Knowing and Managing Our Risks
“Endoscopy” is a word loaded with implications in our community. Providing anesthesia for this basic GI procedure is a major portion of many practices’ professional services. For some anesthesia groups, the volume of endoscopy cases is even growing. Over the past decade, we have all heard numerous warnings about the viability of this line of business because it appears to health insurers that sedation for routine screening lower GI endoscopies does not invariably require the involvement of an anesthesiologist. Some of the largest private health plans have adopted and revised medical necessity policies restricting the availability of anesthesia for endoscopies. Medicare carriers in 19 states have Local Coverage Determinations in place, defining the patient conditions for which they will pay for anesthesia for endoscopies. More than a few practices have already adjusted to a smaller caseload.
Many successful groups have justifiable concerns about the future of their endoscopy services. The lead article in this issue of the Communiqué, Scoping out Endoscopy, addresses those concerns and places them in the context of analyzing total, combined practice profitability. As ABC senior staff members Jody Locke and Hal Nelson conclude, “anesthesia for GI endoscopy has been and continues to be a viable income source for anesthesia groups. The key to success is understanding your payer policies, indicating underlying conditions and co-morbidities, and using advanced beneficiary notices so that you can balance bill the patient, when appropriate.” Equally important is the authors’ point that we must analyze each anesthesia line of business independently, not limiting our financial study either to overall profitability or to any one dominant procedure.
Another issue that warrants your attention is common to all employers and employees, not just to anesthesia practices. The rules defining independent contractor status have been tightening up. John Mulligan, Esq. describes recent enforcement developments at both the federal and state level in his article Risks and Issues in Treating Anesthesia Group Professional Staff as Independent Contractors. He recommends unequivocally that groups that characterize individuals who regularly work for them as independent contractors review the status of each “independent contractor” so as to minimize potential devastation in their qualified retirement plans and other assets.
If you do find that some individuals’ classification is questionable, you will also want to take note of the companion piece written by Mr. Mulligan with ABC’s Jill Thompson, Practical Considerations in Converting Personnel from Independent Contractor Status to Employee Status.
The risks discussed in the independent contractor articles are among the many business risks that Mark Weiss, Esq. recommends treating strategically in Managing for Success Requires Managing Risk.
Some risks simply cannot be avoided. Susan Firestone, Administrator at NYU Langione Medical Center and a member of the MGMA Anesthesia Administration Assembly (AAA) Executive Board is very forthright about the uncomfortable situation of patients whose managed care plan turns out not to cover the anesthesia care they have received (Managed Care Participation – Yes or No?) Ms. Firestone suggests placing notices regarding anesthesia coverage in the surgeons’ and hospitals’ preoperative patient information packages, but she also notes the limitations of this effort. Counseling patients who call on how to approach their managed care plans requires time and patients, but according to Ms. Firestone, many patients have reported their success to her.
Rounding up the current collection of articles is a summary of the Family Medical Leave Act by ABC staff member Stephanie Zvolenski. This discussion simply lays out the statutory requirements with which certain anesthesia groups must comply, demonstrating in one more context that preparing for common events such as emergency leave requests is the way to minimize risk.
The upside of risk is opportunity. Many management books advise searching for new opportunities whenever there is an adverse event, and we agree with that idea. Over the last several years ABC has sought out solutions for some of the challenges that anesthesia practices face and is pleased to have brought our clients the Quantum Clinical Navigation System™, the F1RSTAnesthesia Record (FAR) digital pen for completing anesthesia records and most recently the ePreop electronic preoperative record system. As we urge you to do, we will continue to identify practice needs and do our best to meet them through topnotch products and services—we are all in this together.
With best wishes,
Tony Mira
President and CEO
