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Anesthesia Business Consultants, LLC
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Have you read our blog lately? It's full of articles specific to the anesthesiology and pain management fields: http://ow.ly/SM2jh
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Learn more about the history of anesthesiology by clicking here: http://ow.ly/lr9H303mBQ3
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Our Communique is dedicated to articles and advice, that are anesthesia and pain management community specific: http://ow.ly/SM1ys
Communique is a professional quarterly publication dedicated to providing resourceful articles and advice to the anesthesia and pain management community.
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A Refresher for Anesthesiologists on Avoiding Fraud and Abuse

The Centers for Medicare and Medicaid Services (CMS) has published a booklet for physicians on avoiding fraud and abuse. The booklet contains an overview of current fraud and abuse laws and resources for further information. Anesthesiologists should make sure they understand these laws and the voluntary steps they should take to self-report if they discover potential fraud or abuse in their own practices.

An anesthesiologist recently received a several-year prison sentence for prescribing controlled substances without a legitimate medical reason. One of this physician’s patients died from taking hydrocodone, which the physician had prescribed for no legitimate medical purpose.

This is an extreme case involving criminal behavior. Still, any allegation of Medicare or Medicaid fraud or abuse surely ranks at the top of an anesthesiologist’s—any physician’s--list of nightmare scenarios. It behooves anesthesiologists, as well as nurse anesthetists and anesthesia practice managers, to know the “red flags” of fraud and abuse that could lead to civil, criminal or enforcement liability. Failure to understand current laws or how to take the appropriate steps could expose you to risk without your even realizing it.

Did you know, for example, that the Affordable Care Act (ACA) requires physicians to establish a compliance program and to designate a compliance coordinator in their practices? Or that the ACA established an Open Payments System that requires pharmaceutical and medical device manufacturers to report any payments they have made to professional practitioners, and that this data is available on the internet?

The Centers for Medicare and Medicaid Services (CMS) has published a 20-page booklet, Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians , which offers physicians a primer on current laws, along with a compendium of resources for finding assistance with problems and answers to questions, information on reporting suspected fraud and abuse, and links to educational videos and other publications and materials.

Read the rest of our article here: http://ow.ly/PYta303xx6n

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Our eAlerts system notifies you of the latest industry information regarding regulatory changes, compliance reminders and other changes in anesthesia policies.
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OIG Advisory Opinion Secrets and Strategies

The OIG Advisory Opinion (Advisory Opinion) process allows parties of actual or proposed transactions to obtain the opinion of the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services as to whether that transaction violates the federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b) (AKS).

There’s an official process for obtaining an OIG Advisory Opinion. Then there’s the actual way that the process works. And, then there are the secrets and strategies that can be used in connection with opinions.

For decades, I considered Advisory Opinions as a set of guideposts as to how the OIG, as the primary agency charged with enforcing the federal AKS, thinks as to the application of that statute. But then I realized that there was a very different way to think of them, use them, and obtain them, which led to my work as the attorney for the Requestor of Advisory Opinion 13-15 and on many projects advising on the Advisory Opinion process and the AKS since then.

I’m going to share some of that information with you.

Background

In order for you to grasp the dynamics of the OIG Advisory Opinion process, you first need to understand the basic elements of the AKS and its history.

In summary form, the AKS prohibits the knowing and willful solicitation, offer, payment or acceptance of any remuneration (including any kickback, bribe or rebate) directly or indirectly, overtly or covertly, in cash or in kind: (1) for referring an individual for a service or item covered by a federal healthcare program, or (2) for purchasing, leasing, ordering, or arranging for or recommending the purchase, lease, or order of any good, facility, service or item reimbursable under a federal healthcare program.

A violation is punishable as a felony: up to five years in jail, plus up to $25,000 in fines. It can also lead to exclusion from participation in federal healthcare programs.

The AKS language is extremely broad. But what did Congress really intend to prohibit?

The AKS statute was altered by Congress many times since it was first signed into law in 1972. Its scope has been changed. And, it hasn’t always made violation a felony.

