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Summer 2014

M&As Still Going Strong: Position Your Anesthesia Practice

Analogies make us stop and think. Sonya Pease, MD, chief medical officer of TeamHealth, invites us to consider that customers of service industries such as restaurants reward outcomes rather than work processes in this Communiqué’s lead article, Working for Tips…. Much as patron satisfaction is key to success in the restaurant business, patient satisfaction is an outcome that physician compensation is going to reflect, whether we believe that patients are appropriate judges of quality medical care or not.

Patients’ perception of the caliber of the care they receive is determined in part by their doctors’ communication skills. Implementing multimodal pain and post-operative nausea and vomiting programs are very important, and so are the clinician’s self-introduction and expressed concern for the patient’s comfort. Think about the waiter’s keeping customers informed about delays and asking whether they need anything. These are skill sets most physicians “didn’t learn in residency but it is imperative we learn [them] and use [them] going forward,” as Dr. Pease writes.

The quality of the outcome in anesthesiology care depends, too, on the pre-operative work. Identifying and treating anemia before surgery, in Dr. Pease’s example, can have a “profound impact on patient outcomes as well as costs.” Analogously, solid preparation for the type of corporate restructuring of which we are seeing so much—take-overs, mergers, practice sales or offers of hospital employment—by identifying one’s group’s strengths and weaknesses is key to successful negotiations and reorganizations. In Pre-Op Your Anesthesia Practice, Howard Greenfield, MD of Enhance Healthcare provides a practical checklist for an anesthesia group “preoperative assessment” with such familiar categories as “age” (e.g., length of hospital contract), “height/weight” (e.g., number of MDs/CRNAs/AAs) and “past surgical history” (e.g., change in group governance), as well as a “review of systems” in which “neurological” encompasses the “group’s ability to communicate internally … and externally….”

A fundamental question in the pre-op assessment of a practice is its net worth. Mark Weiss, Esq. explains succinctly that an anesthesia practice is worth exactly as much or as little as a willing buyer will pay—and how its value may differ according to the perspectives of the senior and junior anesthesiologists who are considering selling.

There are still many alternatives to a sale or acquisition, Mr. Weiss reminds us in What’s Your Anesthesia Group Worth? And Why It Might Not Make Any Difference. One of those involves forming or joining a management services organization (MSO), as discussed by self-styled MSO “evangelist” William Hass, MD, MBA in Management Service Organizations and Anesthesia Practices Today and in the Future. Another might focus on expanding The Role of Anesthesiologists in the Intensive Care Unit. Jody Locke reviews the requirements for realizing the potential of the ICU for anesthesia practices.

As always, we devote a portion of the Communiqué to reporting clinical services in compliance with the ever-evolving rules laid down by Medicare and other payers. Articles in this issue range from the general principles of good documentation described by Darlene Helmer in Improving the Documentation of Anesthesia Procedures to the very specific review of Field Avoidance and Special Positioning by Kelly Dennis. If you are involved in providing pain medicine or critical care services, you will also want to read the articles by Neda Ryan, Esq. and Joette Derricks.

We hope that all our readers are having a successful summer. We look forward to bringing you new information this fall.

With best wishes,

Tony Mira
President and CEO