Chapter 97: Practice Management

KEY POINTS

1. The structure of an anesthesiology practice is a crucial component in the smooth delivery of anesthesia to patients, due in part to the establishment of lines of authority, creation of escalation policies, determination of a decision-making structure, creation of information management and management of communication to the group.

2. There are multiple practice models, each of which has different benefits and risks. One should seek the practice model most appropriate to one’s career goals and the environment that best suits the individual.

3. Within any practice the staffing model, extent of supervision, and distribution of cases is complex. Overall and day-to-day staffing are determined by the case mix and complexity, level of provider experience and specialty training, physical condition of the patient, surgeon variables and expectations, hospital policies, and supervision regulations for trainees.

4. In the provision of anesthesia services, professional effort is reimbursed in a distributed model with payments that include base relative value units (accounting for anesthetic complexity), time units, and additional unit modifiers multiplied by a dollar conversion factor.

5. Hospital relationships are crucial, and a group must comprehend hospital concerns and priorities when negotiating contracts for anesthesia services, coverage of service lines, and call obligations.

6. Both hospitals and groups negotiate with third-party payers; the needs of both parties must be clear and both parties must be willing to negotiate to achieve reasonable offers as well as an accurate understanding of the value the group brings to the hospital and contracting organization.

7. Billing for anesthesia services must ensure that every service rendered is captured and that all monies contractually obligated for those services are collected. Documentation of the anesthetic service billed is essential; from the viewpoint of the payer, if the service was not appropriately documented it did not happen and will not be reimbursed. Knowledge of and compliance with external rules and regulations is essential for the financial health of the practice and to protect the practice from adverse legal action.

8. Accurate accounting and tracking of practice information is essential. This includes both fiscal and performance data (total cases and units, cases and units per location, payer mix, charge lag, charges, contractual adjustments, cash collections, accounts receivable, net collection rate, days in accounts receivable, aged accounts receivable, total credit balances, collection agency net collections, etc) as well as quality, safety, and hospital requested data (percent of cancellations, percent of on-time starts, quality improvement metrics, etc).