Initially, the statue was aimed at criminalizing the sort of “fee splitting” that medical ethics long prohibited. The original 1972 statutory language made violation a misdemeanor. And, it was aimed solely at Medicare and Medicaid patients, not the current, broad scope of all federal healthcare program patients. It prohibited the solicitation, offer or receipt of “any kickback or bribe in connection with” furnishing Medicare or Medicaid services or referring a patient to a provider of those services.
Over the ensuing years, there were multiple amendments as a result of industry complaints that the statute picked up more than “bad” conduct—that it criminalized behavior long considered appropriate, such as paying physicians to serve as medical directors. Somewhat strangely, Congress both broadened the language and, over time, enacted statutory exceptions, delegated authority to the OIG to adopt safe harbors (i.e., regulatory exceptions) and, finally, gave the OIG the power to issue
Advisory Opinions.

The Advisory Opinion Process

The OIG is permitted to issue an Advisory Opinion upon the request of a person or organization involved in an existing arrangement or in an anticipated transaction in which the requestor in good faith plans to undertake what may be subject to AKS.
Note that the requestor’s good faith in respect of an anticipated transaction may be contingent upon receiving a favorable Advisory Opinion. Distinguish this from a hypothetical query and from a general question as to interpretation, neither of which are permissible as the basis of an Advisory Opinion request.

It’s also important to understand that an OIG Advisory Opinion has no application to any individual or entity that does not join in the request for the opinion, and that no individual or entity other than the requestor(s) may legally relay it.

Both the regulations pertaining to Advisory Opinions and the checklists provided by the OIG outline the information required to be provided to the OIG and the costs of an opinion. For purposes of this article, be aware that the request has to be in writing and that among the information that must be provided is:

What I call the “who” information:
The name and addresses of the requestor and all other actual and potential parties to the extent known to the requestor.
The name, title, address and daytime telephone number of a contact person.
Each requesting party’s Taxpayer Identification Number.
Full and complete information as to the identity of each entity owned or controlled by the individual, and of each person with an ownership or control interest in the entity.

What I call the “what” information:
A complete and specific description of all relevant information bearing on the arrangement and on the circumstances of the conduct.
All relevant background information.
Complete copies of all operative documents, if applicable, or narrative descriptions of those documents. For existing arrangements, that means complete copies of all operative documents. For proposed arrangements, complete copies of all operative documents, if possible, and otherwise descriptions of proposed terms, drafts or models of documents sufficient to permit the OIG to render an informed opinion.
Detailed statements of all collateral or oral understandings (if any).

And, then there’s the certification:

The request must include a signed certification that all of the information provided is true and correct and that it constitutes a complete description of the facts regarding which the Advisory Opinion is sought.

Read our full post here: http://ow.ly/DSo5303vL26

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Communique is a professional quarterly publication dedicated to providing resourceful articles and advice to the anesthesia and pain management community.
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We serve thousands of anesthesiologists and CRNAs nationwide with billing software solutions. Learn more about what we do by visiting our website: http://ow.ly/SM0hy
Founded in 1979, ABC is the leading provider of anesthesia billing and practice management software.
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Learn about the importance of the integration of psychology into pain practices by reading this article courtesy of Pain Medicine News: http://ow.ly/tkxG303mCPa
A growing body of evidence shows that an interdisciplinary approach to the treatment of chronic painful conditions is most beneficial to patients.
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The Perioperative Surgical Future

Presented with this opportunity by Dr. Salk, how will each of our anesthesia groups create its own future? How will you as a physician maintain your professional relevance? Will you continue to commit yourself to fading traditional practice patterns and reimbursement models? Or will you take advantage of the paradigm shifts in medicine that are already upon us? Payers are demanding better results, hospital administrators are in need of help, patients are in the middle without access and the specialty of anesthesia needs a tune-up. The perioperative surgical home promises to address it all.

