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Winter 2017


Anesthesia’s Transition to Value-Based Care

The fate of the Affordable Care Act (ACA) remains unclear following the outcome of the presidential and Congressional elections (with president-elect Trump stating his desire and Republicans in both House and Senate showing their zeal to repeal the ACA, as discussed in our final eAlert of 2016). The bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) and the healthcare sector’s transition to value-based care are expected to remain intact, however. As Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS), advises eligible clinicians, move ahead as planned with your participation in the Quality Payment Program (QPP).

Considering the QPP’s newness and complexity, many clinicians are likely to feel some uncertainty regarding what they must report, how they must report it and how they will fare under the new Medicare payment system. According to a national survey of more than 17,000 physicians by The Physicians Foundation reported in September, only 20 percent of respondents indicated they were somewhat or very familiar with the system.1

To assist in this first performance year, Kathryn Hickner, Esq. returns to this issue with an overview of the QPP and its two tracks, the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Ms. Hickner encourages anesthesia providers to “promptly and proactively develop a strategy to thrive under MACRA and the QPP,” noting that CMS expects the majority of eligible clinicians to participate in MIPS in this initial performance year and anticipates that 90 percent will receive a neutral or positive payment adjustment. To us, that looks like a clear sign that the QPP can be met with confidence.

Although most eligible clinicians are expected to participate in MIPS in the QPP’s first year, CMS expects clinicians to eventually participate in APMs, so it is not too soon for those of you who are not already in APMs to explore the possibilities. Anesthesia consultant Asa C. Lockhart, MD, MBA takes us on a brief but intriguing journey of some potential options developed by the American Medical Association and the Center for Healthcare Quality and Payment Reform.

An innovative care delivery model that is gaining traction within anesthesiology and with which many of you are already familiar is the perioperative surgical home (PSH). In his sixth in a series of articles on the PSH, Rick Bushnell, MD, MBA discusses how anesthesiologists can parlay the clinical skills they already have to optimize and risk-stratify patients during the preoperative appointment that is a hallmark of the PSH.

Regardless of what happens to it in the next few years, the historic and controversial ACA has left its mark on American healthcare and healthcare payment. According to Maurice Madore, MBA, CPC, chief client officer of Anesthesia Business Consultants, while millions fewer Americans lack healthcare coverage as a result of the ACA, “providers have been forced to restructure how they get paid for services as patients have become responsible for a higher percentage of their healthcare costs.”

Also in this issue:

  • Consultant Will Latham, MBA gives us another article on strategic business planning. This time, Mr. Latham probes the ins and outs of the strategic planning retreat, providing practical advice on organizing the event and keeping it on track.
  • Frequent contributor Mark F. Weiss, JD discusses the little known “verein” or confederation model, a potential business structure for anesthesia groups interested in forming a larger structure out of existing groups that “frees the organizers from many of the problems encountered in creating alignment.” The verein structure “lowers the barrier of ‘trust to entry,’” Mr. Weiss writes. “It’s far easier to trust in a vision if it doesn’t require giving up your ownership and local control, and becoming liable for someone else’s debts.”
  • Jody Locke, MA vice president of anesthesia and pain practice management for ABC, reviews the evolution of the electronic medical record in anesthesia, sheds light on why EMR implementation within the specialty is often fraught with challenges, and offers guidance to anesthesia practices for avoiding some of the obstacles.

We look forward to seeing many of you at the 2017 ASA Practice Management Conference in Grapevine, Texas.

With best wishes,


Tony Mira
President and CEO


12016 Survey of America’s Physicians: Practice Patterns & Perspectives, The Physicians Foundation, September 2016. http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf