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Summer 2013


Securing the Future for Anesthesiology and Pain Medicine Practices

The decisions that anesthesiologists and pain medicine specialists must make are more fundamental and consequential than ever as we enter the final months before implementation of Obamacare in January 2014. Adding staff, adding locations or even altering income distribution systems are easy decisions in comparison, especially since they lend themselves to well-defined quantitative analysis. Creating and selecting options that involve the very nature and identity of groups is much more challenging. Three of the articles in this issue of the Communiqué explore different aspects of the answer to the question, “How do we secure our future?”

The broadest view and the most basic recommendations are to be found in Will Latham’s article Strengthening Your Anesthesiology Group. Mr. Latham proposes two steps groups can take to reduce the pervasive environmental uncertainty: strengthen group governance and, with a more predictable decision-making process in place, develop a group-endorsed strategic plan. From defining the group’s collective vision through recognizing opportunities and dangers on to setting objectives and strategies, strategic planning is critical for groups that want to control their direction and identity.

Jody Locke’s article Timing is Everything: Divining the Wisdom of Anesthesia Aggregation in the Current Environment describes an example of anesthesia practices that have merged to create an important new player in the region, implementing a highly strategic long-range plan.

In Creating a Clinical Database: Opening Pandora’s Box or Mining the Treasure Trove, UCLA Anesthesiology Department Chair Aman Mahajan, MD and Jody Locke take a new look at the role of databases in creating power and influence in groups’ hospital relationships. The authors clarify the differences between familiar databases that serve billing and accounts receivable purposes, on the one hand, and those that can answers larger questions about quality, potential savings and clinical opportunities for practice expansion, on the other. They consider frequently-heard arguments against developing powerful clinical databases such as cost, time spent away from patients, and the already-high quality of anesthesia care and demonstrate that all of these are outweighed by the potential benefits of databases designed to capture and logically index all the information generated case by case. The most successful groups seek to manage their data in such a way as to identify issues that no one else has thought about and to change the existing practice paradigm. “Vital to that goal is having valuable data that can be shared with hospital administrators to identify rate-limiting steps in existing processes and to propose solutions that uniquely reflect the value anesthesia brings to the facility. It is only when this is the focus and intent of the data, that it becomes truly useful.”

In the shorter term, groups need to ask themselves whether their preparations for the implementation of ICD-10 diagnosis coding next year are on track. Joette Derricks’s article Are You Ready for ICD-10? points the way.

Groups who work with trainees—whether medical residents or allied health professionals such as emergency medical technicians—should take note of the need to match the patient to the trainee’s skill level, as illustrated by Brian Thomas, Esq. in Student Training Programs May Pose Significant Liability Exposure to Anesthesiologists. Kim Riviello, DNP, CRNA examines another risk management issue in A Retrospective Study of Gastroenterology Facility: Are the Patients Sicker?and provides a synthesis of published studies to show that outpatient facilities that anesthetize patients without anesthesia professionals should be aware of the prevalence and consequences of co-morbidities.

Readers often ask me how we are able to come up with new topics for this quarterly publication and our weekly Alerts. You know as well as I do that we live and work in a dynamic, exciting environment. There is always something new to say even when the topic is a familiar one such as the need for data. There are always new voices, too. If you would like to share an analysis, review or study in these pages—or to comment on what you have read—we are eager to hear from you.

With best wishes,

Tony Mira
President and CEO