Led by the Centers for Medicare and Medicaid Services (CMS), payers are mandating coordinated care and improved quality through pay-for-performance reimbursement models. CMS will soon pay up to a four percent bonus for high self-reported performance scores and impose similar-sized penalties on relatively less successful providers. In 2018 the difference between maximum positive and negative scores will be eight percent and by 2022 the difference will be 18 percent…every single year. Private payers will follow suit, but this 18 percent CMS incentive alone is strong enough incentive that anesthesiologists should fully embrace quality metrics and coordinated care. Those metrics and coordinated care are best embodied by anesthesiologist presence and leadership in the perioperative surgical home preoperative clinic.

Surgeons and hospital administrators need anesthesiologists more than ever. Both are facing their own demands for increased quality metrics and reducing length of stay. Both are subject to their own system of CMS penalties, caps and bundled payments.
Both are severely in need of quality anesthesia leadership and partnership. If they haven’t yet realized the value of your perioperative skill set, then it’s time for you to offer your assistance. You may not personally know it, but your management and vision are in demand outside the operating room. Your new management target is the 20 percent of sickest patients presenting for surgery. In an era where the emphasis is to reduce length-of-stay and readmissions, your anesthesia preoperative surgical involvement is your opportunity for medical, logistical and administrative leadership.
Patients don’t have reasonable access to anesthesiologists. Anesthesiologists do not have reasonable access to patients. We are both subject to a marginal default anesthesia care model that confines access to three minutes before surgery and five minutes afterward. This is the standard of care, but whom does it serve? Whose ‘standard’ is this? How does this model constitute access? Our patients are frequently old, medically complex, pediatric, pregnant or otherwise facing critical moments in life. How is it that we, as a specialty, pretend to serve these people well by spending only the most minimal amount of time with them immediately preoperatively? Are we as anesthesiologists really that good than in the three minutes before surgery we can assess these complex patients, give them optimal care, a quality experience and our best effort? Is this really our best effort? Both patients and anesthesiologists would be much better served by establishing perioperative surgical clinics. Anesthesiologists must make themselves available.

As a specialty, anesthesia has lost a lot of access in the last 25 years. Our patients used to be admitted the night before and then stayed days after surgery. We had a chance to round on them before surgery, write orders, optimize or cancel. We rounded on them after surgery and had an opportunity to learn by observing the results of our work. Now our OR practice too often amounts to mindless assembly-line work; meeting patients three minutes ahead of time, five minutes in recovery, turn over the room in 20 minutes. “Wash, rinse and repeat.” This process makes for a timely, efficient anesthesia practice but what of quality, patient experience and the perception of our specialty? What of anesthesia medical management and leadership? We have abdicated our responsibilities by delegating the preoperative and post-discharge work to others. The perioperative surgical home offers anesthesia a platform. This is the means by which we reclaim ownership of the entire process and credibility with patients, surgeons and administrators.

The best minds in the American Society of Anesthesiologists (ASA) are pointing the way to the perioperative surgical home (PSH); anesthesiologist-staffed clinics are seeing complicated patients days to weeks ahead of surgery. For the ASA, this is the moral and medical core of the future of our specialty. Medically, who better than anesthesiologists to understand the physical challenges posed to patient physiology by surgeries? Logistically, who better to coordinate the preoperative work-up, the acute intraoperative care and the post-discharge medical management? At Pacific Valley Medical Group (PVMG) in Pasadena, California, we understand that cause.

Read the rest of our article here: http://ow.ly/mHzB303AaSL

Thoughts? Please comment below.
Communique is a professional quarterly publication dedicated to providing resourceful articles and advice to the anesthesia and pain management community.
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Physicians should use these 3 tips from Becker's ASC when disclosing medical errors: http://ow.ly/pwdM303mDko
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"There are only two mistakes one can make along the road to truth; not going all the way, and not starting." Buddha
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Did you know? Competitive residencies make for higher physician salaries. Read Becker's Hospital Review's post to find out why: http://ow.ly/yDRM303mD6r
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"All you need is the plan, the road map, and the courage to press on to your destination." Earl Nightingale
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The largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
Introduction
Anesthesia Business Consultants, LLC (ABC) is the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management. ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions. http://anesthesiallc.com/about-abc

