“Patient Safety Issues Spur NIH Shake-Up” was an above-the-fold headline in the Washington Post on May 11, 2016.  NIH Director Francis Collins, MD is replacing top leadership at the 200-bed Clinical Center with a new management team with experience in oversight, compliance and patient safety in the wake of an independent review that found that safety had become “subservient to research demands.” Also in the news recently was a study published in The BMJ (BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2139 [Published 03 May 2016]) by researchers at Johns Hopkins urging the Centers for Disease Control (CDC) to list medical error, broadly defined, as the third most common cause of death in the U.S. after heart disease (611,105 deaths per year) and cancer (584,881 deaths per year).  According to the study, the annual number of U.S. deaths attributable to medical error is approximately 251,454—more than three times higher than the 98,000 preventable deaths cited...

Deciding on new models for an anesthesiology practice is one of our very biggest challenges. It is not realistic for anesthesiologists to continue believing that if they consistently provide good quality care, all of their financial and business issues will take care of themselves. “The beliefs and strategies that have gotten us to where we are today will not get us to where we want to be tomorrow,” as ABC Vice President Jody Locke writes in his article The Road Not Taken in this issue of The Communiqué. The transition to value-based payment, combined with the strong trend toward larger anesthesia groups and tight affiliations with national anesthesia companies and/or with health systems, has changed the landscape for traditional independent practices. Bill Britton sums up the current environment in Critical Issues to Consider When Exploring the Sale of Your Practice: hospitals are facing mounting pressures to minimize operating costs, including the...

On July 13, 2015, we informed you of CMS’s Two-Midnight Rule.  After much pushback from industry stakeholders and from the judicial system since our alert, CMS proposes to eliminate the notorious payment reduction under the Two-Midnight Rule in its FY 2017 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule (Proposed Rule).  Though not slated to be finalized until the latter part of 2016, hospitals and their partners can be optimistic that the penalty under the Two-Midnight Rule may soon be a memory. The Two-Midnight Rule, effective beginning October 1, 2013, was enacted with the intent of curbing payment for inpatient hospital admissions (i.e., Part A).  The Two-Midnight Rule generally states that payment under Medicare Part A is appropriate if the admitting physician has a reasonable expectation that the patient’s stay would span at least two midnights.  For patients expected to stay less than two midnights, payment under Medicare Part B (i.e.,...

Correlation does not equal causation. One fresh demonstration of the truth of this axiom appears in an article in this month’s issue of Gastroenterology (Wernli KJ, Brenner AT, Rutter CM, Inadomi JM. Risks Associated With Anesthesia Services During Colonoscopy. Gastroenterology 2016; 150: 888-894). The research team, from the Group Health Research Institute in Seattle, performed a prospective cohort study of nationwide claims data from 3,168,228 colonoscopy procedures in adults aged 40 to 64 in the Truven Health MarketScan Research Databases from 2008 to 2011. Moderate sedation was performed in 65.6 percent of the procedures included in the study; deep sedation (in most cases using propofol) was provided by anesthesiologists or nurse anesthetists in 34.4 percent. The study authors found a correlation between use of anesthesia services and a 13 percent higher risk of any complication within 30 days: specifically, higher risk of perforation, bleeding, abdominal pain, complications due to anesthesia, and...

How would you like to know exactly what’s going to happen in the future so that you can prepare for and profit from it? I have a crystal ball. Here, let me share it with you. We’re going to review some of the trends currently impacting, and soon to impact, hospitals that will, I predict, lead to their destruction, at least as we know them. There is absolutely no question that these trends are going to have an impact on your anesthesia practice. Start preparing now. Trend 1: Hospitals Are Getting Bigger and That is a Weakness Government induces physician labor Obamacare favors the growth of hospitals with its incentives for aligning physicians. Think Accountable Care Organizations (ACOs) and other incentives to coordinate care, meaning coordination via hospitals. Although reports lag by several years, at least 20 percent to 30 percent of all practicing physicians are currently employed by hospitals. There...