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Fall 2013


Value for Hospitals, Anesthesiology Practices and Physicians

As we head into the final quarter of the year, the departmental and group stability that anesthesiologists seek remain elusive. Hospitals and health systems continue their drive toward consolidation. National management companies report more and more acquisitions of anesthesia practices. The Affordable Care Act’s Health Insurance Exchanges will have begun to enroll beneficiaries by the time this issue of the Communique is in your hands, with much of the uncertainty over the functioning unresolved. Indeed, after forty attempts by the House of Representatives to repeal the Affordable Care Act, much of the law will be in effect by January 1, 2014, unless there is a successful forty-first or forty-second attempt, which strikes us as unlikely. Defunding may yet kill the ACA, but for now we must proceed on the assumption that the law will be very much with us next year.

The new environment demands accountability as well as “value” and not “volume” from providers, as we have heard many times. “Value” is the aggregate measure of patient outcomes (e.g., mortality rates, patient satisfaction, and absence of complications) divided by total cost per patient over time. Michael Hicks, MD, MBA introduces a value concept that is relatively new to health care—but a natural fit for anesthesiology—in the cover article, A New Approach to Anesthesiology and Health Care System Safety: High Reliability Organizing (HRO). HRO differs from Lean and Six Sigma in that it involves a culture of mindfulness; it is more than a set of process-improvement tools. Read the article to discover the five basic requirements of HRO mindfulness (preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience and deference to expertise). Plan to attend the Advanced Institute for Anesthesia Practice Management in Las Vegas April 11-13, 2014 to hear Dr. Hicks’s presentation on HRO.

A very different angle on the relationship between outcomes and cost is the heart of Jody Locke’s article, What is the Value of a Chronic Pain Practice to an Anesthesia Group? Every hospital-based anesthesia group considering adding a chronic pain medicine service line should consider the risks and the known costs that lead to disappointment in many cases. To succeed, the chronic pain division must attract the right patients with the right insurance, which will probably require analysis and marketing; the pain specialists must develop and follow individualized patient treatment plans, and the practice must anticipate greater expenses for billing, scheduling, insurance verification, pre-authorizations and record-keeping. That is just the beginning. Constant monitoring and oversight are also necessary. Keeping the anesthesiologists’ and pain physicians’ workloads balanced is difficult. Venture into this realm with your eyes open.

Sometimes the relationship that founders is not with the facility or colleagues, but with patients. In our context, this means pain patients. Neda Ryan, Esq. provides an overview of the relevant considerations in How to Legally Break Up with Your Patient.

For those who may conclude that the rigors of increased accountability and the hassles of growing the revenue stream are excessive, Mark Weiss, Esq. sounds an alert in his article The Siren Song of Hospital (Un)Employment. Hospitals’ quest for “alignment” of physicians is a different word for “control.” Hospital control may not be benign, and it may not entail the income security sought by many anesthesiologists.

Malpractice expert Christopher Ryan, Esq. discusses yet another set of pros and cons in his article So You’re Thinking about Serving as an Expert Witness? Here’s What You Need to Know. The most obvious benefit is the compensation. Interested anesthesiologists who are new to the exercise should check their employment contracts, as these sometimes provide that expert witness fees belong to the practice rather than the physician. On the negative side, “most of the time testifying as an expert means being cross-examined by attorneys for hours on end,” in Mr. Ryan’s unflinching words.

As is often the situation, much of the information we provide to the anesthesia community consists of “Don’ts” and various warnings. That is not to convey the impression that we fear the future. We think it remains very bright for anesthesiologists who try to anticipate and creatively adapt to the many changes in our near and long term futures. We hope that you will keep proving us right.

With best wishes,

Tony Mira
President and CEO