Communique Fall 2015

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    Our Pacific Valley Medical Group (PVMG) in Pasadena, California consists of 29 partners. Were an independent, single specialty group primarily serving Huntington Memorial Hospital and Shriners Hospital for Children, Los Angeles. We love our practice, our hospi-tals and our community, and as a group we think we do a great job. As is true for most anesthesia practices, the delivery of our standard, elective anesthetic involves meeting a patient three minutes ahead of time, delivering anesthesia in the OR, landing that person in recovery and moving on to the next; wash, rinse and repeat. We delegate pre-operative management and post-discharge care to others. But


    Continued on page 6

    The PerioPeraTive Surgical home: righT

    for our grouP? Rick Bushnell, MD, MBA

    Director, Department of Anesthesia, Shriners Hospital for Children, Los Angeles, CA and Huntington Memorial Hospital, Pasadena, CA

    Anesthesia Business Consultants is proud to be a











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    e Organization Control Reports

    S E R V I C E O R G A N I Z AT I O N S

    The Perioperative Surgical Home: Right for Our Group? . . . . . . . . 1The Future Aint What It Used To Be . . . . . . . . . . . . . . . . . . . . . . . . . 2Improving Board Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Stark 101 for Anesthesiologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Anesthesia Informatics: The Future is Upon Us . . . . . . . . . . . . . . 11Ensuring the Hospitals AIMS Produces the Business Information Your Practice Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Managing the L Word in Your Practices Retirement Plan (Liability, That Is) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20A Basic Primer on the Bundled Payments for Care Improvement Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Event Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24


    The fuTure ainT WhaT iT uSed To Be The late great Yogi Berra was famous for his humorous and wise observations. It is true that the future aint what it used to be. Until a few years ago, the future did not encompass the perioperative surgical home (PSH), but the potential impact of the PSH model cannot be doubted now. It is hard, if not impossible, to argue with the relevance of the model as value-based purchasing takes hold within the governmental and private payer markets. The lead article in this issue, The Perioperative Surgical Home: Right for our Group? by Rick Bushnell, MD, MBA, a private practice anesthesiologist in Southern California, is a shining example of the response that the proponents of the PSH hoped to bring about. The PSH is emphatically right for Dr. Bushnells groupa single specialty private practice, which, like many others, has been successful at providing traditional surgical anesthesia care but is wondering not just how to survive, but rather whether this is the best we can do. This is such a refreshing perspective: the PSH seen as an opportunity to elevate our own practice of anesthesia and as something much more than a defensive strategy. Because the three-minute pre-op interview often shortchanges the patient and the patient-anesthesiologist relationship, Dr. Bushnells group plans to place a physician in the clinic to see patients both pre-operatively and following discharge. The group has recognized that anesthesiologists must expand their skill sets in order to be effective in providing pre-op and post-op care. By the time you read this, Dr. Bushnells group will have participated in a PSH strategy meeting hosted by one of their hospitals. We look forward to keeping you posted on the progress of the venture in a series of follow-up articles. The future not being what it used to be, but being, in fact, much more challenging, anesthesia practices must have leadership that is performing well. Readers who serve on their groups Boards of Directors will probably recognize some of the behaviors that can undermine performance in the newest article by Will Latham, MBA, CPA,

    of Latham Consulting Group: Improving Board Performance. They will also benefit from seeing to it that present and potential Board members understand their role and responsibilities, which Mr. Latham lays out succinctly while also explaining when and how to remove dysfunctional Board members. Many anesthesia group Boards will at one time or another contemplate a practice-related financial relationship that implicates the federal Stark law. Over the last 25 years, an impressive mythology has grown up over what is, and what is not, a Stark violation. Understanding the basic principles of this complicated law is important, if only to avoid wasting time worrying about how it might apply when it actually is not in issue, and the 10-point primer offered here by Kathryn Hickner, JD of Ulmer & Berne, LLP (Stark 101 for Anesthesiologists) will help groups focus on what they need to know. A less familiar legal risk for anesthesia groups that offer retirement programs including 401(k) plans is the responsibility of the plan fiduciary. The fiduciary may be a member of the group, or the group may engage an investment firm or professional. Patrick Runyen, CPA, CFP of Independence Advisors sets out some of the liabilities to which anesthesia groups, as plan sponsors, may be exposed in Managing the L Word in Your Practices Retirement Plan (Liability, That Is). The future is not what it used to be in the realm of anesthesia practice management, either, ABC Vice President Jody Locke reminds us in Anesthesia Informatics: The Future is Upon Us. Whether we like it or not, while a pen, an anesthesia record and a good billing agent used to be the essential keys to financial success, a whole new set of high-tech tools is becoming necessaryspecifically with the requirements of PQRS and QCDR reporting, the meaningful use program and ICD-10 coding. Those new tools will also be called for participating in alternative payment models forthcoming from Medicare. Although few anesthesiologists are participating in the early versions of these models, which ABC

    Vice President Joette Derricks summarizes in A Basic Primer on the Bundled Payments for Care Improvement Initiative, reviewing the fundamentals of the BPCI Initiative will held to prepare readers for the further efforts CMS is going to undertake to meet its goal of having 50 percent of Medicare payments in alternative payment models by 2018. One cannot help but ask the question raised by Mr. Locke: At what point does the provision of care become less relevant than the documentation of the care? The question is, of course, rhetorical at this point. Anesthesia practices simply must make the necessary investments in information technology and accept their responsibility for seeking to make healthcare accountable and more cost-effective. Jessica Kovash, CHTS-PW, of Koratek Perioperative Consulting, LLC takes a pragmatic look at anesthesia information management systems in her article Ensuring the Hospitals AIMS Produces the Business Information Your Practice Needs. Whether your hospital is looking at a new AIMS implementation or already has an AIMS in place, there are steps you can take to make sure it turns the data captured by the system into the business information your practice needs. Changing healthcare delivery models and payment systems, and the information technologies that are ever more integral to the new models, present us with enormous opportunities as well as challenges. We take comfort in the conclusion that most anesthesiologists, like the public, know that healthcare can be much better. I, for one, believe that we are getting there.

    With best wishes,

    Tony MiraPresident and CEO

    Th e Co m m u n i q u Fa l l 2015 Pag e 2ANESTHESIABUSINESS CONSULTANTS


    The Scene: Monthly Board Meeting

    Gotham Anesthesia Associates is a 45-physician anesthesiology group providing services to patients in and around Gotham, New Jersey. Several years ago the group agreed that it was too large to have all members of the group involved in every issue the group considers. At the time they developed a five-physician Board that was to guide the day-to-day, week-to-week operations of the group. The group settled on five members to allow for representation of each of the major service locations and/or sub-specialty area. The Board meets once a month at 6:15 PM. Unfortunately, typically only Dr. Jones (the groups President) and the Administrator are present at 6:15 PM. Other physicians join the meeting at various points and business typically gets started by 6:45 PM. Dr. Peters never arrives before 6:45 PM because, he says, we never start until then anyway. The groups agenda is sent out three days in advance of the meeting, with back-up information. Drs. Jones, Peters and Thompson always review this information thoroughly before coming to the meeting. Dr. Smith typically looks over just the agenda. Dr. Roberts gets his agenda and information from the Administrator when he arrives at the meeting. At the beginning of the meeting