ach year ASA sponsors a Conference on Practice Management. Usually held the first weekend in February, it brings together anesthesiologists, administrators, consultants and regulators to review the business of anesthesiology. Speakers cover economic, professional, marketplace, regulatory and organizational aspects of the specialty.

The Conference on Practice Management rotates among cities, most recently in San Antonio, Texas, La Jolla, California, and Ft. Lauderdale, Florida. The 2005 conference will meet in San Francisco, California, at the Grand Hyatt Hotel, February 4-6. Structuring the conference for audience participation and break-time networking means limiting attendance to 400 to 500 people. Since the conference usually sells out, early registration is desirable. Information will first appear on the ASA Web site in October.

Speakers at the 2004 conference included 11 anesthesiologists, three lawyers, two practice administrators, one business consultant and one federal regulator. Most of the anesthesiologists lead large groups or have business degrees; all have information useful for anesthesiology practices. New at the 2004 conference was a session with discussion tables that was led by speakers and practice management committee members. Attendees rated the small-group discussions very highly, and we will repeat this in 2005. Table 1 shows the 2004 discussion table topics, and Figure 1 (below) portrays the collegial and interactive format.

Figure 1. Robert E. Johnstone, M.D., and Lydia A. Conlay, M.D., Ph.D., lead a discussion of academic anesthesiology practice management issues. (Photo by Steven L. Sween, M.D.)

The Committee on Practice Management oversees the organization of the conference. Committee members seek the best speakers on the hottest topics and carefully consider how attendees rated presentations at the most recent conference. Proving particularly popular in 2004 were Judith J. Semo, Esq., speaking on “Hospital Stipend Negotiation,” Ann S. Lofsky, M.D., on “Medical Malpractice Insurance,” and Alexander A. Hannenberg, M.D., on “The Future of Payments for MAC and Sedation Services.”

Ms. Semo, a lawyer with Squire, Sanders & Dempsey in Washington, D.C., is known to anesthesiologists as the primary author of “Starting Out: A Practice Management Guide for Anesthesiology Residents.” In her talk, she related that “increasing financial pressures, combined with a shortage of anesthesiologists and nurse anesthetists, have forced many anesthesiologists to seek financial assistance from the hospitals at which they practice.” She offered advice on how much assistance to request, how to structure the payments and how to negotiate the arrangement.

Dr. Lofsky, a California anesthesiologist and director of the Doctors Company, discussed how malpractice liability insurers view anesthesiologists and provided some industry statistics. Only 8 percent of death claims result in indemnity payments, but these payments average $225,000 to the decedents’ families. The indemnity for brain damage cases averages $630,000 per claim paid. Two emerging areas of risk are ischemic optic neuropathy and sleep apnea after postoperative narcotic medication.

Dr. Hannenberg, ASA Vice-President for Professional Affairs, reviewed the rise of medical necessity policies due to concerns by payers about the legitimacy of monitored anesthesia care services. He also described an increasing interest in anesthesiologist-administered sedation, especially for endoscopy, but without consensus on how to pay for it. Comparing the fees resulting from reporting sedations under anesthesia codes with those for the underlying procedure shows wide variances ($57 versus $420 in one example) that anesthesiologists should understand. He predicted changes in coding and payments for procedure sedations.

Other popular talks that illustrate the breadth of topics include “Practical Issues in O.R. Management,” “Understanding the Hospital/Anesthesia Group Relationship,” “Calculating the Cost of Covering a New Facility,” “Measuring Clinical Productivity for Anesthesiology” and “Academic Practices: Getting From Surviving to Thriving.” Conference speakers are generally adept and colorful. Some quips heard at the 2004 conference included:

• “The trouble with being punctual is no one’s there to appreciate it.” — Vinod Malhotra, M.D.

• “You may have a practice management problem if: Your administrator is unsure whether to run off with the accounts receivable or payable …” — Robert E. Johnstone, M.D.

• “When a weatherman’s predicting snow, it doesn’t mean he likes it.” — Alexander A. Hannenberg, M.D.

Primary goals for the conference are to educate and inform anesthesiologists. Pricing for the conference is modest at $325.

Certificate in Business Administration (CBA)
The Committee on Practice Management also oversees the CBA program. This very successful program held an alumni reception at the 2004 conference and organized a plenary session panel. Panelists debated how best to respond to a hospital request for proposals for anesthesiology services. George E. Gratzick, M.D., a South Carolina anesthesiologist, told a gripping story of unwanted crisis management when it happened at his hospital. The CBA program costs $3,500 and has 66 physicians enrolled this year. Asa C. Lockhart, M.D., directs the program and plans to make the CBA alumni reunion an annual event.

Registration for both the Conference on Practice Management and CBA program opens each year at the Annual Meeting.

Robert E. Johnstone, M.D., is Professor and Chair, Department of Anesthesiology, West Virginia University, Morgantown, West Virginia. He is the Director from West Virginia and a Colonel in the United States Army Reserve.