2012: There Is Much To Do

Tony Mira
President and CEO

From day to day, the great majority of anesthesiologists, nurse anesthetists, anesthesiologist assistants and their group practices provide excellent patient care. Most enjoy comfortable relationships with their hospitals and surgery centers, too.

The world of health care is changing all around us, though. Every anesthesia practice needs to understand the more important changes and to adapt, or plan to adapt. In this issue of the Communiqué, you will find a number of articles that will help you prepare for the short-term and long-term future.

We start with Mark Weiss, Esq.’s Protecting Your Exclusive Contract, Your Practice and Your Profits. Mr. Weiss aptly shows that the process of negotiating your next hospital contract starts the moment you have signed this one. The anecdote about Walt Disney’s arrival at Universal Pictures’ headquarters in New York to renegotiate the terms of their deal, only to find that Universal, not he, held the copyright in his cartoon character and that Universal had hired away Disney’s cartoonists is aptly chosen. Preparing to negotiate your next hospital contract also requires a complete understanding of the present agreement and solid relationships not just between the hospital and the group, but also between the group and its anesthesiologists.

ABC’s Arne Pedersen takes the issue of planning farther out in time in his article The Benefits of Strategy. Mr. Pedersen reviews four major benefits of a strategic plan – providing a format or venue for a group to address issues; elucidating strategic objectives; allowing the group to coalesce around the strategic objectives, and accountability—and concludes that take advantage of the benefits of strategy will permit the group to dictate its own future.

The strategic planning process, especially for larger groups with high aggregate expenses, might include an objective of obtaining better value in its insurance contracts. Sara Carpenter, CPA, CFO of Doctors & Surgeons National Risk Retention Group, explains the origins of the risk retention group alternative to traditional malpractice insurance in Federal Insurance Legislation—Can It Help Me?­ With a 25-year history, the risk retention industry has established a solid track record and a risk retention product should be on the radar of any group interested in changing its professional liability coverage.

A regular subject of planning in anesthesia practice is compliance. Abby Pendleton, Esq. and Jessica Gustafson, Esq. provide an overview of enhanced governmental and private sector activity in monitoring claims for physicians’ services in Anesthesia Practices Should Prepare for More Audit Activity. The attorneys suggest three strategies: (1) focus on documentation improvement, (2) stay on top of payer policies and guidelines and (3) engage in educational activities.

In his article What Is Your Value Proposition? Is Your Practice the Steak or the Sizzle?, ABC Vice President Jody Locke describes different strategies that groups wishing to secure their future should consider. First, identify the stakeholders: group members, surgeons, patients, administration and operating room staff, typically, as well as the objective of each. Then build solid lines of communication to each and determine how to provide the service that will make your group more valuable than competitors queuing up to take your place. Understand, for instance, that patient satisfaction to a hospital administrator means many things beyond a successful patient outcome.

What is the “sizzle?” It includes exceeding “customers’” expectations—not just explicit expectations, but even those that the customers themselves have yet to articulate. The hospital does not necessarily expect the anesthesiology group to initiate programs to improve drug and technology management, for example, but these are among several areas where anesthesiologists might prove their unique value. The group that takes risk while defining new opportunities to create value is a committed and valued partner.

The final regulations on Accountable Care Organizations (ACOs) appeared on November 2, 2011. Greater flexibility in eligibility and in governance of ACOs, simpler quality performance standards and especially the creation of a “track” that does not involve financial

risk sharing make it easier to launch ACOs, as explained by Neda Mirafzali, Esq. and Kathryn Hickner-Cruz Esq. in CMS Finally Speak (Again): The Medicare Shared Savings Program Final Rule and Its Relevance to Anesthesiologists. ACOs and other new healthcare delivery system models that tie payments to quality and efficiency achievements are very much part of anesthesiologists’ future.

The ability to participate fully in ACOs and more generally in shared savings programs with other providers and with payers is central, we believe, to anesthesia groups’ longer term survival. Many readers supported that view in their responses to a survey that we conducted in October, 2011. That is why we are launching the Zenith Anesthesia Practice Network, which will allow client anesthesiologists to engage collectively in clinical quality data gathering and benchmarking, among other activities including group purchasing. We will keep you aware of its development in future issues of the Communiqué. We will also willingly consider your ideas for other topics that we might address—and of course welcome proposals for articles that you may be interested in writing.

With all good wishes for continuing success in 2012,

Tony Mira
President and CEO