Quality and Other Components of the Value Proposition

No anesthesiologist has ever told me that he or she thought that the measures established by Medicare’s Physician Quality Reporting System (PQRS) or even the Surgical Care Improvement Project (SCIP) provided much insight into the quality of his or her practice. To the contrary, clients and friends have often asked me, “Why are we reporting these process measures? What do they prove?”

We are very pleased to welcome the well-known anesthesiologist and writer Karen S. Sibert, MD to the pages of the Communiqué and to bring you Dr. Sibert’s thought-provoking reflections on the PQRS and SCIP quality measures. In The Dark Side of Quality, Dr. Sibert systematically reviews the literature and leads the reader to share in the conclusion that, at best, the PQRS/SCIP measures have not reduced surgical site infection rates and, at worst, in the case of tight glucose control for cardiac surgery patients and preoperative beta blockade for non-cardiac surgery patients, they may even have contributed to higher mortality rates. In contrast, the rigorous process analysis underlying the protocol for the prevention of catheter-related bloodstream infections has yielded improvements in quality. The Centers for Medicare and Medicaid Services (CMS) are pursuing other, less demonstrably effective measures such as patient satisfaction and hospital readmission rates. The financial penalties attached to failure to document adherence to all these measures do not bode well for hospitals, anesthesiologists or their patients.

Robert Stiefel, MD is also an anesthesiologist writing for the Communiqué for the first time. As Dr. Stiefel makes abundantly clear in What Do Hospitals Want From Anesthesia Groups?, the pressures to comply with the quality measures questioned in Dr. Sibert’s article are considerable. However well-researched and principled arguments against slavish adherence to the measures might be, they could cost anesthesia groups their hospital contracts—their livelihood. Hospitals are experiencing intense local quality and service competition and the anesthesia group that helps their administration score highly on the standard measures, including patient satisfaction, helps its own position. Even more important to keeping the contract, as Dr. Stiefel explains, are contributions to efficiency and cost savings—and on the Five Cs of leadership: culture, consistency, communication, customer service and collaboration.

One important way for physicians to exercise leadership is through ownership of an MSO, as long-time anesthesia administrator Joe Laden explains in The Physician-Owned Management Services Organization. These MSOs allow physicians to maintain 100 percent control of their practices while optimizing efficiencies, enhancing quality (in the true sense) and building long-term financial assets. Mr. Laden’s detailed description of the economies of scale that are possible when groups centralize their administrative functions should be read by every anesthesia practice as part of its strategic planning, whether or not an MSO turns out to be the best option.

Another way in which many anesthesiologists consider enhancing their revenues is by investing in ambulatory surgical centers. The investment may be purely voluntary, or it may result from pressure from the ASC owners who have an anesthesia franchise to award. Healthcare attorney Neda Ryan, Esq. provides a thorough refresher on the applicability of the federal anti-kickback statute and Stark law to these transactions in Thinking of Investing In, or Renting Space In, an ASC? Have You Taken Compliance into Consideration?

Despite doctors’ best clinical efforts, sometimes things will go wrong and a patient may end up with an injury. “Medical errors happen,” writes Christopher Ryan, Esq. and Danial Laird, MD, JD in Should You Apologize for a Poor Outcome? The authors are litigators (one of whom, Dr. Laird, previously practiced as an anesthesiologist) and their focus is on the implications of apologies in malpractice lawsuits. While acknowledging the argument that expressing regret shows compassion, which may prevent a claim, they raise concerns about the ability of patients to recall, years after the fact, whether the doctor voiced sympathy or actually made a statement of culpability. State laws on what constitutes an apology and whether it may be used at trial vary. The take-away message is that doctors who would like to apologize for a poor outcome should always involve their risk management department.

Unless this issue of the Communiqué is the only practice management publication you have read in recent memory, you are already aware that the deadline for implementation of ICD-10 is just about six months away. Darlene Helmer, ABC Vice President of Provider Education and Training, reviews the six key steps in preparing for the transition—planning, communicating and training, assessing and improving workflow, testing software and processes, implementing changes and surviving the first months after implementation—in ICD-10 is the Latest Y2K: The Potential Impact on Provider Revenue. The clock is running, but those who are following these steps, or who begin to take them now, still have time to prepare.

ABC is embarking on a new educational venture for anesthesiologists and others interested in the business side of anesthesia practice. Together with the Center for Continuing Education at Tulane University Health Sciences Center and Medical Business Solutions, we are sponsoring the Advanced Institute for Anesthesia Practice Management (AIAPM) that will take place in Las Vegas on April 11-13, 2014. We certainly hope to see you there. We would also be most interested in hearing from readers who want to learn about—or to present—a topic at the 2015 AIAPM. As always, we would also like your suggestions for future issues of the Communiqué.

With best wishes,

Tony Mira
President and CEO