In order to be their hospitals’ valued partners, anesthesiologists should understand the needs and forces driving the institutions’ leadership. Some of the strongest of those forces today are creating a wave of merger and acquisition (M&A) activity. In 2012 there were more than 100 deals in the U.S., twice as many as three years earlier. If the relationship dynamics do not encourage partnership between the group and the C-suite, it is nevertheless important to be able to gauge whether one’s hospital is going in the right direction (or staying in the right place).
A recent report from the management consulting firm Strategy&, Succeeding in Hospital and Health Systems M&A: Why So Many Deals Have Failed, and How to Succeed in the Future, is instructive.
In the first of a pair of studies, the authors found that the majority of hospital and health system mergers in the period 1998-2008 had failed to...
With remarkable timing, news
of a lawsuit brought by the parents of a teenager left in a permanent
vegetative state after a routine endoscopy coincides with the
announcement that the Food and Drug Administration (FDA) has granted
Premarket Approval for the SEDASYS® system, a computer-assisted personalized sedation system.
The patient was not
anesthetized using a SEDASYS machine or any other form of
robo-anesthesia, of course. According to the May 1st New York Daily News article,
“The suit to be filed in Westchester Supreme Court alleges that doctors
improperly administered anesthesia in failing to consider the patient’s
height and weight; improperly monitored her vital signs; excessively
inflated her abdomen, causing cardiac arrest, and removed a breathing
tube prematurely.” The point of the juxtaposition of the two news items
is to highlight the inherent risks of routine anesthesia even when
administered and monitored by experienced anesthesiologists.
The SEDASYS manufacturer, Ethicon Endo-Surgery, Inc., a...
Astonishingly, after decades of discussion, there is still a lot of uncertainty as to what the anesthesia medical direction rules mean by the requirement that the medically-directing anesthesiologist be “immediately available.”There has never been a numerical time or distance limit for “immediately available,” although there was a substantial debate about potential parameters with the American Society of Anesthesiologists in the 1990s. Thus, in investigating a False Claims Act whistleblower case that began in 2008, auditors from the Department of Health and Human Services Office of the Inspector General (OIG), acting with the Department of Justice, performed an on-site visit to the surgical facilities at the University of California-Irvine to see for themselves how long it would take a supervising anesthesiologist to travel between ORs, including ORs located in different buildings. An auditor from the San Diego OIG field office described the visit to UCI in a May 8, 2013 OIG podcast:Well, when...
What do orthopedic surgery,
cardiology, radiology, gastroenterology and urology have in common?
Compensation in all five specialties is higher, on average, than it is
for anesthesiology, according to Medscape’s Physician Compensation Report: 2013.
Anesthesiology has slipped
from fourth place to sixth place among the most highly-compensated
specialties since last year’s report. Average compensation among
full-time anesthesiologists as reported by Medscape is $317,000—a number
that strikes us as rather low. The explanation may lie partly in the
fact that more respondents reported incomes of less than $200,000 per
year than reported earnings in excess of $500,000. The data apparently
include compensation levels at implausibly low levels ($100,000 or less
reported by 6% of the respondents). The mode is $300,000 to $399,999,
with 18% reporting compensation of $300,000 to $349,999 and 15%
reporting $350,000 to $399,999. Medscape’s Anesthesiologist Compensation Report: 2013.
Medscape defines
compensation in the standard manner: “For employed physicians,
compensation includes...
The Centers for Medicare and
Medicaid Services (CMS) and the Department of Health and Human Services
Office of the Inspector General (OIG) last week published parallel
proposed rules that would remove certain obstacles to hospitals’ paying
for the electronic health record (EHR) technologies used by
anesthesiologists, pain specialists and other physicians.
When a hospital or other
entity that may be seeking patient referrals, such as a medical device
manufacturer, gives something of value to a physician, the gift
potentially may violate both the anti-kickback statute and the physician
self-referral statute.
The anti-kickback statute (Section
1128B(b) of the Social Security Act) provides criminal penalties for
individuals or parties that knowingly and willfully offer, pay, solicit,
or receive remuneration in order to induce or reward the referral of
business reimbursable under Medicare or any other federal health care
program. In 1987 Congress passed legislation requiring the development
and promulgation of regulations, the so-called...