Every organization believes it is unique. The fact is that some are more distinctive in their respective industries than others. The anesthesia billing and practice management industry has many types of players, many of which have enjoyed considerable success over long periods of time. There is no one way to meet the practice managements of an anesthesia group. http://anesthesiallc.com/abc-advantage

Given this reality, we believe there are three aspects of ABC’s history and culture that not only makes it unique in the industry, but which also position it for continued growth and success well into the future. They have to do with our focus, our operational approach and the management structure. Few companies have achieved a comparable position of prominence and strength in the anesthesia market. http://anesthesiallc.com/clinical-technology

Unlike many of its competitors which are continually redefining their market focus, ABC has remained true to its core market of anesthesiologists, CRNAs and organizations that employ them. This continued focus on anesthesia has proven to be a consistent asset and advantage to our clients, enhancing the credibility of our insights and advice. http://anesthesiallc.com/publications

Operationally, the company has also maintained a strict discipline of centralization and resisted the temptation to distribute key processes to a variety of small local offices that cannot be managed as effectively. While the advantages of this disciplined approach are not always obvious to prospective clients, they are clearly evident in the consistent results provided to existing client practices. http://anesthesiallc.com/industry-info

Much has been made of the potential advantages of public companies to raise capital for growth and expansion, but the disadvantages can be equally as frustrating. Managing a business based on the input and expectations of shareholders does not always result in the most appropriate business decision-making. Since ABC is closely held by Tony and Sue Mira, they can set the agenda and manage the business as they see necessary. Thus far, the value of their judgment has proven itself in spades. http://anesthesiallc.com/careers

Anesthesia Business Consultants is a team of committed and well coordinated professionals who have dedicated themselves to the business of anesthesia billing and practice management. Over the course of the company’s 30 year history, Tony Mira has recruited only those with proven expertise in key aspects of the business such as medical coding, compliance, accounts receivable management, contracting and practice development. This careful screening has made ABC the place to be for those who value their reputation and credibility. http://anesthesiallc.com/easyblog/latest

It should come as no surprise that turn-over and attrition of key staff are almost non-existent; people work for ABC because they want to be part of a winning team. No staff works harder, but none takes as much pride in the results. It is no accident that ABC’s client retention and customer satisfaction are the highest in the industry. http://anesthesiallc.com/abc-advantage/dashboard-update

The company’s unique history and culture are evident in every aspect of each client relationship. Our success reflects the importance of both the general and the specific. A number of general challenges and constraints define our focus and strategies in the management of payor behavior. We must all be industry experts with a solid understanding of national trends and issues. At the same time we must accept and appreciate what distinguishes each client practice. Ultimately it is this attention to the details of a practice that makes us so effective. http://anesthesiallc.com/abc-advantage/zenithanesthesia-practice-network

It is for this reason that we don’t view ourselves as a solution or a service; but rather as a business partner. Not only do our contingency fees align our incentives with the client, but our culture and history epitomize the spirit of customer service. Our vision is to provide our clients with innovative and valuable practice management tools and solutions that allow them to realize their own particular strategic visions and business plans. http://anesthesiallc.com/abc-advantage/quality-management-pqrs

If you ask an Anesthesia Business Consulant employee what the company provides its clients, they are likely to say three things: cash, information and advice. These are the three legs of the stool that supports each client practice. It is not an easy proposition to support because no one member of the team can do it all. The team supporting each client must work in a logically integrated and collaborative manner. A vice president of client management may orchestrate the service, but the account manager is just as important as each of the other members in assuring that the full scope of expectations are consistently met. http://anesthesiallc.com/abc-advantage/billing-and-reimbursement

With regard to our ability to effectively collect what is collectable given the services each client performs and the payors who will be responsible for compensating them, our results speak for themselves. We have learned how to manage payors and keep them compliant to the terms we have negotiated. Our practice management tools allow us to establish and expected payment for each and every case so that we can measure the effectiveness of our management strategy and collections efforts. http://anesthesiallc.com/abc-advantage/practice-management

