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Spring 2008


Picking The Right Battles

Tony Mira
President and CEO, ABC

I am pleased to share another issue of the ABC Communique with you. It is always an interesting challenge to decide which of the many timely and interesting submissions we should include in our anesthesia practice management journal. So many topics seem so important at the time they are identified; it is just not that easy to know which ones will truly impact the future of the specialty. As recent events have clearly highlighted, sometimes the battles we steel ourselves most for, ultimately resolve themselves. Too often it is the seemingly insignificant sideline that consumes our time. Let us hope that the ABC crystal ball is reliable and that we have once again identified topics and opportunities that will be relevant and useful to you in the management of your practice.

Consider some of the challenges that have become hot topics at recent anesthesia management meetings. Only a year ago we were all bracing ourselves for another reduction in the Medicare Conversion factor. Despite all the dire predictions, the rate was increased by a larger percentage than I can remember ever having been approved for a single year. More recently, Aetna appeared to be destined to set a precedent that would change reimbursement policy for endoscopic anesthesia; a disproportionate amount of time was dedicated to this topic at the ASA Practice Management Conference in Tampa. Once again, wiser heads prevailed and Aetna backed down. PQRI would appear to be next in line as one of those public issues that confuses and confounds our clients. The concept is simple enough; provided that CMS and the insurance plans could agree on a set of criteria and a mechanism for paying practices for their compliance. My read on this one is that we are all in a wait and see mode. Meanwhile, another drama is playing itself out in HCA board rooms across the country. Having shelled out close to $96 million in anesthesia subsidies last year, the company has gone on the aggressive to control its anesthesia costs. We can only hope this remains a HCA issue, but I hardly think we will be so lucky. There is a reason anesthesia incomes only went up about 1.8% last year as compared to the 10.6% the year before. Hospital administrations nationwide are really pushing back on anesthesia requests for support and the traditional arguments are just not working so well any more.

Each spring the American Society of Anesthesiologists Conference on Practice Management provides us a timely reality check. Program Chair Robert Johnstone, M.D., who assumed the position of ASA’s Vice President for Professional Affairs when Alexander Hannenberg, M.D. was elected First Vice- President last fall, described ten issues that are defining the future of anesthesia practice. These included “healthcare reform resulting from the 2008 congressional and presidential elections, marketplace battles over payer policies, workforce scopes of practice, and the roles of anesthesiologists in perioperative care.” Thriving in this changing environment, according to Dr. Johnstone, will involve “enlarging the perspective of each issue, understanding the drivers of change, and including regulators, legislators, and public citizens in the solutions.”

The 2008 ASA Practice Management Conference consisted of more than twenty five presentations on topics both timely and of enduring interest. The dominant theme was—as it has been for several years, consistent with our experience—preparing financial information and negotiating with hospitals. Summaries appear in the ASA Newsletter and in the very valuable compendium of abstracts that you may order from ASA. For those of you who are not aware of this annual meeting, let this note serve as an introduction to what has become the most important practice management meeting of the year. The conference, and the abstracts, are a good place to start your own strategic review and planning process. They certainly helped us kick-start ours.

Another fundamental management topic, understanding comparative costs per anesthetizing location, is the focus of the lead article in this issue of the Communique. We hope that this article and others here will help you to manage your practices more productively and give you a few valuable insights that you could not find anywhere else.

Please know that we always welcome comments and feedback on our editorial choices as well as suggestions for future topics. Nothing would please us more than to have a reader contribute his or her assessment of a key issue. It is never easy to pick the right battles, much less to know how to resolve them definitively. If there is one thing I have learned over the years no matter how good our individual judgment it can always be honed with the critical experience of experts.