employment contract for notices of termination.
An exit interview is available upon request.
Former employees who who leave RMSAP while in good standing may be considered for reemployment.
In cases where a separated employee seeks reemployment, an application must be submitted and the
applicant must meet all minimum qualifications and requirements of the position applied for in order
to be considered. Current CRNA compensation is graduated based on years with RMSAP. If you leave
and return, years with RMSAP resets to zero upon rehire.
An applicant or employee who is terminated with cause or who resigned in lieu of termination for
cause will be ineligible for rehire.
COMPENSATION FOR WORK AND BENEFITS
Please see specific pay rate information in your personalized contract.
Physicians and CRNAs will be paid at the beginning of the month for shifts worked the preceding
month. Pay will typically arrive on or around the 2nd of the month.
Incentive pay will occur monthly. An incentive reimbursement form and instructions will be provided
at NCMC and MMC as mentioned above. Incentive reimbursement paperwork will be faxed to ABEO at
the end of the month and reflected in the following mid-month paycheck.
Incentive hours will be verified using case information. Group A CRNAs that stay past their shift will
receive pay for anesthesia time after 3:15/5:15/7:15. MVO and other incentive CRNA shifts will receive
credit for total time between the first anesthesia start time of the day and the last anesthesia stop time
of the day plus 30 minutes, with a minimum compensation of 4hrs.
ABEO will arrange direct deposit.
All CRNAs and physicians working 1.0 FTE will have access to company healthcare benefits.
RMSAP offers health insurance, dental insurance, and vision insurance. Premiums will be deducted,
pre-tax when applicable, from your paycheck. 401k and HSA deductions, if you enroll in these
deductions, are also pre-tax.
The employee handbook may be updated periodically as RMSAP evolves. Updates will be posted on the
RMSAP website.
