Leverage Technology to Improve Your Anesthesia or Pain Practice: Nine Takeaways from AIAPM

SUMMARY Strategic business planning, including identifying your anesthesia group's strengths, weaknesses, opportunities and threats; analyzing the impact of external political, economic and other forces, and developing a mission and vision statement is essential for leveraging and making intelligent decisions regarding technology in the current environment. We offer nine takeaways from a presentation by ABC Chief Quality Officer Bryan Sullivan at the recent Advanced Institute for Anesthesia Practice Management.

The Advanced Institute for Anesthesia Practice Management (AIAPM), held the weekend before last in Las Vegas, offered anesthesiologists and CRNAs a wealth of practical advice on surviving and thriving in a complex and uncertain healthcare environment.

Among the presenters was Bryan Sullivan, chief quality officer for ABC, who shared his thoughts on leveraging technology to improve anesthesia and pain practices. We've distilled selected takeaways from his presentation here.

Don't make technology decisions without a strategic plan. "A piece of technology should never be the end goal," but should serve the group's strategy and reflect the group's needs and goals, Sullivan stressed. He recommended starting with a SWOT analysis of your group's strengths, weaknesses, opportunities and threats. Widely used in the early stages of projects, a SWOT analysis can help practices sift through the plethora of options, make clear, methodical choices and avoid rushed decisions based on anxiety due to compliance pressures. Repeat the SWOT analysis yearly, review it quarterly, and ask a trusted partner outside of your practice—your billing partner, for example—to review your analysis. (See sample SWOT analysis below.)

Many practices do not value strategic planning as much as they need to now that the Quality Payment Program (QPP) has started, Sullivan said. "The feedback I get from some groups is that they don't think it's worth their time or they don't want to cause conflict within their practice. But it's one of the most critical things you can do right now for your group. What is unique about your group within your market? If it is nothing, then that's something you should identify as a weakness."

Source: "Leveraging New Technology to Help Improve Your Anesthesia or Pain Practice," by Bryan Sullivan, presented at AIAPM, April 30, 2017. Sullivan's complete presentation is available here.

Develop a mission and vision statement. A mission statement defines who you are and who your client is. A vision statement defines how you want to do your work in future years. "If you don't have a good grasp of those, it's going to be hard to develop actionable objectives as you go forward," Sullivan said. Developing a mission and vision should be a group activity. Engage more people in the process to improve acceptance and commitment within the group.

Don't get blinded by keeping track of only high priority items. "It's easy to focus on the bigger, higher priority items in your strategic plan and lose sight of some of the smaller priority items," said Sullivan. "One of our clients lost a contract because they weren't keeping an eye on some of the smaller pieces. I've also seen groups win contracts because they did focus on some of those smaller priority items. I'm not saying that it's necessary to devote too much time to the lower priority items, but it is important to have an on eye on them and have some type of plan for keeping track of them."

Use 2017 to address the elephant in the room. The elephant, of course, is the QPP, which will begin compensating clinicians based on the quality, safety and cost effectiveness of their care. As we've discussed in previous eAlerts (Mapping Your MACRA MIPS Strategy for 2017, MACRA Flexibility for Anesthesia Providers: Set Your Own Pace in 2017), the Centers for Medicare and Medicaid Services (CMS) has designated this first year of the QPP a transition year to help clinicians adjust to the new reporting methodology.

The bar was deliberately set relatively low for 2017, making it easier than it ever will be again for clinicians and groups to avoid a negative payment adjustment. "Don't consider this a get-out-of-jail-free card," said Sullivan. "If you don't have a strategy in place, it's going to be really difficult in the future. At that point, you'll desperately need the technology. Consider this your opportunity to make longer-term decisions to protect yourself in future years."

Develop realistic expectations for 2017. If you are participating in the Merit-Based Incentive Payment System (MIPS) track of the QPP, it is highly unlikely that, as an anesthesiologist, you will receive the four percent bonus available to the highest-performing eligible clinicians (ECs) and groups, regardless of how well you perform in 2017. This is because most of the measures available to anesthesiology do not have national benchmarks or are "topped out," i.e., have a high performance rate across all providers. (For more information, see our April 3, 2017 eAlert, Your MACRA MIPS Composite Score: A Guide for Anesthesia Practitioners.)

