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Spring 2010

Navigating The Recession Through Knowledge and Elbow Grease

Did the title of the first article in this issue of the Communiqué, Assessing the Impact of the Recession on Anesthesia, make you think that we were reporting bad news? We are pleased to note that data from our clients show that the recession had not on average, as of 2009, had a substantial impact on their practices.

ABC Vice President Jody Locke analyzed data from 20 large, representative anesthesia practices in 20 different states for the two-year period 2008-2009 and found that the total number of surgical and obstetrical anesthesia cases had increased by nearly 4.5 percent. While growth in the number of procedures was negative (9 percent fewer cases), only 1.4 percent of overall practice revenues (down from 1.6 percent) came from elective cosmetic cases. Health plan payments in 2009 were up 3.64 percent compared to 2008—but patient payments had dropped more than 8 percent, perhaps reflecting the cost shift from employers and health plans to employees, and individual loss of coverage.

On this last point, the subject of balance billing patients is of increasing interest. In his article Out Of Network Penalties: How Your Patients Can Help You Receive Payment In Full, Hal Nelson, ABC Director of Compliance and Client Services, discusses the potential benefits of a form letter explaining the process of appealing a claim denial sent to patients as soon the initial out-of-network penalty is assessed. Mr. Nelson also updates readers on the nuances of billing for postoperative pain management in the Compliance Corner.

As was also observed by Mr. Locke, hospitals are becoming more reluctant to support their anesthesiology departments through stipends. He concluded that trend awareness, strong negotiating talent and attentive customer service, above and beyond clinical excellence, can help make or break a practice—as has always been the case, in good economic times as well as in down markets.

Ensuring income in retirement and not just during the working years is very important to most anesthesiologists and nurse anesthetists. Josephine Ballard of ABC’s Financial Management team provides an overview of an interesting vehicle for increasing pre-tax contributions to retirement plans in Cash Balance Plans.

In the Fall 2009 issue of the Communiqué we introduced readers to the Shareable Ink® electronic anesthesia record, a system that is now being marketed as F1RSTAnesthesia Record (FAR) in partnership with ABC. In Shareable Ink® – Pilot Project, written by Kathy Payne, Vice President of Operations for ABC-Western Region, three key stakeholders reveal their impressions of the technology. FAR permits anesthesiologists to document cases using a digital pen on a familiar anesthesia record. It provides an uncomplicated and inexpensive bridge to a future Electronic Medical Record (EMR) and we invite you to learn more.

The articles summarized above give you a glimpse of the range of expertise found among ABC staff. We also benefit from the lengthy anesthesia experience of a number of lawyers in private practice. Giving a nod to the increased competition and the public relations imperative that characterize anesthesia practice today, Adrienne Dresevic, Esq. and Carey Kalmowitz, Esq., identify ways to reduce the risk that marketing efforts may violate the federal Anti-Kickback and Stark self-referral laws in Healthcare Marketing – Navigating the Regulatory Landscape. Abby Pendleton, Esq. reminds us that The Anesthesia Community Must Be Prepared for Increased Audit Activity by RACS and Others.

The business environment in which anesthesiologists practice becomes more challenging every year. Most of the challenges are external to the conduct of individuals and groups. The uncertainties of health care reform can paralyze hospital systems and surgery practices. Residency programs and nurse anesthesia schools may train too few providers – or too many. An anesthesia practice may bill perfectly for perioperative visits, only reporting visits that satisfy the definition of the level of evaluation and management service selected, and then be blindsided by an investigation by a RAC that doesn’t understand Medicare payment policy.

Knowing your own practice by tracking your clinical and financial performance benchmarks both internally and across the relevant market (local or national) puts you at an immediate advantage, however. Making sure that you understand the laws and regulations that have an immediate impact on your practice is equally important. We hope that our quarterly Communiqués and weekly Alerts are helping you with both of these endeavors

Tony Mira
President and CEO