As we enter 2014, we expect to see the term “Big Data” become increasingly familiar. Wikipedia defines Big Data as the “collection of data sets so large and complex that it becomes difficult to process using on-hand database management tools or traditional data processing applications” and notes that “The trend to larger data sets is due to the additional information derivable from analysis of a single large set of related data, as compared to separate smaller sets with the same total amount of data, allowing correlations to be found to ‘spot business trends, determine quality of research, prevent diseases, link legal citations, combat crime, and determine real-time roadway traffic conditions.’ [Citations omitted].” In healthcare, the value of large data sets for clinical research and for prevention of disease is clear. The Multicenter Perioperative Outcomes Group registry and the National Anesthesia Clinical Outcomes Registry noted in Dr. Richard Dutton’s article, Using Big...

  There are now more than 500 Accountable Care Organizations (ACOs) up and running in the U.S.  Since they first appeared on the health care horizon, interest in their potential to improve quality while reducing or at least holding down costs has continued to grow.  Specific approaches and strategies for shifting the quality/cost equation such as ASA’s Perioperative Surgical Home model are developing with a view toward participating in future ACOs.  How—and how well—are ACOs working as the health care system’s transition to value-based care proceeds?  Overall, the results are a mixed bag. Of the 114 ACOs that joined Medicare’s Shared Savings Program (MSSP) in 2012, only 54 achieved savings in their first year of operations.  Still, 106 new ACOs joined the MSSP in January 2013, and another 123, covering 1.5 million patients, signed up to participate in 2014.  Many of those ACOs may have opted for the low-risk, one-sided model in which...

The current upheaval in the business of anesthesia has been previously reviewed in various issues of the Communiqué. While complex forces are involved in these changes, one aspect of practice management is vitally important for both individual anesthesia professionals and their anesthesia services: disruptive change.1 Disruptive innovation occurs when processes are improved and adopters of these new processes have operational and financial advantages over their competitors. Disruptive innovation is most likely to start in service niches rather than engulf an entire industry. Anesthesia professionals in ambulatory surgery centers (ASCs) are most likely to undergo disruptive innovation. Why will these changes occur in ASCs? With increasing out-of-pocket expenses, patients are going to be more cost conscious than ever before. Demands from patients, referral sources, and insurers will require ASCs to provide high quality services at the lowest possible costs to survive. ASCs are fertile ground for disruptive change because their lower acuity...

  The Office of the Inspector General (OIG) in the Department of Health and Human Services released its Work Plan for 2014 on January 31, several months later than usual in part, at least, because of the sequestration and government shutdown engineered by our dysfunctional Congress last fall. The Work Plan explains the OIG’s priorities and provides a brief description of the activities it will initiate and continue during each fiscal year.  The document identifies the year in which the OIG expects to issue one or more reports as a result of the review, and indicates whether the work was in progress at the start of the fiscal year or will be a new project during the year.  As reports are issued, they are posted to OIG's website. Perhaps the best news in the 2014 Work Plan is the lack of any new anesthesia issues, although review of the use of the...

Higher acuity cases such as joint replacement and spinal fusions have moved into the ambulatory surgery center setting over the past few years as minimally invasive techniques allow surgeons to perform traditionally inpatient procedures in an outpatient setting. The anesthesiologist plays a crucial role in making these cases successful. If patients have a great experience, appropriate pain expectations and continue to make progress after they return home, they’re likely to recommend the center to others and revisit the next time they need a procedure. “When a patient says they didn’t have a good experience and felt sick, we just can’t cut that person loose. We have to check up on them and I think ASCs do a great job of looking at the patient surveys and following up,” says Charles Tullius, MD, an anesthesiologist in Savannah, Ga. “If the patient has one knee done at the center, they’ll return when they...