Know your exemptions. MIPS presents a huge challenge for anesthesia and there is no overarching exclusion for the specialty, Sullivan said. However, if you are participating in MIPS, your anesthesia group might actually be exempt from the reporting requirements for MIPS's Advancing Care Information (ACI) category, which focuses on the use of electronic health records in improving patient care and replaces the Meaningful Use program. These exemptions can have a significant bearing on your technology strategy. If more than 75 percent of your services are delivered in an inpatient hospital, on-campus outpatient hospital or hospital emergency room (CMS place of service [POS] codes 21, 22 and 23, respectively), you are exempt from the ACI requirement.

You are also exempt if, like some anesthesiologists and most radiologists and pathologists, you are considered a non patient-facing clinician; that is, you bill fewer than 100 of the CPT codes for face-to-face encounters. According to Sullivan, the majority of providers will be able to leverage this exemption, but it is important to validate this with your billing partner. He recommends focusing first on determining whether you are exempt from ACI as a hospital-based physician.

Note: CMS has announced that ECs should expect a letter in May from the Medicare Administrative Contractor who processes their Part B claims containing the MIPS participation status of each EC associated with the Taxpayer Identification Number (TIN) in the healthcare organization. Following, for your information, is a link to a zip file containing the letter.

https://qpp.cms.gov/docs/QPP_MIPS_Participation_Status_Mailing.zip

Track your environment. Most of the opportunities and threats identified by your SWOT analysis will come from forces outside of your practice. Sullivan suggested using the strategic management tool known as PESTLE to analyze how the anesthesia market, healthcare landscape and third parties are shaping the external Political, Economic, Social, Technological, Legal and Environmental factors affecting your group. For example, political factors include MIPS, HIPAA and other regulatory compliance issues, and economic factors include the growth of high-deductible health plans. Walking through these different elements and identifying specific factors in each of these areas can help your group determine where to focus and develop a strategic plan.

Find partners who understand anesthesia. "The QPP is going to affect every part of your practice in the next few years. You need to become your own strong advocate and make sure you have partners within your sphere of trust who are very knowledgeable about this program," Sullivan said. "A lot of the public literature is not immediately relevant to anesthesia, so it's important to partner with someone who understands how the program works for the specialty."

Think IoT, think cybersecurity. The healthcare internet of things (IoT), including new wireless and wearable health-monitoring technologies such as the Apple Watch, is going to shift the healthcare technology landscape quickly because these technologies are advancing at an exponentially increasing rate. The huge amount of healthcare data that will be captured by these emerging technologies, combined with improvements in interoperability and the vast amount of healthcare data already being captured and transferred by existing health information technologies, such as electronic medical records, will lead to some true innovations and successes. IT companies are testing the boundaries of what is practical, financially viable and relevant.

The biggest threat to IoT and these wearable technologies is security, and it is something that anesthesiologists, as healthcare professionals who will be using these technologies to care for patients, need to think seriously about. Sullivan cited a recent article in Wired regarding the vulnerability of medical devices to hacking.

"Don't just rely on your technology partner to be your advocate for security," Sullivan stressed. "This is you on the line. Of course you can pass liability contractually, but this is your livelihood. Make sure you're protecting yourself as well as you can. Remember that cybersecurity is critical to your overall success, and expect to encounter more issues around security in your private practice and your facility."

Sullivan also provided a stratification of the available technologies for anesthesia and chronic pain. These include:

• Inpatient hospital information systems (HIS)
• Ambulatory electronic medical record (EMR)
• Anesthesia information management systems (AIMS)
• Patient portals
• Perioperative management platforms
• Patient engagement
• Patient management
• Call schedule systems
• Medication management
• Chronic pain EMR

Technology profoundly affects our specialty whether we like it or not, and will continue to do so. The more proactive individual practitioners and groups can be in understanding and planning for it, the better off they will be.

With best wishes,

Tony Mira
President and CEO