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Spring 2018

On Waivers, ASCs and Independent Anesthesia Practice

The rules pertaining to waivers of copays are certainly worth understanding. “It is an understatement to say the consequences of inappropriate waiver practices are significant,” write returning authors Frank Carsonie, JD, and Nathan Sargent, JD, in their lead article for this Communiqué.

In the current era of increased federal and state governmental scrutiny, anesthesia practices must do all they can to avoid the appearance of impropriety. The safest course is to avoid granting copay waivers as a matter of policy, except in cases of well-defined and documented hardship. “There are ways for healthcare providers to grant waivers compliantly,” they note, but “the critical point is to understand what is permitted and what is not.” Mr. Carsonie and Mr. Sargent address the finer points of this topic.

Also in this issue:

  • Howard Greenfield, MD, of Enhance Healthcare Consulting and Jody Locke, MA, of Anesthesia Business Consultants explore strategies for success in today’s market as an anesthesia provider in ambulatory settings. Circumstances are not what they once were. “Never has it been so important to exercise rigorous due diligence and to objectively evaluate the potential benefits and risks,” they stress. “In the past, relationships with most ambulatory facilities would only enhance an anesthesia practice. This is no longer the case. The three rules of success are: 1) know what you are getting yourself into; 2) make sure the numbers make sense; and 3) monitor performance closely and continuously.”
  • Roseanne M. Fischoff, MPP, economics and practice innovations executive with the American Society of Anesthesiologists, shares stories and lessons learned from participants in the ASA’s Perioperative Surgical Home (PSH) Learning Collaborative, an initiative launched in 2014 to further the team-centered, patient-centered model of care that is gaining traction within the specialty and expanding the anesthesiologist’s role. Improvements made using this innovative paradigm in different types of facilities continue to show it to be “a viable and effective care model that can be incorporated into institutions of any size and for a wide variety of procedures and modalities,” she writes. The ASA program’s third iteration, the PSH Learning Collaborative 2020, soon to begin, will assist participants in PSH pilot implementation, optimization, expansion and the transition to value-based care.
  • Robert Johnson, MBA, of Enhance Healthcare Consulting looks at call responsibility among anesthesiologists—a subject about which very little is really known. Mr. Johnson reviews the findings of a recent survey and outlines his firm’s plans for future research in this area.
  • Mark F. Weiss, JD, offers perspective on dealing with the anesthesia services request for proposal (RFP), stressing the importance for anesthesia practices of reinforcing group cohesiveness and developing “a true business that is broader than based simply on one hospital, so that you can negotiate from a place of strength.”
  • In an era of widespread consolidation within anesthesia, Will Latham, MBA, of Latham Consulting Group, speaks out in support of independent anesthesia group practice and explores how groups that wish to remain independent can do so. First, realize that it won’t be easy, he states: “If your goal is to stay independent, there is work to be done.” Strengthen group governance, develop a cohesive strategic plan, consider mergers, build effective relationships with hospital leaders, deal quickly and decisively with disruptive group members, and pursue new business opportunities, Mr. Latham recommends.

Again this year, the Advanced Institute for Anesthesia Practice Management will offer a wealth of learning and networking opportunities on group practice strategy, compliance, billing and coding, and other topics. We look forward to seeing many of you in Las Vegas.

With best wishes,

Tony Mira
President and CEO