Our technology and information management tools are cutting edge.  http://anesthesiallc.com/abc-advantage/onesourceanesthesia

There is simply no more powerful tool than Oracle and no more powerful anesthesia software than First Anesthesia. Our history has helped us identify what anesthesia practices should know to stay productive and efficient. Our large and diverse client base also challenges us to anticipate each new practice management development with appropriate management resources and solutions. Our current technology was specifically designed to anticipate the unexpected with no constraints to the type of data we capture for our clients. http://anesthesiallc.com/about-abc/affiliates

For all the discipline of our approach and the power of our technology, however, nothing can match the value of our experience. Years of creative problem-solving has made us even better problem-solvers. The management of almost every conceivable type of anesthesia practice has made us ever better managers. Each new member of the team brings experience and a fresh perspective that challenges the organization to stay relevant and focused. This ability to sound out issues, explore creative solutions and offer innovative alternatives to clients has proven itself as a significant asset in a wide variety of client management situations. http://anesthesiallc.com/about-abc/our-locations

Anesthesia Billing Consultants is singly-focused on anesthesia billing and practice management services. We provide our clients with the optimal business tools to improve their business process and enhance cash flow
-- all while keeping pace with changes within the healthcare environment. http://anesthesiallc.com/about-abc/what-makes-us-unique

**Anesthesia Billing & Reimbursement

Over its 30 year history, Anesthesia Business Consultants has evolved a distinctive approach to Accounts Receivable management. Consistent results involve the careful coordination of industry experts, optimum processes for each of the specific tasks necessary to resolve a claim and the effective integration of state of the art technology. Each piece of this People, Process and Technology strategy is equally important and a subject of ongoing review, refinement and investment. http://anesthesiallc.com/about-abc/what-we-do

ABC’s service relationships rely on qualified and experienced staff trained to explore the unique clinical services and billing requirements of every client. ABC has invested in the education of all staff members to ensure they understand industry norms, consistently apply analytical tools and keep our clients abreast of relevant accounts receivable market issues and trends. Vice presidents of client services and Account managers and client service vice presidents are continually educating our clients on revenue potential of the services provided, ways of utilizing our powerful management information and insights gained from years of supporting clients nationwide. http://anesthesiallc.com/about-abc/history

Our effective Accounts Receivable management includes a clear and overarching strategy and plan. Payor mix reports help us continually identify and refine claims submission, follow-up, payment verification and account resolution options. There is no aspect of the life of a claim that is not the subject of executive review. Management is continually looking for rate-limiting steps and opportunities for process improvement. http://anesthesiallc.com/about-abc/who-we-are

This philosophy and approach is embodied in our anesthesia billing software, which has been specifically developed to reflect 30 years of feedback and lessons learned. There simply is no more powerful software on the market for managing the arcane and complex requirements of today’s anesthesia practice. Each year millions of claims for anesthesia, pain and intensive care services are specifically formatted and submitted to payors nationwide. This experience and our ability to effectively monitor and modify payor behavior is a key ingredient to our ongoing success. http://anesthesiallc.com/abc-advantage

**Anesthesia Quality Management

Despite its impressive morbidity and mortality statistics, quality management is the new frontier for anesthesia practices. Two factors are driving a serious interest in the technology of measuring quality indicators: a market focus on customer-service and Pay for Performance (P4P). It is no longer enough to believe your practice provides consistently superior care; you have to be able to demonstrate it empirically.

Customer service by anesthesia providers requires that the promise of the three As (Able, Available and Affable) be consistently met without hesitation. This may require provider-specific tracking and feedback on a variety of quality indicators. It may also entail the compilation and presentation of global statistics and comparative quality metrics.

Pay for Performance is clearly an evolving field and the impact on reimbursement is just beginning to be defined and felt by the average anesthesia practice. It is still unclear what the final list of P4P markers will include. This is the challenge. P4P epitomizes the dynamic reality of government involvement in medicine and reimbursement.

