Join the Conversation on Cost Do you have an idea for using improvements in quality to drive reductions in the cost of care?  Has your practice tried something that worked?  Share it. Clinicians and financial managers have plenty of innovative ideas for reducing costs, but these ideas rarely percolate into the public sphere. To change that, Neel Shah, MD, MPP of Harvard Medical School has founded a non-profit organization called Costs of Care to facilitate idea-sharing and learning among healthcare professionals.  Costs of Care sponsors a learning network and a Creating Value Challenge for clinicians, and offers a COST (Culture, Oversight, System support, Training) framework to help clinicians understand and implement high value care interventions in their practices and institutions.   According to Dr. Shah, who spoke at a recent Hospitals and Health Networks webinar, “The New Conversation on Cost,” healthcare organizations need a strategy for reducing costs that combines the insights...

Stress is a part of life for all of us, and anesthesiologists have more than their share in a practice environment where rules seem to shift from day-to-day as the burden of paperwork and performance measurement increases and financial rewards are diminishing or put at risk. Add this to the already daunting pressures associated with long hours in the surgical suites and on-call responsibilities, and it is no wonder that patience wears thin from time-to-time. I have been impressed throughout my career with the manner in which the vast majority of anesthesiologists handle this pressure, but have also seen a few situations where the pressures resulted in behavior that was detrimental to patient satisfaction and/or the reputation of the group. All of us have had times where stress in our personal or professional life has caused us to act or react in a way that we later find regrettable, but for...

The premise is elegant in its simplicity:  The more information you have about a surgical patient’s biology, the greater your ability to tailor anesthesia medication appropriately for that patient and lower their risk of an adverse drug reaction (ADR), longer hospital stay or hospital readmission, and the better and more cost-effective the overall quality and safety of your anesthesia care. It’s an approach that clinicians, scientists and President Obama, through his administration’s Precision Medicine Initiative, hope can be used routinely one day to spare surgical patients from unnecessary risks and complications.  A personalized approach to anesthesia care such as this could also enable anesthesiologists to add value to their institutions and practices as perioperativists, yielding benefits for health systems, payers and, ultimately, society as a whole. Pharmacogenomics, a cornerstone of medical science’s movement toward personalized medicine, uses genetic data to guide drug development and testing and help physicians select the proper medication...

The developers of the Maslach Burnout Inventory define physician burnout as “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”  Some suggest its relative absence should be considered a measure of quality.  No matter how one defines it, it is not a good thing—for physicians, care teams, practice management professionals, patients or healthcare organizations.  As the data show, anesthesiologists unquestionably suffer from it right alongside their peers in other specialties. U.S. Surgeon General Vivik Murthy, MD puts it well in explaining why physician burnout is a serious problem:  If healthcare providers aren’t well, it’s hard for them to heal the people for whom they are caring.” While the phenomenon is far from new and has been extensively studied, recent research confirms that physician burnout is widespread and growing.  In a Mayo Clinic survey of more than 6,200 physicians, 54.4 percent reported at least one symptom...

[Author’s Note: This article is based on my presentation at the 2016 Advanced Institute for Anesthesia Practice Management.] The OIG Advisory Opinion (Advisory Opinion) process allows parties of actual or proposed transactions to obtain the opinion of the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services as to whether that transaction violates the federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b) (AKS). There’s an official process for obtaining an OIG Advisory Opinion. Then there’s the actual way that the process works. And, then there are the secrets and strategies that can be used in connection with opinions. For decades, I considered Advisory Opinions as a set of guideposts as to how the OIG, as the primary agency charged with enforcing the federal AKS, thinks as to the application of that statute. But then I realized that there was a very different way to think of them,...