Do you check your professional association’s web site regularly?  There is more practice-related information there than you may realize.  One recent addition to the resources on the American Society of Anesthesiologists web site (www.asahq.org) is worth your special attention.  The ASA Committee on Quality Management and Departmental Administration (QMDA) has produced a comprehensive set of questions for anesthesiologists and others involved in perioperative patient care that can guide the development of a quality program tailored to your own department.The QMDA Anesthesiology Department Quality Checklist is a “compendium of anesthesia safety and quality measures suitable as a reference for anesthesiology departments of any size as they develop a comprehensive set of quality standards.”  It consists of separate sets of questions for these individuals and offices:Chair of AnesthesiaStaff AnesthesiologistSurgeonCRNA and/or AA Perioperative Nursing ManagerOperating Room NursePACU Nursing ManagerObstetric Nursing ManagerQuality ManagementAdministrationAnesthesia Technicianas well as for Office Based Anesthesia Facilities.  The questions, and the answers received, can...

State governments are under severe financial pressure.  In the last few years, many of them have stepped up their efforts to collect unclaimed property held by private entities such as medical practices.  Every state has an “escheat” or unclaimed property statute that places the burden on those holding such property to deliver it to the treasury or commerce department if the owner cannot be found. Escheatment is the general rule that abandoned or unclaimed property (of all kinds) becomes the property of the state.Several questions about our clients’ escheat policies and procedures have come up recently, suggesting that it is time for all to review their compliance with the applicable laws.  This subject is governed by state statutes that vary in their requirements regarding attempts to notify the owner of the property, e.g., the patient; time limits for delivering the property to the authorities, and other financial procedures.  Forty-two states (including...

On-time case starts can make the difference between profitable and unprofitable operating rooms.  There are multiple causes for late starts, among them clinical complications, unavailable instruments or supplies, unavailable laboratory reports or other paperwork, delays in room turnover and late arrivals on the part of surgeons, patients, and yes, anesthesiologists and nurse anesthetists. Almost all of the problems listed above are within the control of the anesthesiology group in charge of managing the OR.  A June 14th Outpatient Surgery Tip of the Day (www.outpatientsurgery.net) republished four tips to incentivize surgeons and anesthesiologists to arrive on time for scheduled cases.  These tips originally appeared in the November 2010 issue of Outpatient Surgery.   The article by Dan O’Connor was directed to readers who manage both types of physician, but the strategies can be implemented (or at least proposed) by a practice that provides an anesthesiologist-medical director.  Tip No. 1:  Make wake-up calls.  An...

Wow, what a day! You've just left a meeting with the hospital's CEO. Of the fifteen anesthesiologists in your openstaffed department, the CEO wants you to be the new, first medical director of anesthesia services. You've been the department's chair for the past two years, but now you've been offered an administrative stipend of $2,500 a month. It doesn't appear to be any more work than what you've been doing, and the $2,500 is more than you need for the payments on a new Porsche!Just as you feel your grip on the steering wheel, the alarm clock jars you awake. Should you savor the memory . . . or be thankful that it was only a nightmare?DREAM ANALYSIS 101Relax. Put your feet up. In order to analyze the dream, we need to back up a bit and consider the operation of an anesthesia department, as an element of the medical staff,...

Patient AB underwent a rotator cuff reconstruction in January, more than four months ago.  You billed the health plan that Mr. AB’s hospital record indicated.  The health plan denied the claim on the ground that Mr. AB was not enrolled.  You then billed Mr. AB directly for $1072.50 your usual and customary charges for anesthesia for a 120-minute open procedure on the shoulder joint (CPT™ code 01630, 15 units x $75 conversion factor) and an epidural for post-operative pain (CPT™ code 64415, $97.50).  You re-billed the patient in March, in April and again on May 15th.  Your billing office reached Mr. AB on the telephone on May 16th and was told that (1) his insurance was supposed to cover everything, (2) no one had told him to expect a bill for anesthesia separate from the hospital and surgeon statements and (3) he was now unemployed and did not have the money. ...