In both areas, ABC is the leader in providing options to its clients. Many of its key clients are active participants in formulating quality measures. ABC is proud to offer one of the most powerful tools in the industry for the objective measurement and tracking of quality indicators: F1RSTQuality.

**Anesthesia Practice Management

There is no term more overused and misunderstood by anesthesia providers, anesthesia billing companies and medical management consultants than practice management. The reason is simple. There is a certain panache to being able to say “Yes, we provide practice management.” The fact is that for most firms such statements are more wishful thinking than an articulation of a clearly defined scope of services.

Anesthesia medical practice management should be clearly distinguished from Billing and AR management and Financial services. While AR management focuses on the revenue generation and financial services on the management of expenses, practice management defines the context for both. Anesthesia medical practice management comprises all of those non-billing and payable functions essential to the effective management of a practice such as governance, business decision-making, contracting, Human Relations, marketing and customer service.

Practice management is the most flexible aspect of the services ABC provides because each scope of services is customized to the specific business situation and requirements of each medical anesthesia practice. It is also the highest level of service ABC provides in that there is no specific playbook or plan for the success, security and growth potential of each client.

**Anesthesia Compliance & HIPAA

By far the fastest growing and most confusing area of anesthesia medical practice management is compliance. So many entities seem to have a stake in the game. The federal government is perpetually trying to ferret out fraud and abuse; state governments are struggling to manage Medicaid budgets, commercial payors to take advantage of the tools given them by HIPAA and increasingly educated patients are questioning the legitimacy of charges with impunity. Conventional wisdom suggests that all anesthesia medical practices must have a plan, regular educational sessions, be able to identify variances and outliers and an appropriate means of enforcement.

The problem is that most compliance policies are written in vague and non-specific terms. The trick is to know the intent and spirit of the guidelines and apply the general to the specific clinical situations. It is not always clear what position or standard to believe. As is true of so many aspects of the law, precedent can be determinant. Knowing which sources to trust and what guidelines to accept requires a detailed and comprehensive understanding of government policies, audit patterns and trends and payor practices.

Since ABC only manages anesthesia and pain management practices, its compliance staff and auditors are perpetually monitoring the state of compliance. Our staff communicates on a regular basis with those who write Medicare policy in Baltimore, those who are responsible for claims adjudication and legal precedents. The result has been an unblemished record of keeping ABC clients off auditor radar screens. Our approach and plan is the best strategy an anesthesia group can adopt to stay compliant.

It should go without saying that this is an increasingly important part of the effective management of a practice today. However important AR management and revenue enhancement, there is nothing more painful than having to give back money due to inadequate documentation or overly aggressive charge structures.

**Anesthesia Medical Practice: Education and Training

Often it is difficult to share and apply defined best practices and articulated group policy in daily practice and clinical documentation. It goes without saying that any anesthesia practice is only as compliant as the least compliant provider.

Too often educational activities fall to the bottom of the priority list when, in fact, they should be near the top. Over its 30 year history, ABC has grown to appreciate the importance of provider education and the need for educational sessions to be concise, consistent and compelling. This requires a detailed understanding of risk areas, human nature and basic principles of learning. It is not enough to simply articulate logical policies and conventions for billing and documentation; the key to effective learning is validation that the message has been heard and understood.

To this end, ABC staff custom tailor compliance in-service sessions to the unique and specific requirements of each anesthesia practice. This entails general sessions and a variety of specific and targeted follow-up sessions. Initial sessions will present general guidelines while the subsequent will provide an opportunity to review audit data and focus on particular risk areas.

The value of this approach is realized on many levels. Through regular review of clinical protocols and anesthesia medical billing policies, ABC will routinely identify opportunities for revenue enhancement. Such practices also demonstrate the group’s fundamental commitment to compliant billing, which makes the practice more secure and less likely to be audited.

