1 ANESTHESIA GROUP + 1 ANESTHESIA GROUP > 2 ANESTHESIA GROUPS
October 10, 2011
Thriving or even surviving as an independent anesthesia group is more challenging all the time. Medicare payment rates are dropping, fee negotiations with private health plans are painful and hospitals are seeking ways to stop paying stipends to their anesthesiology groups. CMS and TJC regulations and standards are more complex and ever-changing — let alone increasingly difficult to implement.
We hear about integration of healthcare providers as the one direction in which physicians should be looking. Larger organizations, it is true, have better access to capital and to costly resources as well as the advantage of achieving economies of scale, at least theoretically.
Are the security and protection offered through employment by a larger organization the only way out?
ABC does not think so. We are working on a program that will seek to consolidate the strength, the knowledge and skills and the experience of our clients (present and future), our staff and our consultants, with a view toward making those anesthesiology practices that partner with us more than competitive. Our goal is to foster greater collaboration and integration among our clients by creating a structure for improving quality and service and for lowering costs.
Level of Interest Survey
We are about to launch a survey to determine the level of interest in actively participating in an organized network that will initially offer group purchasing and quality data benchmarking. If the results are a green light, the new organization will quickly partner with third-party vendors to make available, at the best available prices, such services as group health insurance coverage, malpractice insurance, expert anesthesia-focused legal services, high-level tax advice, business lines of credit and investment options, HR services including payroll and unified credentialing. Initially there will be no additional cost to our clients for joining the new organization. Services that you choose to use will be available at favorable prices passed through to you directly. We will welcome suggestions for other services that we might obtain.
Group purchasing is the first baby step. Increasing options for short-term anesthesiologist and CRNA staffing by matching positions to available personnel throughout the organization membership is another. We are also in discussions with anesthesiologist-led entities who will provide the clinical expertise and a solid track record in helping anesthesia groups and hospitals improve OR quality and efficiency.
Data Collection and Utilization in Common
Developing a common and interoperable format for data collection – one that will be as universal as the health data environment permits – that will help our participating clients benchmark their practices both longitudinally and horizontally, without duplicative reporting, is also on the near-term horizon. Participating will be easy for clients who take advantage of the new generation of integrated anesthesia information technology that we are about to offer, which will encompass:
- Patient Portal
- Pre-Admission (PAT) tracking
- Preoperative Lab Recommendations and Medical Clearances
- Preoperative Holding Documentation
- Electronic Charge Capture
- Anesthesia Information Management System
- Postoperative Quality Collection
- Electronic Charge Capture
- Full integration to ABC’s F1RSTAnesthesia
- Automatic upload to Anesthesia Quality Institute
How we use this information is of course much more important than the technology itself, although sound technology is a sine qua non – and a given in this instance. Within the new organization, participating clients will have the opportunity (and the obligation) to share quality and efficiency information to add to the common fund of knowledge. Maximum data security, confidentiality and HIPAA privacy compliance are guaranteed. An advisory committee or board of practicing anesthesiologists is anticipated, to help establish the organization’s principles and methods for sharing and eventually standardizing best practices. The specialty of anesthesiology is fortunate in having a long history and well-deserved reputation for improving safety and quality through practice guidelines, standards and advisories. This record and literature will give the physician leadership and participants in the new organization a very sound foundation.
Expanding our reach beyond the quality of anesthesia care, pain medicine and critical care is also key. Participating physicians who want to learn how to lead and thrive beyond the four walls of the OR, the ICU, the ASC or the pain clinic – will have the opportunity to compare and increase information about meeting hospital needs. These needs include pre-surgical testing, OR equipment standardization and ICU nursing, among many.
Beyond First Steps; Towards Accountability
We expect to gain a good deal of knowledge from analyzing our aggregate data and translating those data into quality and efficiency measures, consistent with the anesthesiology, pain medicine and perioperative care measurements already approved by ASA, CMS and the National Quality Forum (NQF). In the process we will achieve the goals of collaboration and innovation. These two goals by themselves will give us the option of creating streamlined tools for third-party payer negotiations. We anticipate offering templates and tools on contract terms other than price, and we hope to implement a “messenger model” that will provide for relaying fee proposals and counter-proposals between payers and organization members, making the contracting process both more efficient and less costly to everyone involved. To ensure compliance with the antitrust laws, we have already engaged antitrust counsel.
The third major goal is accountability – individual and shared. This accountability is what will permit the new organization to help participating groups to stand out and offer hospitals, health systems, health plans and, yes, Accountable Care Organizations (ACOs) the excellence these entities are seeking.
To prepare ourselves to offer the requisite accountability, we will work with the new organization to define episodes of care, bundled payment and other risk-sharing strategies plus the quality improvement loop that are all fundamental to value-based purchasing. The models that we hope to develop will be useful to participating practices as platforms for ACO participation.
Our ultimate vision is for the new organization to transform itself into an integrated network that will create a recognizable brand of high-level anesthesia, perioperative and OR management services. We believe that together we can accomplish this goal, while you maintain your legal independence and identity, with your active support and contribution towards the fund of knowledge and its deployment.
Please help us determine whether to proceed by completing the forthcoming level of interest survey. If you visit our exhibit at the ASA Annual Meeting – and of course we hope that you will – tablets with the survey loaded will be available. We will also let you know as soon as we have the questionnaire running in a web portal. Qualitative as well as quantifiable feedback is very important to this effort. We do look forward to hearing from you, and we thank you in advance.
With best wishes,
President and CEO