Last week we discussed the growing trend toward including performance measures in contracts between hospitals and anesthesia groups.  We identified clinical quality, efficiency and patient satisfaction measures developed by the Surgical Care Improvement Project (SCIP), the Medicare Physician Quality Reporting System (PQRS), the American Society of Anesthesiologists (ASA), the Anesthesia Quality Institute (AQI), Press-Ganey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).  All of these measures can be the basis of hospital or ambulatory surgery center contracts for performance-based payment.Many contracts set forth the quality, efficiency and customer satisfaction activities that are part of the anesthesia group’s quid pro quo for their hospital compensation package without explicitly linking performance rates to payment.  Increasingly, though, the anesthesiologists must meet or exceed agreed-upon benchmarks to earn their payment.Choosing BenchmarksThe benchmarks can be external or internal.  External benchmarks allow for comparison to similar institutions or providers – or to national or...

Health information technology has become the colossus of high quality, high- efficiency medical practice. Anesthesia Business Consultants continues to expand our resources in the area of HIT – as do all of you. With the lead article in this issue of the Communiqué, we introduce to you a major new resource: Bryan Sullivan, Director, EMR and Clinical Integration. Bryan’s article on cloud computing explains an important direction in which HIT is moving.Anesthesiology is on its way to becoming a complete perioperative discipline – as it must, in an environment that will be dominated by integrated, accountable healthcare delivery systems. Richard P. Dutton, MD, MBA, Executive Director of the Anesthesia Quality Institute, describes the role of the AQI in pre- and post-anesthesia assessment in his latest article. In the write-up of his interview with Parish Management Consultants’ Al Patin, “Anesthesia Leadership in the Preoperative Clinic,” ABC Vice President of Client Services Bart...

Electronic capture of patient information before and after surgery is an essential component of an effective anesthesia quality management program.Postoperative data are the outcomes of our work. These include rare safety issues related to intraoperative care, but not always apparent in the OR or PACU: events like neurologic injury, myocardial infarction, aspiration pneumonia or complications of pain management. More common, and increasing in importance, are the “patient-centered” outcomes which will be used by external regulators to judge us: the occurrence of nausea and vomiting, the adequacy of pain management, and overall patient satisfaction.Preoperative information, on the other hand, is the substrate for understanding anesthesia risks. Comparison of outcomes across institutions will require careful risk adjustment, and electronic capture of pre-existing conditions, chronic medications and pertinent diagnostic studies will enable this process. Even information as simple as the ASA physical status can be a powerful tool for understanding anesthesia outcomes across broad...

In recent years, the economic pressures of medicine have incited a paradigm shift in health care delivery, such that surgical procedures are moving from the hospital to the office-based setting. Often called the “wild west of health care,” office- based procedures continue to increase at a rapid pace, with an estimated more than 10 million procedures performed in 2010. A growing body of literature calls for greater leadership in the field of office-based surgery, and for leaders who are educated in all facets of quality improvement. In addition, a recent study found that a comprehensive checklist used in an interdisciplinary, team-based setting resulted in a reduction in surgical complications as well as cost savings.Development of such a checklist and education of practitioners, patients, and office personnel is the mission of the Institute for Safety in Office-Based Surgery. An independent, non-profit 501(c)(3) organization, ISOBS has developed a safety checklist for use in...

Have you and your group been thinking about how to grow your practice? The trend toward anesthesia practice consolidation continues its momentum. Not only do groups seek more and more opportunities to merge, to acquire other groups and to join larger organizations; they are an increasingly attractive acquisition target.Mark Weiss, Esq.’s article “The Company Model of Anesthesia Services: Will Less Money Lead to Jail Time?” is an excellent review of the development of the troublesome “company model” as well an explanation of the associated compliance issues that you don’t have to be a lawyer to understand.For a different perspective, consider AAA Executive Committee member Franc Galinanes’s article “Anesthesia: The Increasing Consolidation of Our Industry.” As a Senior Director for North American Partners in Anesthesia, Mr. Galinanes is in a good position to discuss the advantages of the three major types of consolidation: practice mergers, joining a larger organization and sale to...

On August 22, 2011, as a result of a directive from President Obama, the US Department of Health and Human Services (“HHS”) issued its Plan for Retrospective Review of Existing Rules (“Plan”). The Plan includes a review from all HHS operating and staff divisions (e.g., the Centers for Medicare and Medicaid Services (“CMS”)) that establish, administer and/or enforce regulation. HHS’ Plan aims to review “existing significant regulations to identify those rules that can be eliminated as obsolete, unnecessary, burdensome, or counterproductive or that can be modified to be more effective, efficient, flexible, and streamlined.” While, on its face, a review of unnecessary regulations appears to be beneficial, looking below the surface reveals that the review may create fundamental changes in medical and anesthesia practice. CMS is contemplating reviewing the conditions of participation (“CoPs”) for anesthesia services (42 CFR 482.52) to eliminate the certified registered nurse anesthetist (“CRNA”) supervision requirement, which could...