In today’s healthcare environment anesthesia groups have many issues to deal with, including Accountable Care Organizations (ACOs), pressure on reimbursement, quality tracking, the perioperative surgical home and pressure on hospital subsidies. Despite these concerns, it is important to remember that for groups that enjoy exclusive arrangements with one or more facilities, their key asset is their hospital contract. Without a contract for services, the patients at that facility might well be serviced by another entity, and all other issues would become irrelevant. Since hospital contracts are awarded and retained at the pleasure of facility administration, a fundamental consideration for groups should be to understand the expectations of facility leaders from their anesthesia providers. This article will address that issue from the perspective of the author, an anesthesiologist who consults for both hospitals and providers, giving a unique perspective on these expectations. As the world of healthcare continues to shift from pay-for-volume...

When is it acceptable for anesthesiologists, or nurse anesthetists or anesthesiologist assistants, to use their smart phones in the OR? It is obviously not acceptable when the patient requires the anesthesiologist’s attention and the distraction is gratuitous.  A Dallas, TX jury will consider, in a malpractice trial due to start in September 2014, whether the anesthesiologist’s checking email, exchanging texts, looking up scheduling and accessing the Internet may have contributed to a patient’s death.  The 61-year-old patient died 10 hours after undergoing an AV node ablation at Medical City Dallas, according to the Dallas Observer.  The surgeon (and co-defendant) testified in his deposition that the anesthesiologist was distracted during the case and didn't notice the patient's low blood-oxygen levels until 15 or 20 minutes after she had turned blue. If the trial results in a verdict for the patient’s family, the anesthesiologist’s own deposition testimony about posting to Facebook will have helped...

A Management Services Organization (MSO) is a legal entity created to provide management and administrative services to other organizations. For the purpose of this article, we will describe the physician-owned MSO that provides services to multiple independent anesthesiology groups and is owned and governed by the owners of the anesthesiology groups the MSO serves. The physician-owned MSO is designed to allow private practice physicians to maintain 100 percent control of their practice while optimizing operating efficiencies, enhancing the care they provide and building long-term financial assets. The MSO model allows anesthesiologists to provide services to healthcare facilities, surgeons and patients in a more efficient and cost-effective manner. Following are the specifics of how this is accomplished. An anesthesiology group can divide its general functions into clinical and business. Over the years, anesthesiologists have found that their business operation has increased in importance and complexity as adequate reimbursement becomes more of a...

  Anesthesiologists, once the third most highly-paid specialists, have dropped to sixth place in Medscape’s latest survey of physician compensation.  The 2014 report, based on 2013 data, shows an average income from patient care activities of $338,000 for anesthesiologists, compared to $413,000 for orthopedic surgeons, who are at the top of the list. In contrast, according to the MGMA Physician Compensation and Production Survey, 2013 Report Based on 2012 Data, the average compensation for anesthesiologists was $428,208, or about $90,000, one year earlier.  The median was $427,000 and the 90th percentile was over $584,000.  Furthermore, the MGMA Report indicates that between 2008 and 2012, anesthesiologist compensation increased in every year but 2010. The average anesthesiologist compensation figure produced by Jackson & Coker’s physician salary calculator a year ago was $456,078, as reported in 8 Statistics on Annual & Hourly Anesthesiologist Compensation in Becker’s Hospital Review on April 25, 2013. What should...

Interested parties can now look up how much Medicare paid each of more than 880,000 providers, including 32,641 anesthesiologists, 1,856 interventional pain physicians, 2,999 pain physicians, 30,160 nurse anesthetists and 881 anesthesiologist assistants individually by name. On April 9, 2014, CMS released a massive database, known as the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (Physician Payment PUF), with information on the roughly $77 billion that Medicare Part B paid out to over 880,000 health care providers in 2012.  Part B covers services billed by physicians, non-physician practitioners, laboratories, imaging, ambulance companies and durable medical equipment, all of which except for durable medical equipment are encompassed in the Physician Payment PUF.  The database contains 9.2 million lines and includes the following: Physician or other provider name and office location Specialty and credentials Specific services provided by CPT or HCPCS code and description Place of service Number...