Most anesthesiology practices provide services in ambulatory surgical centers (ASCs), and quite a few anesthesiologists have investment interests in ASCs.  With more than 5,400 Medicare-certified ASCs in the United States, 1.8 percent more than in 2012, a look at the characteristics of successful facilities and at the challenges they face should be worthwhile. Meeting the marketplace challenges is the foundation of success.  Topping the list of challenges for ASCs today, now that the implementation of the Affordable Care Act is underway, are the following: Attracting and retaining surgeons and other physicians who will contribute to the facility’s bottom line.  Securing coverage, high quality and a referral base have always been key, but as more and more physicians opt for hospital employment, the pool of unaffiliated physicians is shrinking.  More than half of new physicians are taking jobs with hospitals rather than entering private practice.  Twenty-nine percent of physicians were working directly...

CMS has announced the selection of the first 27 Accountable Care Organizations (ACOs) to participate in the Medicare Shared Saving Program.  The 27 organizations have agreed to be responsible for improving care for nearly 375,000 beneficiaries in 18 states through better coordination of services among hospitals, physicians and other providers. ACOs organize to achieve quality improvement and greater efficiency, with a goal of ensuring “that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. … When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.” (from the CMS ACO web page). The ACOs selected will involve more than 10,000 physicians, 10 hospitals and 13 smaller physician-led organizations.  More than half of the ACOs are being led by physicians,...