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Summer 2012

Quality, Safety and Practice Management

Tony Mira, President and CEO

Does the title of this article seem boring—or “timeless,” for readers in a more generous mood? If the answer to either question is yes, that is not altogether a bad thing. The United States Supreme Court decision upholding the Patient Protection and Affordable Care Act alleviated much uncertainty about healthcare reform and all of its ramifications, at least until after the November elections. Trends in the delivery of healthcare that began some time ago will continue. “The coming years will bring continued dealmaking and greater scrutiny of hospital and physician performance on quality and cost control,” as speakers said at the June 2012 Healthcare Financial Management Association Annual National Institute. Quality, safety and practice management are as important as ever to the future of anesthesia practice.

Richard P. Dutton, MD, MBA, Executive Director of the Anesthesia Quality Institute, bridges the small valley between traditional mortality and morbidity (M&M) conferences and the AQI’s newest database in the article that begins this issue of the Communique, Puttin’ on AIRS. AIRS in this context is the Anesthesia Incident Reporting System.

A national M&M system, AIRS is open to “any unintended event related to anesthesia or pain management with the significant potential for patient harm,” such as unusual reactions to medications or medical equipment failures. Reported hits and near misses serve to alert to trends in new events and to allow the AIRS Steering Committee to publish case reports of exceptional teaching value in the ASA Newsletter. We urge readers to accept Dr. Dutton’s invitation to “go play around with” the report form on the AIRS website to see this important new tool for themselves.

Another very important anesthesia safety database consists of the loss data collected by the well-known professional liability insurance company dedicated to our specialty, Preferred Physicians Medical (PPM). Brian J. Thomas, Esq., PPM’s Director of Risk Management, alerts us to the rise in allegations of negligence involving OSA patients in his article Obstructive Sleep Apnea: The Not-So-Silent Killer (a subtitle some of us can appreciate all too well). The growing number of OSA-related claims is not surprising, given the steady increase in the proportion of obese Americans. Mr. Thomas’s review of the clinical challenges and protective measures presented by patients with OSA is a good lesson on the issues that might determine the outcome of a malpractice claim.

Anesthesiology and pain medicine, like all areas of medical practice, face practice management risks as well as patient care risks. One that has surfaced only in the last few years is the exposure that comes with physicians’ use of social media – Linked In, Facebook, Twitter, YouTube, blog sites and others. Neda Mirafzali, Esq. provides an introduction to the ethical, legal and marketing landmines (and the benefits) of a public online presence in her article Social Media Policies: Do I Really Need One?

At the top of the list of anesthesia practice management issues is hospital contracting. ABC Vice President Jody Locke, CPC discusses ”New Rules for a New Era” in his article of that title. Negotiating a contract is likely to be much more challenging than it was the last time readers sat down to the task. Decisions on not just the fact or the amount, but on the specific method and data for calculating payments for the services that anesthesia groups provide to hospitals, require more preparation and sophistication than ever. And the time to start planning for the next round of negotiations begins as soon as the final signature is placed on the one just negotiated. As Mr. Locke also points out, however, in a sense “We have come full circle. With each day that passes the business of anesthesia practice management starts to resemble the practice of anesthesia: careful training, timely and reliable data and the willingness and commitment to make bold decisions quickly are the only prerequisites of success.”

Hospital Contracting: New Rules for a New Era notes the importance of data in negotiating the hospital contribution to the group’s income. ABC’s newest Vice President, Joette Derricks, reminds us of some of the reasons why we don’t take data at face value in her complementary article Understanding What Statistics Say, or Don’t Say, About Your Practice. Client Services Director Arne Pedersen, MBA, FACMPE describes another evolving factor in anesthesia groups’ net revenues, the growth of health benefit plans that increase the patients’ out-of-pocket expenses, and strategies to maximize collecting deductibles in his article Deductibles: Impact on the Physician.

The fact that there is always something new to write about anesthesiology and pain medicine quality, safety and practice management makes our authors’ task interesting, to say the least. At the same time we enjoy being able to build on a wealth of experience in many, many areas. We are always mindful, nevertheless, that our physician, nurse anesthetist and anesthesiologist assistant readers entered their professions in order to provide clinical care – not necessarily in order to study the business and policy of health care. It is our ongoing hope that we make it easier for MDs, CRNAs, AAs and their practice management advisors to stay on top of our topics of mutual interest.


Tony Mira
President and CEO