There are many forces affecting anesthesia groups today such as the pending Supreme Court ruling on the Patient Protection and Affordable Care Act, high unemployment, pending cuts in Medicare, and a very slow economy.  Regardless of what one believes, strategically addressing these issues is paramount in providing the necessary road map for the future.  Otherwise, a group may find itself in an unfavorable position.  This article seeks to explore the benefits of strategy for anesthesia groups. By definition, strategy[1] is “a plan, method, or series of maneuvers or stratagems for obtaining a specific goal or result: a strategy for getting ahead in the world.”  Clearly, developing strategy positions a group for success.  Furthermore, Sun Tzu describes the importance of thinking through strategy as such, “the general who wins a battle makes many calculations in his temple ere the battle is fought. The general who loses a battle makes but few calculations beforehand. Thus do many...

Anesthesia is the quintessential service specialty. Establishing and maintaining a consistently strong  relationship with a hospital, a clinic or an ASC is no easier for an anesthesia group practice than for any other type of service provider, be it car mechanic, internet provider or hair stylist; today’s medical consumers know they have options that give them leverage in demanding services and loyalty. For too many anesthesia practices this is a relatively new and somewhat disconcerting state of affairs. Anesthesia vulnerability to replacement has grown in direct proportion to the amount of financial support provided by the facility; practices that receive no subsidy support clearly have the strongest support, at least to the extent that they provide quality care. Competition for anesthesia contracts has ushered in a new era of service expectations and changed the perception of the role of the specialty in the facility. Quite simply consistently good outcomes are simply...

 Last week we discussed the growing trend toward including performance measures in contracts between hospitals and anesthesia groups.  We identified clinical quality, efficiency and patient satisfaction measures developed by the Surgical Care Improvement Project (SCIP), the Medicare Physician Quality Reporting System (PQRS), the American Society of Anesthesiologists (ASA), the Anesthesia Quality Institute (AQI), Press-Ganey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).  All of these measures can be the basis of hospital or ambulatory surgery center contracts for performance-based payment.Many contracts set forth the quality, efficiency and customer satisfaction activities that are part of the anesthesia group’s quid pro quo for their hospital compensation package without explicitly linking performance rates to payment.  Increasingly, though, the anesthesiologists must meet or exceed agreed-upon benchmarks to earn their payment.Choosing BenchmarksThe benchmarks can be external or internal.  External benchmarks allow for comparison to similar institutions or providers – or to national or...

Health information technology has become the colossus of high quality, high- efficiency medical practice. Anesthesia Business Consultants continues to expand our resources in the area of HIT – as do all of you. With the lead article in this issue of the Communiqué, we introduce to you a major new resource: Bryan Sullivan, Director, EMR and Clinical Integration. Bryan’s article on cloud computing explains an important direction in which HIT is moving.Anesthesiology is on its way to becoming a complete perioperative discipline – as it must, in an environment that will be dominated by integrated, accountable healthcare delivery systems. Richard P. Dutton, MD, MBA, Executive Director of the Anesthesia Quality Institute, describes the role of the AQI in pre- and post-anesthesia assessment in his latest article. In the write-up of his interview with Parish Management Consultants’ Al Patin, “Anesthesia Leadership in the Preoperative Clinic,” ABC Vice President of Client Services Bart...

Electronic capture of patient information before and after surgery is an essential component of an effective anesthesia quality management program.Postoperative data are the outcomes of our work. These include rare safety issues related to intraoperative care, but not always apparent in the OR or PACU: events like neurologic injury, myocardial infarction, aspiration pneumonia or complications of pain management. More common, and increasing in importance, are the “patient-centered” outcomes which will be used by external regulators to judge us: the occurrence of nausea and vomiting, the adequacy of pain management, and overall patient satisfaction.Preoperative information, on the other hand, is the substrate for understanding anesthesia risks. Comparison of outcomes across institutions will require careful risk adjustment, and electronic capture of pre-existing conditions, chronic medications and pertinent diagnostic studies will enable this process. Even information as simple as the ASA physical status can be a powerful tool for understanding anesthesia outcomes across broad...