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Winter 2013

Anesthesia Cliffhangers and Reprieves

Over the New Year holiday, Congress finally passed legislation to stop the U.S. economy from going over the fiscal cliff. The new law included a temporary reprieve from the 26.5 percent cut provided for by the Medicare Sustainable Growth Rate (SGR) formula. There will be no SGR reduction throughout 2013—a development that lets us all breathe a deep sigh of relief, even though the formula itself, and its future depredations, are still in the law. Medicare payments to physicians and hospitals are not inviolate for the coming year, it must be noted: automatic two-percent reductions will hit Medicare as part of the “sequestration” process just two months from now if Congress and the White House do not reach another deal.

For many anesthesia practices, the runup to negotiations with hospitals and payers is a cliffhanger—indeed, even contemplating future negotiations often feels precarious. Last year, one of the national anesthesia practice management companies (APMCs) acquired no fewer than eight independent and largely successful anesthesia practices. Other APMCs were just as busy. Consolidation in the health care industry, combined with the shift from paying for procedures to paying for “value,” loomed large in the guise of nonstop discussions of accountable care organization (ACO) formation.

Can anesthesia and pain medicine practices continue to do well by providing excellent patient care—without making real changes to adapt to new definitions of “value” in the health care environment? Michael Hicks, MD, MBA, chief executive officer of EmCare Anesthesia Services in Dallas, TX answers that question with a thought-provoking and well-reasoned “no” in Disruption and the Theory of the Anesthesia Business which starts on page 1 of this issue of the Communiqué.

Dr. Hicks applies Peter Drucker’s “theory of the business” model to the anesthesia department and shows that assumptions about being irreplaceable can come from the wrong questions. Instead, the department or the group should be looking at “abandonment” of products that do not meet the current reality: “For example,” Dr. Hicks asks, “if one were given free rein to design a preoperative care system today would it function and be paid for as it is today? Would it have the same kinds of clinicians used in the same kinds of ways?” As an anesthesiologist, Dr. Hicks has the standing to ask that everyone take an objective look at the role of emergency and gastrointestinal physicians, registered nurses and hospitalists from the point of view of noncustomers. As CEO of a national physician practice management company, he also has the standing to warn colleagues about the perils of poor leadership—particularly the fragmented and sluggish decision-making of overly democratic practices. The lack of disciplined and strategic leadership leaves the anesthesia marketplace wide open in many areas. It also beckons new leaders with innovative ideas about perioperative services and various forms of “disruptive innovation,” in the phrase of Clayton Christensen.

While figuring out and preparing for new paradigms, our readers must of course attend to the immediate and more familiar challenges of anesthesia and pain practice. A number of articles in this issue offer tools for that purpose, starting with Part II of Neda Ryan, Esq.’s Survey of State Prompt Pay Laws covering Montana through Wyoming (Part I, covering Alabama through Missouri, appeared in the Fall 2012 issue of the Communiqué). Other updates include a new Patient Checklist from the Institute for Safety in Office-Based Surgery by Noah Rosenberg, MD and Fred Shapiro, DO; an expanded list of reasons Why You Need a Quality Management Program by Richard Dutton, MD, MBA, and a discussion by Christopher Ryan, Esq. and Neda Ryan, Esq. of important new language in the National Correct Coding Initiative (NCCI) edits in Reporting Post-Operative Pain Management Procedures in 2013. Also on the topic of compliance, ABC Vice President Joette Derricks, CPC summarizes Three Common Issues that appear on a recent CMS contractor medical directors’ list of problem claims.

In More Ingredients for your Alphabet Soup, our newest contributor, Christine Sikora, practice administrator at Hartford Anesthesiology Associates, Inc. explains the requirements and uses of the Joint Commission’s medical staff evaluation tools, the Ongoing Professional Practice Evaluation (OPPE) and the Focused Professional Practice Evaluation (FPPE). Done properly, the OPPE/FPPE process can help anesthesia groups demonstrate the value that they bring to their hospitals.

Rounding out the Winter Issue, ABC Vice President Jody Locke, CPC discusses Is Big Better?from the point of view of a prototypical hard-working, high-quality anesthesiologist whose fifteen-physician group has been negotiating a merger with a larger practice. Mr. Locke conducts a tour de force of the concerns that will preoccupy any anesthesiologist confronted with a major practice reconfiguration. His article is, indeed, a profound counterpoint to Dr. Hicks’s discussion of the imperatives of the changing nature of anesthesiology and perioperative medicine. There can be little argument that the assumptions underlying the business of anesthesia must evolve. What remains constant, of course, and what causes such arduous self-examination is anesthesiologists’ “professional commitment to compassionate care for their patients.”

Dr. Hicks stated explicitly that he hoped to provoke meaningful discussion, a hope that I share. All of us at ABC look forward to continuing the discussion and successfully navigating the challenges with you in the year ahead.

Tony Mira
President and CEO