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Winter 2015

From Monologue to Conversation

 Dear Readers, We are entering the new year determined to enhance our engagement with you. Many of you have provided us with comments and questions on articles in past issues, opening the door to new topics and new contributors and at the very least to different perspectives.

If you have read previous issues of the Communiqué, you know that more and more of our content reflects reciprocal and often iterative learning. It is time to open up this process. We want to hear from you. Beginning with the Spring issue, we will add a “Letters to the Editor” section and we hope that you will write to us ( with your observations on any item that has caught your interest. We will forward all correspondence to the author(s) of the article so that they may respond to your comments or queries, and we will do our best to supplement the authors’ responses in future “Letters to the Editor” pages wherever our own replies are likely to contribute to a useful discussion. Publication of your letters in the Communiqué will remain subject to our discretion, as we’re sure you will understand.

You may have noticed an increasingly conversational format in recent articles. The give-and-take between experts such as Michael Hicks, MD, MBA, and Joe Laden in their article Point-Counterpoint: Do National Anesthesia Management Companies Increase Revenues for Acquired Groups? is a stellar example of the genre. This discussion began in an electronic list serv on the website of the Medical Group Management Association-Anesthesia Administration Assembly, of which both Dr. Hicks and Mr. Laden are members. When they began exchanging views on the relative benefits of exchanging cash flow today for an equity stake or other potential for wealth creation in the future, it was not at all clear that the conversation would turn to the role and value of salary surveys, as it did in their article. There is a strong disincentive for financially successful practices to participate in such surveys—which by their nature show averages below the levels achieved by the leaders—when the surveys are used for prospective salary-setting. As Dr. Hicks says, “the provision of anesthesia services is now a regional and national business and there are many valid business and legal reasons for not sharing revenue and expense information even in the aggregate even though this information has previously been willingly provided.” Thus the dialogue between Dr. Hicks and Mr. Laden has ended up introducing an important topic that has not been touched on previously in the Communiqué—the inherent limitations of compensation surveys in a consolidating marketplace.

Richard Dutton, MD, MBA and Matthew Popovich, PhD also use a conversational approach in their article on the ASA-Anesthesia Quality Institute’s Quality Clinical Data Registry, QCDR Made Simple—Ha! The conversation here, however, is between an unseen interlocutor who asks the questions so many of you are raising about the QCDR, and the QCDR’s designers/managers, for example, “What are my options?” and “What measures can I report on?” It is a format that should make it easier for readers to assess whether and how to participate in reporting to the QCDR, even as the registry and its requirements continue to develop.

In Phoenix Project: Reconstructing a Local Group from the Ashes of its Predecessor, Mark Weiss, JD uses his own hallmark conversational style, notable for its direct challenges to readers (“Even if the hospital hasn’t expressed a preference, you know who shouldn’t remain at the facility, so why fool yourself at the cost of your own future?”) as well as its upbeat conclusions (“the death of an anesthesia group can be leveraged into the birth of a new one.”)

Some of the most useful material presented in our publications comes from the pragmatic conversations that our writers have with our readers and other members of the anesthesiology community that morph into ideas for more generalized education. Understanding the Impact of Individual Exchange Plans on Anesthesia Practices by ABC’s own Jody Locke is one such article. Mr. Locke walks readers through the mechanics of estimating the dollar impact of participating in one or more of the Obamacare Exchanges. The higher patient cost-sharing responsibilities under these health plans drive not just accounts receivable management but also contracting strategies and even prepayment policies.

Still more information that you can use in your practice throughout the year are staff articles on Current Procedural Terminology® (CPT) code changes for 2015, on ICD-10 coding and on the National Practitioner Data Bank.

Please do send us your ideas on additional topics you would like to see addressed—or to address yourself!—as well as your comments on any of the information, suggestions or conclusions contained in this issue. We are looking forward to the next stage in our ongoing conversation with you.

With best wishes,

Tony Mira
President and CEO