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Spring 2015


The Only Constant In Healthcare Is Change

The specialty of anesthesiology, and indeed all of health care, is somewhere in the middle of its long transition away from a volume-driven cottage industry. Details of the destination are not yet clear, but one change of which we can be confident is the shift away from in-hospital care toward outpatient settings. Nearly two-thirds of procedures are now performed on an ambulatory basis. With the advent of more and more minimally invasive techniques— not to mention ever-safer anesthesia—that proportion will continue to grow.

Stanford Plavin, MD gives us a window into the mindset necessary for anesthesiologists to succeed in the ambulatory surgical center (ASC) environment, where “the microscope is powerful and the lights are bright” and where even the identity of our customers is changing. “What do the ASC’s customers want?” he asks in Anesthesiologists and the World of ASCs: A Different Value Proposition. Dr. Plavin recommends surveys to identify their satisfaction with the anesthesiologists and nurses and with the services provided. Surveys can help to identify the strengths and weaknesses of the ASC and point toward the factors that contribute the most heavily to success, in the process giving direction to the practice’s strategic plan. The results of well-executed surveys will often come as a surprise.

“Succeeding” takes on a different meaning when used in the context of leadership transitions. That is the meaning used in Jody Locke’s article Lack of Succession Planning: Problem or Symptom. To meet the challenges of all the changes driving the practice of medicine in general and anesthesiology in particular, solid leadership is imperative. It cannot be left to chance; hence the need for succession planning. The traditional culture of many anesthesia practices is more like that of “professional fraternal organizations” than that of enterprises that take active charge of their own future. Leadership involves long-term responsibility for the actions of others, something that is not emphasized in training. Any organization that hopes to continue even after the departure of current leaders must engage in succession planning. Succession planning starts with three fundamental questions: (1) how does the group identify good potential leaders? (2) How does it ensure their preparation for the role? And (3) how does the organization manage continuity when a leader is replaced? Every group should be exploring these and the other questions raised by Mr. Locke.

Another form of change occurring with considerable frequency is the merger of anesthesiology groups. We are happy to welcome Will Latham, MBA, CPA back to these pages and to include his guide to the merger process, Anesthesia Group Mergers: Strategies for Success. This article is a keeper for any group going through a merger today—or possibly in the future. The 14 steps and the list of key issues addressed in the typical merger process can serve as a roadmap, especially when they are read in conjunction with the “pitfalls to avoid” such as “dueling attorneys”—attorneys representing the party that has engaged them, seeking the best deal for that party. The quest for advantage may torpedo the entire negotiation process. The need to advocate for the combined (post-merger) entity should be in the consciousness of every party interested in the merger’s going forward.

Jerry Ippolito, MBA, MHSA outlines an important avenue for adapting to changing hospital relationships in Chronic Pain Management: An Overlooked Opportunity to Financially Partner with Your Hospital & Preserve Your Contract. While many hospital administrators do not think of pain medicine as an attractive source of revenue, this can be very-shortsighted. Mr. Ippolito shows how “comprehensive pain management programs that are strategically positioned, energetically developed and well run can attain strong profitability within a relatively short time.” In fact, anesthesiologists contemplating setting up independent chronic pain practices ought to factor in the potential damaging effects of “denying the hospital the opportunity to generate additional revenue.”

What about making the best possible decisions to manage your anesthesia practice here and now? Some change in our professional lives is driven by internal, not external forces; improved financial reporting should be considered by any group that has less than total confidence in its reporting systems (and perhaps by others as well). Gregory Zinser gives a rundown of the essential financial reports, and of the format of those reports, that will “facilitate review, understanding and discussion” in his article Numbers Don’t Lie, but…

Also in this issue of the Communiqué are articles by regular staff contributors Darlene Helmer (The Trend Toward Code Consolidation) and Joette Derricks (Reviewing Anesthesia and Pain Management 2014 CERT Data to Improve Documentation and Revenue). In these two articles, Ms. Helmer and Ms. Derricks continue their mission of presenting current information that will keep readers abreast of changing codes and documentation requirements.

We hope to see many of you at the Advanced Institute for Anesthesia Practice Management (AIAPM) which we are presenting jointly with Tulane University Health Sciences Center and Medical Business Solutions, LLC at the Cosmopolitan Hotel in Las Vegas on April 17 through 19, 2015. If you are unable to attend, please watch your electronic mailboxes in July for highlights from the talks—and plan to join us for the next AIAPM in April 2016. As always, it will be our privilege to continue expanding the specialty’s practice management knowledge base whether face-to-face or through these pages.

With best wishes,

Tony Mira
President and CEO