Anesthesia practices looking to optimize their value proposition at their respective facilities have sought a greater role in the preoperative preparation of their patients. The emphasis on efficiency and the continuity of care in recently suggested models of healthcare reimbursement, including Accountable Care Organizations, have drawn renewed attention to opportunities within the preoperative clinic. The economic reality is that providers and facilities are not getting paid to provide those services under current reimbursement rules. Preoperative clinics can provide benefits in quality of care and cost reduction, in addition to the significance of improving patient and surgeon satisfaction. Anesthesia practices are in a unique position to develop the preoperative clinic into a valuable resource.The expenses of a poorly performed preoperative assessment are borne by both the surgical department and anesthesia provider (as well as by the patient) in the form of poor utilization. Patient satisfaction and outcomes are affected by delays and...

In recent years, the economic pressures of medicine have incited a paradigm shift in health care delivery, such that surgical procedures are moving from the hospital to the office-based setting. Often called the “wild west of health care,” office- based procedures continue to increase at a rapid pace, with an estimated more than 10 million procedures performed in 2010. A growing body of literature calls for greater leadership in the field of office-based surgery, and for leaders who are educated in all facets of quality improvement. In addition, a recent study found that a comprehensive checklist used in an interdisciplinary, team-based setting resulted in a reduction in surgical complications as well as cost savings.Development of such a checklist and education of practitioners, patients, and office personnel is the mission of the Institute for Safety in Office-Based Surgery. An independent, non-profit 501(c)(3) organization, ISOBS has developed a safety checklist for use in...

Written by: Shawn Michael DeRemer, MD and Gregg M. White, CRNA, MSAnesthesia Associates Northwest, LLC (AANW), Portland, ORHealth care delivery has gradually shifted from in-hospital to outpatient settings, most recently to physicians’ offices. In fact, in 2009 the number of office-based procedures in the United States numbered 12 million. Nevertheless, though outpatient surgery may be more convenient and financially beneficial for both doctors and patients, many physicians are not taking advantage of the full realm of possible procedures that could be offered in an office setting.In 2010, we decided to expand our own anesthesia management and staffing services business by helping physicians expand their practices. Our idea was to bring the surgical suite to physicians’ offices via a fully equipped van that would deliver all necessary resources — and also foster a “culture of safety.”WHAT WE NEEDEDWe went to task outfitting a slick- looking van with everything a physician might need...

Have you and your group been thinking about how to grow your practice? The trend toward anesthesia practice consolidation continues its momentum. Not only do groups seek more and more opportunities to merge, to acquire other groups and to join larger organizations; they are an increasingly attractive acquisition target.Mark Weiss, Esq.’s article “The Company Model of Anesthesia Services: Will Less Money Lead to Jail Time?” is an excellent review of the development of the troublesome “company model” as well an explanation of the associated compliance issues that you don’t have to be a lawyer to understand.For a different perspective, consider AAA Executive Committee member Franc Galinanes’s article “Anesthesia: The Increasing Consolidation of Our Industry.” As a Senior Director for North American Partners in Anesthesia, Mr. Galinanes is in a good position to discuss the advantages of the three major types of consolidation: practice mergers, joining a larger organization and sale to...

??When asked why he robbed banks, Willie Sutton responded, “Because that’s where the money is.”Ambulatory surgery center (“ASC”) owners, often surgeons, seek to obtain a share of anesthesia fees for the same reason. But instead of a gun, many are turning to a new model of money extraction, the so-called “company model.”The abrupt bank robber approach to demanding a kickback is clearly illegal: “Bob, if you want to provide anesthesia at Greenacres ASC, you’ve got to pay us thirty cents on the referred dollar”.Although there are far more ASC owners willing to take the bank robber approach than the industry likely will admit, some ASCs are choosing a slightly softer approach — forcing the anesthesiologists working independently at the ASC to instead work for an ASC affiliated entity that distributes a share of the anesthesia fees back to the ASC owners.“Bob, if you want to provide anesthesia at Greenacres ASC, you’ve...