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Fall 2014

The Challenges are Great—And So Is the Expertise in Our Specialty

No fewer than four experts in anesthesia practice management have contributed articles to the Communiqué for the first time in this issue. We are struck—not for the first time—at both the vast knowledge reservoir in our community and the generosity of so many professionals who go the extra mile to share their expertise. Let us take this opportunity to thank our regular authors and especially newcomers Danielle Reicher, MD; Steve Boggs, MD; Pat Everett, CPA, CMPE and Ron Booker, JD, CPA.

Anesthesiologists have been seeking out the best electronic health record systems (EHRs) to improve data collection for both clinical and administrative purposes, not to mention for purposes of qualifying for the Medicare Meaningful Use payment incentives. Dr. Reicher describes a specific and very important application of EHR technology in Making Meaningful Use More Meaningful: communicating with patients. Have you thought about the value to the patient of documenting the medications and doses given and any unusual reactions or airway difficulties, particularly if the patient has concerns about anesthesia? In one of her examples, Dr. Reicher notes that anesthesiologists may sometimes “observe hives or anaphylaxis after giving a combination of medications. We know that the most common allergic reactions are due to antibiotics or muscle relaxants. … We may need to refer the patient to an allergist and we certainly want them to be aware of all the medications they received. All of this information can be recorded in the electronic record after a thorough discussion with the patient.” Does this not suggest an excellent way of affirming the role of the anesthesiologist in the management of the entire perioperative episode? And as Dr. Reicher, who has been recording her patients’ care through F1RSTUse for several years, makes clear, EHRs are an excellent way to “become more engaged with our patients and the healthcare system in general.”

One of Dr. Boggs’s areas of particular interest is GI sedation—an interest that is sadly timely, with the September 4 death of comedienne Joan Rivers a week after undergoing an endoscopic procedure during which she suffered a cardiac arrest. For the past several years, Dr. Boggs has been working closely with endoscopists at Mount Sinai in New York and elsewhere, evaluating turnover time and safety metrics. He will be presenting both at a Point-Counterpoint session and on a panel at the ASA Annual Meeting in New Orleans in October, and he gives us a detailed preview of his arguments in Computer-Assisted Personalized Sedation (CAPS): Will It Change the Way Moderate Sedation is Administered? We were pleased to have the opportunity to provide Dr. Boggs with claims data showing that the cost of anesthesia and anesthesia providers may be quite competitive with cost of CAPS.

Pat Everett’s name is very familiar in the anesthesia community. In his article Anesthesia Practice Attributes Your Hospital Leadership Teams Value Most, Mr. Everett distills an extraordinary amount of hands-on experience with both anesthesia providers and hospitals into a list of the top five attributes of highly successful anesthesia groups with whom he has worked. The list starts with “strong leadership.” The idea that leaders should be strong is familiar enough—but does everyone realize that the kind of strong leadership that really matters to hospitals entails the ability to make decisions quickly, without the “need to take this back to my group first?” Another attribute of a great group is consistent application of clinical standards and protocols to patients across all the anesthesiologists in the group. Read Mr. Everett’s article and take very seriously his conclusion that what hospital leaders want most is “a group of anesthesia professionals who ‘fly under the radar’ and about whom they rarely hear complaints.”

Look closely, too, at The Value of a Quality Practice Administrator, written by another extremely experienced anesthesia practice administrator, Ron Booker. There is more—much more—to the business side of anesthesia than revenue cycle management; anesthesiologist, CRNA and AA recruitment and retention, and managed care and hospital contracting. Mr. Booker uses carefully chosen examples of typical and atypical practice challenges to show the value of a high-quality administrator who possesses sound skills in four essential domains: decision-making, problem-solving, communication and relationships.

Laura Dyrda’s is another new name in the Communique—but Ms. Dyrda is in fact well known and much appreciated under her previous byline, Laura Miller. Ms. Miller serves as the Editor-in-Chief of Becker’s ASC Review and Spine Review. An ever-growing majority of anesthesiologists, CRNAs and AAs provide services at ambulatory centers and certainly need to be sensitive to the specific pressures weighing on the facilities with which they partner—or hope to partner. Ms. Dyrda’s summary 10 Concerns Facing ASCs Heading Into 2015 highlights concerns that may not be immediately apparent to clinicians, such as the lack of any government incentives to begin using EMRs like those offered to hospitals and physicians, patient familiarity with outpatient surgery and competition with hospitals to recruit physicians.

We welcome returning contributor Rick Dutton, MD, MBA who brings us up to date on a vitally important new mechanism for anesthesia professionals to report performance data to Medicare: The Qualified Clinical Data Registry (QCDR). Going forward into 2015 and beyond, physicians must report such data to Medicare in order to avoid payment penalties under both the Physician Quality Reporting System (PQRS) and the Value-Based Modifier program. The claims-based method of reporting that most anesthesiologists have used to date is being phased out in favor of registries. At the same time, the number of quality measures that physicians must report in order to avoid penalties is increasing. The National Anesthesia Clinical Outcomes Registry (NACOR) run by the Anesthesia Quality Institute (AQI), which is headed by Dr. Dutton, solves both problems by having obtained QCDR certification. Dr. Dutton will be presenting at the ASA Annual Meeting and we encourage you to hear him as well as to read his article.

Within ABC, we have a wealth of knowledge that it is also our privilege to share in these pages. Darlene Helmer, Vice President of Provider Education and Training covers Medicare’s Modifier 59 Expansion in this issue’s Compliance Corner. Joette Derricks, Vice President of Regulatory Affairs and Research, alerts readers to Potential Revenue Losses with Health Insurance Exchange Patients Due to Premium Payment Default. Both article titles are mercifully self-explanatory!

Let me once again express our deep gratitude to the anesthesiologists, administrators, journalists and compliance and regulatory experts who have given us the content for this issue of the Communiqué. The sophistication and energy of all these individuals benefits and inspires us all.

With best wishes,

Tony Mira
President and CEO