CSA Callback

  • Chamberlin, Keith, MD, MBA, FASA
| May 27, 2013

The business of medicine is rapidly changing. Help! I can’t keep up!

My colleagues commonly express the notion that medicine is changing rapidly — right before our eyes, even — and that it is difficult for physicians to keep up. Generally, I believe those concerns refer primarily to the business aspects of medicine, and they’re right: the business of medicine is transforming, and anesthesiology is no exception.

As the new health law, the ACA (Affordable Care Act) and its many components roll out, we hear new terms such as ACO, CPOE, EMR, EHR, etc. What’s really going on? It all boils down to the same thing — there is going to be less money (a lot less money) available for distribution to all the stakeholders: physicians, hospitals, Skilled Nursing Facilities, ancillary care givers and so on.

While our physician colleagues through the practice of medicine continue to make tremendous advances, improvements and new discoveries in drugs, equipment and medical techniques, these no longer rise to the forefront of news. What is written about and discussed in the media as well as the office lunchroom is the Wall Street takeover of medicine and the massive business changes taking place. For employers, employees and especially the medical community, questions abound, such as: Should I be an employee of a foundation? Should I partner with the hospital for a co-management agreement? And so on.

Whatever the scenario, the ACA means eventually less reimbursement for everyone, including anesthesiologists. The evolution of the ACA will take shape in various forms including decreased compensation for services, altered staffing levels and greater use of lessor-trained, but licensed, “midlevel” providers practicing to “the limit of their license.” There is no doubt that those practitioners will be constantly attempting to push that  “limit” into ever expanding new areas. These types of changes are not limited to anesthesiology, but to all physician services and specialties. The ACA ushers in a new time with new rules, and yet most doctors are ill equipped to handle this aspect of their practice.

With hospitals receiving less money, what were once ironclad agreements between hospitals and physicians, without any possible negative change, are suddenly “at risk.” At times, hospitals are even going as far as putting out a Request for Proposal (RFP) for a new anesthesia group. Hospitals have been replacing anesthesia groups at an increasing rate. The current group, which may have worked at the facility for 20 years, will be encouraged to compete with the new responders. If this happens in your hospital, the whole process of RFP and major change may come as a shock, and you will likely need some help. The CSA is here to educate and provide support.

Even though the issue may be presented as generally being about money, it is likely that additional concerns will be inflated to make the case. Small deficits in professional behavior such as walking into the hospital in overly casual clothing or eating in the hallway may become serious issues, to be brought up as a reason to perhaps change anesthesia groups — to a group which is also perceived by hospital administrators as being less expensive. Be forewarned, all kinds of issues you thought would never be a problem, will become problems. Hospital budgets are being cut across the state.

The good news is that the CSA can help you. 

Recognizing these issues, and always trying to stay ahead of the curve, the CSA has decided to trial a separation of the Legislative and Practice Affairs Division into two working groups: Legislative — with its huge workload and constantly changing laws and regulations, and Practice Affairs — totally dedicated to the business of anesthesiology.

Practice Affairs will strive to provide members with timely educational materials in print and electronic formats. New educational materials on the business of anesthesia are continuously made available on the CSA website’s Practice Resources. You are encouraged to submit any material you think pertinent to the business practice of anesthesia to communications@csahq.org.

In addition, the CSA is implementing a new member service: a “call-back consult” for questions of a more urgent nature. Members can reach out to the CSA by calling 650-345-3020 or emailing membership@csahq.org and share some preliminary details about their concern with a staff person. You may be asked to answer a series of questions by the staff, and members will be referred to another volunteer CSA member with extensive experience in handling the relevant issues. The callback will typically be arranged within 48 hours, and members will be entitled to a 15-minute consultation, at no cost. All consultations and advice are strictly the opinions of the individual advisors, and do not necessarily reflect that of the CSA. Experience tells us that frequently 15 minutes may be all you need to set you on the right track.

If the issues you discuss appear to require a more in-depth approach, possibly including site visits, interviewing surgeons, constructing a staffing grid, calculating a compensation for services (stipend), reviewing departmental policies and procedures, or helping with quality improvement processes, the CSA will provide a list of consultants from whom members may wish to retain services.

Today we are in a time of constant, rapid and generally negative business change for the specialty of anesthesiology. It is important for you to know that the CSA recognizes your needs and has made changes to help ease the transitions being introduced into our practices. We encourage you to read the educational materials and to call us. One of the many benefits of being a member of the CSA is help when you need it. Just pick up the phone… and call your professional society, the CSA.

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