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Winter 2009


Painful Considerations

Tony Mira,
President & CEO, ABC

It goes without saying that times are tough and money is tight. As a company, our auditors have prepared us for a five percent drop in revenues in 2009. We are not alone. Our clients are already starting to feel the cumulative effects of recession, consumer-driven healthcare and fewer elective cases. Because of this we are all tasked with exploring new and creative ways to maintain cash flow to support current salary and compensation levels for our clients. If ever there were a time for out of the box thinking, this is it.

All too often our clients tend to see themselves as captive to such host institutions and at effect of such market factors. This need not be the case. In this issue of Communiqué we explore just one possible avenue of opportunity: pain management. The argument for expanding the anesthesia practice into the realm of chronic pain is clear: few physicians are as adept at needle placement and the management of pain as those whose training in pharmacology and physiology makes them experts in the selection and administration of analgesics and the effective diagnosis and management of complicated symptomatology. For many the counter argument is equally as compelling: effective management of an outpatient pain practice represents a paradigm shift from the hospital-based service most of our clients provide so successfully and a potentially perilous diversion from core competencies.

In our quest for answers to these potentially perplexing questions we have called upon some of our most qualified staff and friendly clients to help you sort out the pros and cons, and practical considerations. Pain management is a broad term for a broader spectrum of practice options. No matter where you fall on the continuum, our contributions will take you from the general to the specific, allowing you to explore and contemplate the strategic and financial considerations of pain. Whether these ideas and insights allow you to further grow and develop your practice or the wisdom of caveat emptor, they are sure to pique your interest and challenge your assumptions.

As always, we strive to provide you with relevant contemporary experiences and practical tips and guidelines from across the company and across the country. Portland’s Ruth Morton profiles success factors for one client’s practice in our opening piece, while Seattle’s Paul Kennelly outlines how a pain management practice fits in the context of a larger anesthesia group. Pittsburgh’s Cathy Reifer then shares some of her research and knowledge of OIG risk areas. Atlanta’s Hal Nelson adds his list of the ten most common missed revenue opportunities for the pain practitioner. Deena Andrews in our Michigan headquarters contributes an explanation of the bell-shaped curve of evaluation and management services.

We also offer variety with a discussion of retirement plan options by Jill Thompson, information on important changes to the PQRI for 2009 along with some ideas on how PQRI pay-for-reporting will set the stage for pay-for-performance and pay-for-perfection from Karin Bierstein, an update from MGMA-AAA’s president, Brenda Dorman, on the social networking tool that has replaced the AAA list serv, and some insight into the future of diagnosis coding from Sharon Hughes. In this issue, we are also very pleased to offer you the reflections of the anesthesiologist who wrote “Have You Hugged Your Anesthesiologist Today?” We are sure you will recognize moments from your own professional lives in this beautiful entry from the author’s blog, Notes of an Anesthesioboist. These are all important aspects of the ever changing and always fascinating discipline we call anesthesia practice management. May they offer you new insights, stimulate your thinking about your own practice and, ultimately, help you plot the future of your practice.

Thanks for your continued support.