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Winter 2014

Another Year of Changes Lies Ahead for Anesthesiologists

As we enter 2014, we expect to see the term “Big Data” become increasingly familiar. Wikipedia defines Big Data as the “collection of data sets so large and complex that it becomes difficult to process using on-hand database management tools or traditional data processing applications” and notes that “The trend to larger data sets is due to the additional information derivable from analysis of a single large set of related data, as compared to separate smaller sets with the same total amount of data, allowing correlations to be found to ‘spot business trends, determine quality of research, prevent diseases, link legal citations, combat crime, and determine real-time roadway traffic conditions.’ [Citations omitted].”

In healthcare, the value of large data sets for clinical research and for prevention of disease is clear. The Multicenter Perioperative Outcomes Group registry and the National Anesthesia Clinical Outcomes Registry noted in Dr. Richard Dutton’s article, Using Big Data for Big Research: MPOG, NACOR and other Anesthesia Registries, are exciting tools for anesthesia researchers.

Another important concept in our thinking is “disruptive innovation,” to which Dr. Michael Hicks introduced us in his article Disruption and the Theory of the Anesthesia Business a year ago, in the Winter 2013 issue of the Communiqué. Dr. William Hass—a first-time contributor here—takes the concept and applies it to anesthesia services in ambulatory surgical centers in Disruptive Change, Anesthesiologists, and ASCs. ASCs are particularly fertile incubators for disruptive change, according to Dr. Hass, because they are more cost-sensitive than other facilities and because their lower-acuity cases offer opportunities for staffing and technological innovations. Combining the cost pressures to which ASCs are so sensitive with the fact that personnel is the greatest expenditure in anesthesia, Dr. Hass predicts that we are going to see combinations of anesthesia professionals and clinical technology that are far different from today’s models. He is right.

One key facet of ambulatory anesthesia practice that is changing rapidly right now is the shift of certain high-acuity cases to the ASC setting, which Laura Miller of Becker’s ASC Review discusses in her article Performing High Acuity Cases in ASCs: The Anesthesiologist’s Role. The ability of anesthesiologists to manage patients’ postoperative pain through nerve blocks is the deciding factor in many cases. The practicing anesthesiologists interviewed by Ms. Miller also point to the specialty’s role in managing the team that brings the appropriate patients to the ASC, keeps them on schedule and discharges them suitably educated about what to expect during recovery.

We have been expecting disruption, if not necessarily innovation, in the market for anesthesia services for endoscopy for better than a decade. ABC Vice President Jody Locke examines the reality through the combined data of 26 practices across the country in Endoscopy: Revisited and concludes that where the revenue yield per case, combined with the productivity of the facility, makes anesthesia for endoscopy profitable, the service is still a valuable line of business. And that is the situation for many practices across the country. Monitoring volume, payer mix and payer policies, accounts receivable and productivity by site will tell each practice whether and when it is time to revisit providing anesthesia for endoscopy.

Some of the changes on which we focus in this issue of the Communiqué are annual rather than epochal. Coding expert Kelly Dennis provides a comprehensive review of a major recurring—and evolving—topic in Reporting Postoperative Pain Management in 2014. ABC Vice President Joette Derricks brings us up to date on coding and payment developments in 2014 CPT Coding and Key Reimbursement Changes.

We hope that all of the information will help ensure a successful year for all of our valued readers.

With best wishes,

Tony Mira
President and CEO