The old Chinese proverb “May you live in interesting times” is certainly apropos for our members’ experience, and certainly would be merely interesting if not for the tremendous impact of change on practice and patient care.
Since I started at ASA in March, I have spent significant time visiting with members in their practices, both private practice and academic, across the country. Practices have been large and small, some hospital-based, others were part of “large groups.” Everyone I met is looking carefully at the future and considering their strategic options.
The changes anesthesiologists face are bigger than the Affordable Care Act (“Obamacare”). Rather, they reflect trends that have been long under way, including the business of health care in an era of tight resources, consolidation of insurers and health systems, the impact of the electronic record and “big data,” and an increasing focus on quality. Certainly, all change is local. However, from my observations, I am discerning a number of key trends:
• Consolidation of practice into groups of increasing size, formation of networks or integration into large private equity-based or stock traded firms. Anesthesiologists are looking for tools to evaluate their options.
• Impact of market competition as hospital executives seek to lower costs. Members are looking for ways to better understand their costs and the means by which they can reduce both practice and perioperative (patient care) expense.
• Pursuit of value: The need to demonstrate quality is a theme throughout health care. The reporting of quality measures through the Physician Quality Reporting System is now embedded in Medicare and in many private and Medicaid plans. Quality assessment is an integral part of maintenance of certification, and many hospital systems are requiring evidence of quality as part of their contracts with physician groups. I am observing many practices participating in quality reporting, implementing quality improvement processes and hiring or designating quality improvement managers. The high rate of participation in the Anesthesia Quality Institute (nearly 25 percent of participants are physician anesthesiologists, of which 70 percent are ASA members) and success of the first Anesthesia Quality Meeting (AQM) held in Chicago in November are evidence of members’ intense interest (see below for more information on the AQM).
• Impact of big data: Related to the previous trend is the impact of data management on the specialty. Physicians in many specialties are being called upon to become informaticists. This is particularly true for hospital-based specialties such as anesthesiology that must grapple with implementing, using and optimizing complex enterprise-wide systems as well as their own specialty-based systems.
• Increasing management challenges as practices get larger and consist of an increasingly diverse workforce. This comprises generational differences in the practice of medicine and, in many cases, the impact of working with multiple disciplines that are part of the care team model.
• Importance of new skills in leadership, finance, management and related areas as members seek to get MBAs, take advantage of programs offered by the ACHE, ACPE or MGMA, or ASA’s Certificate in Business Administration program.
Your continuing insights into challenges you experience are vital as ASA develops strategies to support you through this time of change. One critical resource will be the Perioperative Surgical Home model of care. In October, the ASA House of Delegates approved a proposal from the Committee on Future Models of Anesthesia Practice to help develop this model and share practices through a learning collaborative. Look for more information on this project in ASAP and the ASA NEWSLETTER in coming months.
Of course, many resources are available now. ASA’s Payment and Practice Management Department, under the direction of Sharon K. Merrick, M.S., CCS-P, is growing to keep up with changing times. Sharon and her staff work closely with the ASA committees on Practice Management and Economics to offer our membership an ever-increasing variety of practice management resources. The practice management staff members are particularly excited to offer new payment and practice management memos, which can be found on the Practice Management portion of the ASA website. These memos, which they hope to produce multiple times per month, offer timely, useful tips on important issues related to billing and other day-to-day aspects of your practice. Recent memos cover “ICD-10-CM/PCS: Thirteen Months and Counting…,” “The Aging Anesthesiologist” and “RACS – Be in the Know.”
Established ASA practice management-related productscontinue to break new ground. Our PRACTICE MANAGEMENT Conference has set attendance records each of the last few years. A total of 919 individuals attended the conference in 2013, compared to 777 in 2012. Of note at PRACTICE MANAGEMENT 2014 is a pre-conference session on January 24 called “The Business Model for Perioperative Care,” which will introduce basic concepts of the Perioperative Surgical Home model of care – a major focus of the society in 2014.
I’d also like to remind you of the new ASA Quality Meeting (AQM) educational event, the first of which took place last November. A collaborative effort between several ASA committees and staff departments, including heavy input from practice management experts, the 2013 AQM offered education activities designed to help physician anesthesiologists develop quality-improvement activities in their practice. This is critically important as everyone from accrediting organizations, to government, to patients increasingly demand quality outcomes at lower costs. Feedback from the sold-out AQM was overwhelmingly positive. Of note, 87 percent of those responding to a survey about the AQM remarked that after the meeting, they “will create/revise protocols, policies and/or procedures” when they return to their offices. Building upon this success, the AQM Spring Meeting will take place April 12-13, 2014 in Dallas and be themed “Creating and Measuring Quality in Anesthesiology™.”
Finally, please feel free to let me know about yourexperience and how we can help. The best way to reach me is by email at firstname.lastname@example.org.