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Fall 2016

Anesthesiologists and the Changing Healthcare Landscape

As we noted in our eAlert on the topic, the medical community’s transition to the International Classification of Diseases and Related Health Problems 10th revision (ICD-10) has, contrary to expectations, gone fairly well so far. In fact, it has gone much better than anticipated, with rates of claims denials remaining essentially unchanged before and after the new system’s initial rollout. Does this early success mean that the ICD-10 transition will be smooth sailing from here on out, now that the “grace period” has ended?

As ABC Vice President Jody Locke tells us in What Do We Really Know About ICD-10’s Potential Impact on Anesthesia?, while it is unlikely that payers will radically alter their usual practices by beginning to hold anesthesia claims to match them against the surgical claim, we can’t say this with certainty. Mr. Locke urges anesthesia practices to stay abreast of potential trouble spots and to “prepare for the worst and be relieved when it turns out payers are as reluctant to change their behavior as providers.”

Another pressing regulatory issue is the second round of audits by the Health and Human Services Office of Civil Rights—now including business associates—of compliance with the Health Insurance Portability and Accountability Act (HIPAA). The audits are intended to improve compliance, writes Neda Ryan, Esq, but “OCR also maintains its right to launch a more thorough investigation into an organization that it discovers, or believes, to pose a threat to the privacy and security of individuals’ protected health information.”

Kathryn Hickner, Esq, delves into the Comprehensive Care for Joint Replacement Model (CJR Model), an alternative payment program. Unlike many other programs to come out of Center for Medicare and Medicaid Innovation, the CJR Model is not voluntary. It behooves us to know more about this program, which applies to items and services provided to Medicare beneficiaries.

HIPAA, ICD-10, CJR and the plethora of regulatory requirements—and long hours clinicians spend complying with them—can sap professional passion. So can clinical responsibilities in the operating room when those responsibilities become repetitive, routine and lacking in opportunities for professional growth. In The Perioperative Surgical Home: Invest in Good Will, his fifth in a series of six articles, Rick Bushnell, MD, MBA, describes the potential of this care delivery model to rejuvenate the specialty, rekindle enthusiasm and reinvigorate careers.

The renewed excitement for one’s specialty that can come from expanding anesthesiology’s role in the delivery of value-based care is one thing; the collective soul-searching required to develop a cohesive strategic plan with colleagues in one’s anesthesia group is another. It’s an essential activity physicians often avoid, hoping it will magically take care of itself, either because they don’t perceive its importance or because they fear it will lead to conflict, according to consultant Will Latham, MBA. To help quell these fears, Mr. Latham offers a straightforward strategic planning primer.

In Anesthesia Mergers and Acquisitions and Post-Termination Obligations: Have You Terminated Your Future?, Mark F. Weiss, JD, explores an aspect of group practice that is particularly relevant in the current environment of heightened merger and acquisition activity—namely, what happens when an anesthesia group is acquired and the contract includes “post-termination obligations”—provisions, such as covenants not to compete, that survive the nominal term of the agreement. Mr. Weiss cautions anesthesia practices to “take into account exactly what it is that you are selling and what its value is.”

Non-compete agreements “are crucial to securing the value of the practice,” note Amanda K. Jester, JD, and Ashleigh VanLandingham, JD, in their first article for the Communiqué, What Anesthesiologists Need to Know About Enforcement of Non-Compete Agreements. “Failure of the covenant to meet technical elements for enforceability can be fatal,” they warn, stressing the importance of regular reviews of applicable state statutes and case law and adjustments in covenants and the practice’s overall strategy to ensure that the covenants remain enforceable.

We hope to see many of you at the American Society of Anesthesiologists annual meeting in Chicago, October 22-26.

With best wishes,

Tony Mira
President and CEO