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Spring 2017

On Congress, Carveouts and Crafting a Resilient Professional Identity

Much has happened on the healthcare legislative front since our last issue of Communiqué, published not long after the presidential election. Notably, the American Health Care Act of 2017 (H.R. 1628) (AHCA)—the House bill that would have repealed and replaced key provisions of the Affordable Care Act (ACA)—was withdrawn after failing to receive sufficient support. Just days after the defeat, however, House Speaker Paul D. Ryan signaled new determination, indicating plans to pursue a “two-track” effort to change the healthcare system, with White House press secretary Sean Spicer stating “We’re at the beginning of a process.”

As this issue of Communiqué goes to press, we don’t know what that process will look like or how it will unfold. But in Predictions for Healthcare in a Trump Era, Neda Ryan, Esq. compliance counsel for ABC, offers thoughts on some of the healthcare issues that will continue to matter to anesthesia practitioners during the next few years, with an emphasis on compliance and information technology security.

In Why Your Compliance Efforts May Be Worthless, frequent contributor Mark F. Weiss, JD tackles compliance from another angle, namely, the legal difficulties anesthesiologists and other physicians can find themselves in if they make certain kinds of deals and arrangements believing they are protected from federal scrutiny. “Federal prosecutors are demonstrating their willingness to charge healthcare providers and other scheme participants with federal crimes related to underlying state law violations, including those in respect of state laws that have nothing in particular to do with healthcare fraud and abuse,” writes Weiss. “For a variety of reasons, not the least of which is that the federal government collects huge multiples in settlements and fines for every dollar put into investigating and prosecuting physicians and others for healthcare-related crimes, physicians, other providers and facilities now have targets painted on their backs.”

Compliance headaches of all kinds, including the time and effort required to meet healthcare’s stringent and occasionally unfathomable regulatory requirements, are often cited as key contributors to physician burnout. But, as anesthesia providers know, compliance issues are only one of a constellation of factors that can leave physicians feeling empty and drained.

In her first article for Communiqué, organizational psychologist Brianna Barker Caza, PhD of the University of Manitoba contends that professional identity also plays a role, especially when that identity is idealized and reality doesn’t match expectations. The more idealized the image, the shakier the ability to bounce back from stress and the higher the burnout risk, argue Dr. Caza and co-author M. Teresa Cardador, PhD, MPH of the University of Illinois at Urbana-Champaign. Anesthesiologists can boost their resilience by cultivating a broader, more flexible professional identity that breaks free of the highly specialized and narrow sense of professional role and duties often wrought by medical training and socialization, they suggest.

While broadening their professional identities, anesthesiologists might consider exploring new ways to broaden their responsibilities in the hospitals they serve. One relatively untried possibility is leadership of the intensive care unit. As ABC Vice President Jody Locke, MA suggests, “In the current environment where the focus of payment reform is on bundled payment arrangements, it may be time to review what were once considered core competencies of anesthesiologists and reassess the strategic opportunity to enhance the scope of the relationship between the anesthesia practice and the facility.” The goal of an anesthesiologist-led ICU is not to generate revenue, he asserts, but rather, for anesthesiologists to enhance the quality of critical care medicine and to position themselves favorably for the future of hospital contracting by applying their clinical skills in different ways to support their organizations’ strategic and financial goals.

Also in this issue, ABC Vice President Gregory Zinser provides a strategy to help anesthesiologists achieve their personal financial goals for retirement. The model he presents can be used to answer such key financial planning and retirement questions as “How long do I need to continue income-producing activities?” and “What average annual investment return is needed to cover all anticipated expenses between now and the end of life expectancy?”

Finally, we welcome back consultant Will Latham, MBA who probes the fundamentals of effective governance, including the differences between governance and management, the importance of delegating authority and determining when a supermajority vote is and is not warranted.

This year’s Advanced Institute for Anesthesia Practice Management in Las Vegas promises to enlighten participants with sessions on group practice strategy issues, compliance, billing, coding and more. We look forward to seeing many of you there.

With best wishes,

Tony Mira
President and CEO