**Anesthesia Strategic Management

Positioning an anesthesia practice for long-term success involves a variety of factors often overlooked when plotting a viable strategic plan.
The effects of inadequate strategic thinking are demoralizing to providers who were trained to believe that quality care and good outcomes were most important. Hospital Requests for Proposals (RFPs) for anesthesia services are on the rise. Practices that once enjoyed a good and productive working relationship with their administration are suddenly finding themselves displaced by organizations with more clout, better marketing and a more innovative and often cost-effective approach to the administration’s service requirements.

ABC consultants offer effective practice management solutions by guiding hundreds of clients through the strategic planning process. In some cases, this may involve the facilitation of a strategic planning session in which the group dedicates time to the creation or refinement of a mission statement, a review of governance, compensation plan refinement, and the review and evaluation of business opportunities or succession planning.
In other cases, service is ongoing and integral to a broader scope of practice management services. Typically, key business metrics are established to facilitate the ongoing assessment or profitability of the practice as a whole and the detailed evaluation of individual lines of business. ABC practice managers routinely help clients identify opportunities for expansion and or diversification.

In either scenario, ABC clients benefit from the company’s years of experience, diverse client base and expert practice managers and consultants. What distinguishes ABC’s provision of this service is its integration with our practice management. We have an extensive and relevant database of benchmarks and examples to base our recommendations on.

**Anesthesia Consulting

For many ABC clients, the first exposure to our talent base and expertise is through our anesthesia practice consulting team. Anesthesia practice consulting proposals run the gamut of anesthesia practice management issues from coding and compliance audits to staffing assessments to business pro formas. These are ad hoc projects unrelated to an ongoing service relationship with ABC.

The growth of ABC’s anesthesia practice consulting business is a direct reflection of two distinct phenomena. First, a growing number of anesthesia practices are facing new and unanticipated developments and challenges from hospital contract negotiations to requests for specific forms of business analysis such as opportunities to invest in ASCs. They need qualified anesthesia practice consulting experts to perform careful analysis, provide reliable advice and support in the implementation or execution of a new process or contractual commitment.

Other clients are interested in a relationship with ABC, but want to validate our expertise and insights. It is not uncommon for prospective anesthesia medical billing and practice management clients to request a practice evaluation as a precursor to a formal proposal for services. Such projects allow us to demonstrate our knowledge of payor policies and rates and our understanding of the subtleties of anesthesia and pain management reimbursement.

While many practices know what sorts of management services they need to optimize collections and ensure the security of their franchise, many others do not. Detailed consulting engagements and practice reviews allow for the development of a more specific scope of services that will best service the particular practice management requirements of the group.

**Anesthesia Financial Services

Given the challenges of maintaining physician and CRNA incomes while effectively managing recruitment and retention, an effective strategy for managing the expenses of an anesthesia practice becomes more critical. While it used to be true that many anesthesia medical practices could stay competitive by focusing only on revenue generation (payor contracting, aggressive Accounts Receivable management and hospital subsidies), few can succeed long-term without monitoring expenses assiduously. This involves a comprehensive and rigorous plan for carefully evaluating each line item, comparing it to a budget or industry standards, evaluating options and making changes when necessary.

For some practices, this may involve the calculation of paychecks consistent with a very specific and particular compensation plan. It is not always easy to strike an appropriate balance between compensation and deferred compensation. Too many practices find themselves caught off guard when physicians leave the practice because most buyouts are unrealistic and illogical.

A quick review of even the most routine of practice ledgers inevitably reveals opportunities for more effective anesthesia practice management. Health insurance costs are rising at an uncontrollable rate, malpractice premiums can vary significantly from one carrier to another, and groups often struggle with fundamental questions such as which items should be paid by the group and which should be pushed down to the individual provider. This type of practice management requires an extensive technical knowledge of the tax code, pricing norms and extensive practice experience with anesthesia practices in similar situations.

ABC clients are increasingly finding this level of service an invaluable enhancement to the effective management of the practice. Not only do ABC financial managers understand the underlying issues, but they bring state of the art accounting tools and technology to bear in the pursuit of income maximization. Not only are our practice financial services specifically tailored to the needs of an anesthesia practice, but our pricing is typically far more cost-effective than any other out-sourced option.