Compensation packages for senior practice administrators in large, private anesthesia groups can be well into six figures. That’s a lot of money, but are they really worth it? During this time of turmoil in the healthcare market where there is tremendous pressure on all healthcare providers, including doctors, to do more for less, does it make sense to pay one individual so much money? Each anesthesia practice must decide who they want to help run their business and how much they should be paid. However, the following issues should be a part of the equation. The business side of anesthesia is very complicated. Anesthesiologist, CRNA and AA recruiting and retention. Scheduling. Retirement plans and health insurance benefits. Employee policies and enforcement. Managed care and hospital contracting. Revenue cycle management (billing and collections). Coding. Compliance. Accounting. Payroll. Risk management (lawsuits) and insurance. Continuous quality improvement. Computer and communication systems. Strategic planning...

No fewer than four experts in anesthesia practice management have contributed articles to the Communiqué for the first time in this issue. We are struck—not for the first time—at both the vast knowledge reservoir in our community and the generosity of so many professionals who go the extra mile to share their expertise. Let us take this opportunity to thank our regular authors and especially newcomers Danielle Reicher, MD; Steve Boggs, MD; Pat Everett, CPA, CMPE and Ron Booker, JD, CPA. Anesthesiologists have been seeking out the best electronic health record systems (EHRs) to improve data collection for both clinical and administrative purposes, not to mention for purposes of qualifying for the Medicare Meaningful Use payment incentives. Dr. Reicher describes a specific and very important application of EHR technology in Making Meaningful Use More Meaningful: communicating with patients. Have you thought about the value to the patient of documenting the medications and doses given...

For as long as anesthesia providers can remember, the payment for post-operative pain procedures has been bundled into the surgeon’s global fee. The exception to this general rule arises when the surgeon requests the anesthesiologist to administer the service. Although the National Correct Coding Initiative (NCCI) Coding Policy Manual for Medicare Services (Manual) provision has not changed, Medicare contractors’ payment for post-operative pain procedures is beginning to shift and the anesthesia community must be aware of this shift and ensure compliance with The Center for Medicare and Medicaid Services’ (CMS’) and its contractors’ documentation requirements. The CMS annually releases the NCCI Manual, which was developed to “promote national correct coding methodologies … to control improper coding leading to inappropriate payment in Part B claims.” The Manual includes a section specifically pertaining to billing for anesthesia providers furnishing post-operative pain procedures. This section provides that post-operative pain services are included in the...

Anesthesiologists are uniquely qualified to coordinate the care of patients in the intensive care unit because of their extensive training in clinical physiology/pharmacology and resuscitation. Some anesthesiologists pursue advanced fellowship training to subspecialize in critical care medicine in both adult and pediatric hospitals. In the intensive care unit, they direct the complete medical care for the sickest patients. The role of the anesthesiologist in this setting includes the provision of medical assessment and diagnosis, respiratory and cardiovascular support and infection control. Clinical competence and expertise in meeting the needs of a critically ill or injured patient unfortunately does not automatically transfer to payer’s documentation and coding requirements. The following article reviews the critical care services documentation, coding and billing guidelines. * * * The American Medical Association’s Current Procedural Terminology® (CPT) Codebook defines critical care as the direct delivery by a physician(s) or other qualified health care professional of medical care...

Are there any anesthesia or pain medicine practices that have not yet implemented a patient satisfaction survey? The answer is of course “yes.”  Quite a few anesthesiologists question the relevance and usefulness of patients’ opinions regarding their care, asking, for example, whether patients are evaluating “pain-free surgery or pain-free parking.”  Others are leery because there are no standards for patient surveys and because so few instruments have been validated.  The subjective patient experience is, however, an outcome measure that is here to stay.  Current and projected uses include quality assessment, for anesthesiologists as well as for hospitals and ambulatory surgery centers; quality improvement; provider comparisons; competency assessment; pay-for-performance programs; marketing, and education and coaching. The vast majority of health systems have deployed patient experience surveys, if for no other reason than under CMS’ Hospital Value-Based Purchasing program, hospitals can either lose or gain up to 1.25 percent of their Medicare payments...