Practice Management 2015 Foresees the Future

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  • Sibert, Karen, MD, FASA
| Feb 02, 2015

If you were not among the 870 people who attended the ASA Practice Management meeting in Atlanta on Jan. 23-25, you may have been surprised by the Obama administration’s announcement the very next day.

Health and Human Services (HHS) Secretary Sylvia Burwell announced in a press conference on Jan. 26 that HHS has set a goal of tying 30 percent of Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.

She also said that HHS plans to tie 85 percent of all fee-for-service Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as Hospital Value Based Purchasing and Hospital Readmissions Reduction.

You were better prepared for this news if you heard Stan Stead, MD, MBA, the ASA’s Vice President for Professional Affairs, give the meeting’s keynote address. “Fee for service is being changed into fee for outcome,” he told the group. Between 1992 and the present, anesthesiologists’ average unit payment effectively dropped from $13.94 to $12.02, in inflation-adjusted dollars, he said. “The fee-for-service system is paying less and less.”

The only way for anesthesiologists to survive is to align with health systems to maintain market share and contract successfully for accountable care and long-term sustainability, Dr. Stead explained. “Physicians and health systems must take joint responsibility to help each other” by reducing variability of cost in an episode of care, reducing avoidable complications, and reducing readmissions.

“Healthcare reform is moving from insurance reform to delivery system reform,” Dr. Stead told the audience, with intense competition among health systems to provide value-based care.

As if to underscore Dr. Stead’s remarks, a group of the top US health systems and payers announced on Jan. 28 the formation of the Health Care Transformation Task Force, a private-sector alliance which aims to accelerate the transformation to value-based care. Payers involved include Aetna and Blue Shield of California. The alliance plans to improve the ACO model and develop a standard system for bundled payments.

Leadership vs. Management

The CSA was well represented at Practice Management 2015. Sam Wald, MD, MBA, the CSA’s chair of the Educational Programs Division, helped organize the day-long preconference titled “Building Effective Leaders.” He invited Allan Lind, PhD, one of his former professors from the Duke University Fuqua School of Business, to speak to the group on strategic thinking and on the differences between leadership and management.

Leadership, explained Professor Lind, “generally refers to direction and inspiration that is tied to positive interpersonal relationships.” Management, on the other hand, refers to “influence and motivation” through an organization’s incentives and authority structure. Both leadership and management are needed for optimal performance, he said.

Dr. Wald led attendees through a lively negotiation exercise. Divided into groups of four, each participant role-played as the manager of a bakery, a grocery, a liquor store, or a flower shop. They had to work their way through the competitive details of negotiating floor space, temperature control, and advertising as participants in a shared marketplace. The details were very different from daily life in the OR, but there were obvious parallels to negotiating an agreement among groups with priorities that may conflict – like surgeons, nurses, and anesthesiologists.

Zeev Kain, MD, MBA, the chair of the Department of Anesthesiology at the University of California, Irvine, spoke to the leadership preconference about the importance of interpersonal communications in motivating individuals and groups, and leading the difficult process of changing healthcare.

Electronic health record: Friend AND Foe

Neal Cohen, MD, PhD, Vice Dean and Professor (Anesthesia and Medicine) at the University of California, San Francisco, discussed the risks and unintended consequences of the transition from paper to electronic health records (EHRs) in his talk before the full session.

For example, he said, it’s common to identify more medication errors after implementation of an EHR. “I question if this is a function of better reporting, or is it truly more errors?”

The jury is still out on whether charting time is actually reduced or not, Dr. Cohen noted, but there are definite financial benefits in terms of better charge capture. Physicians who use an EHR generate almost $50,000 per year in more revenue per FTE.

The automated download of physiologic data is definitely more accurate, Dr. Cohen asserted. 

Linda Hertzberg, MD and
ASA staffer Jeff Schulz

“My patients are having enormous fluctuations in blood pressure and heart rate ever since I started using the electronic records,” he said with a smile. Reviewing paper records over the prior year, “it was amazing to see how stable the vital signs were!”

CSA Past President Linda Hertzberg, MD, a member of the ASA Committee on Practice Management, moderated one of the panel presentations and led residents in a discussion group on the role of mentoring. Other CSA officers in attendance at the conference included Past President Narendra Trivedi, MD, Legislative and Practice Affairs Division (LPAD) Chair Mark Zakowski, MD, and the two LPAD Vice Chairs, Keith Chamberlin, MD, MBA, and Jeffrey Poage, MD.

Next year's ASA Practice Management meeting will be held in San Diego from Jan. 29-31, 2016.

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