The attorney-client privilege seems like a simple enough concept, but it is full of complexities.  Anesthesiologists and administrators who handle communications with their groups’ lawyers need to know how to protect the privilege.  Ongoing whistleblower litigation, U.S. ex rel. Baklid-Kunz v. Halifax Hospital Medical Center, Case No: 6:09-cv-1002, 2012 U.S. Dist. LEXIS 158944 (M.D. Fla. Nov. 6, 2012), offers valuable guidance. The attorney-client privilege shields certain confidential information from discovery or from admission into evidence in a court proceeding.  The communication is protected so long as (1) it was between attorney and client, (2) it was made in confidence for the purpose of rendering legal advice and (3) it remains confidential.   Communications with outside counsel are presumed to be privileged, but the presumption is rebuttable.  The burden of proving that the privilege has been lost or waived is on the other party.   In the case of communications with in-house counsel, whose...

Anesthesia Business Consultants (ABC) announces today that the combination of its F1RSTUse technology with myAnesthesia from iMDsoft has produced the premiere offering for mobile EHR technology. ABC and iMDsoft offer anesthesia and pain management professionals the opportunity to maximize their EHR Incentive Payments while achieving complete and easy electronic anesthesia documentation at a new level of mobility. Completely independent of hospital IT infrastructure, this cloud-based service has no hardware or software requirements for hospitals or surgery centers other than the use of an iPad, and no technical knowledge is required for installation or use.Stanford R. Plavin, MD, President of Ambulatory Anesthesia of Atlanta (AAA), elaborates, “Ambulatory Anesthesia of Atlanta, LLC is a unique practice. We have a number of diverse outpatient clinical settings, while also supporting an established office-based anesthesia division called Mobile Anesthesiologists of Georgia. We work with practices and locations which have a variety of IT settings and infrastructures....

The New York Times has continued its assault on colonoscopies in its June 1st article entitled “The $2.7 Trillion Medical Bill:  Colonoscopies Explain why U.S. Leads the Work in Health Expenditures.” The Times’ charge that health care costs more in the U.S. is directed against medical services in general, with colonoscopy singled out as a “compelling case study.”  The article claims that they are the most expensive screening test that healthy Americans routinely undergo, with more than 10 million patients purportedly undergoing the procedures every year (a number ten times greater than a decade ago).  Moreover, as is true of many other health care services, screening colonoscopies vary considerably across the country in both the frequency with which they are performed and in pricing.  The Times included data from the Healthcare Blue Book showing that the cost of colonoscopy varied, in metropolitan areas across the U.S., from a low of...

The Sustainable Growth Rate (SGR) formula that constrains the annual update to the Medicare payment rate is projected to reduce physician payments by 24.4% in 2014, unless Congress intervenes. Congress—that is, the “committees of jurisdiction”—is considering sweeping changes to the payment system, including repeal of the SGR.  The legislators agree that the SGR is a flawed and unsustainable mechanism.  All three committees will have conducted hearings within the four-week period that began on May 7th, when the Health Subcommittee of the House Ways and Means Committee held its most recent hearing to discuss how the federal government, along with physicians, could develop new payment policy.  During a hearing before the Senate Finance Committee on May 14th, the first such hearing in six years, Chairman Max Baucus (D-MT) said that it is time “to repeal the SGR once and for all this year.” The House Energy and Commerce Committee’s Subcommittee on...

  It is a privilege to bring you another article from Michael R. Hicks, MD, MBA, this time on Successfully Competing in Anesthesia Services Today. Throughout his career as an anesthesiologist and executive, Dr. Hicks has developed unique insights into the qualities that make for success. As a physician, he writes for his peers honestly and without trepidation. Dr. Hicks’s wisdom is among the most valuable information we have published in the Communiqué. In the current issue, he addresses anew the concept of disruptive innovation in anesthesia practice—but as he notes, “successful companies within the anesthesia space are still focused on implementing and executing sustaining innovations” such as quality and process improvement and “better management practices built upon fiscal and behavioral discipline.” The needed innovations will come from five different strategies identified by Dr. Hicks: Actively manage the performance of the practice and its members, recognizing that neither the group nor...