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Anesthesia Business Consultants, LLC
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Is it time for your anesthesiology practice to embrace pharmacogenomics? Find out:
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ABC's Affiliate Company, Plexus TG, Implements Anesthesia Touch for Buckeye Anesthesia Services

The Anesthesia Business Consultants (ABC) affiliate company and trusted anesthesia information management (AIMS) partner, Plexus Technology Group, LLC (Plexus TG), is pleased to announce successful implement its anesthesia information management solution, Anesthesia Touch, at the Institute for Orthopaedic Surgery (IOS), a specialty hospital in Lima, Ohio. The Institute for Orthopaedic Surgery was one of 102 hospitals out of approximately 4,000 in the US to receive a five-star Overall Hospital Quality Rating from the Centers for Medicaid & Medicare Services (CMS).

Anesthesia Touch on the iPad delivers Buckeye Anesthesia clinicians with enhanced mobility and flexibility by automatically capturing vital signs and providing access to patient demographics and surgery schedules through an interface with the facility’s electronic health records (EHR). Unlike their previous anesthesia documentation system, Plexus TG’s Anesthesia Touch is customizable to their workflow, including the ability to customize the quality information that is captured in their anesthesia EMR.

“Anesthesia Touch has become a mainstay of our practice and our staff has been extremely happy with the platform,” said Paul Scheiwiller, DO, anesthesiologist & president of Buckeye Anesthesia Services.

We are delighted Buckeye Anesthesia Services, a valued client of ABC, chose to implement Plexus TG’s anesthesia EMR. In addition to streamlining their anesthesia documentation workflow, they are simplifying their billing process by electronically sending billing data directly to ABC. We are appreciative for the opportunity to continue to work with Buckeye Anesthesia and to support their efforts to providing the highest level of quality anesthesia care to their patients.

Plexus TG’s Anesthesia Touch continues to receive high KLAS ratings from their clients in the anesthesia market. Visit the KLAS website at for more information.

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Read this post courtesy of Becker's ASC to discover the 5 things you need to know about CMS's emergency preparedness final rule for ASCs:
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When ‘Production’ Undermines Anesthesia Safety: Food for Thought on Physician Employment
A recent lawsuit raises interesting questions about the extent to which employed anesthesiologists and other clinicians are being asked by their institutions to cut corners on patient safety in the interests of financial goals. Anesthesiologists considering employment should become familiar with the types of employment contract provisions that could interfere with professionalism and patient safety.

An anesthesiologist filed a $9 million whistleblower retaliation and wrongful termination lawsuit against his former employer in July alleging he had been fired for voicing concerns about hospital policies and procedures that required anesthesiologists to cut corners on patient safety. We have no opinion on the merits of the lawsuit, nor any information supporting or refuting the plaintiff’s allegations, but physicians and hospitals might consider the issues raised by this scenario.

The suit alleges the anesthesiologist, a clinician with 19 years of experience who managed adult, pediatric and obstetric cases, was retaliated against during his second year at the institution for questioning an approach to perioperative care that favored production over safety. According to the complaint, administrators told him that co-workers had complained about him and that he should complete a communication course, which he did; but seven months later, the hospital told him his expiring contract would not be renewed. The case has not yet gone to trial. (We are following it and will provide updates as information becomes available.)

Among other things, the lawsuit alleges that, in order to hasten discharges, the hospital instructed anesthesiologists to withhold preoperative Versed and postoperative Dilaudid, and to give only the minimum dose of fentanyl in surgery. The policy of skimping on anesthesia to bolster production and cut costs allegedly extended to pediatric patients as well.

Another policy required surgical patients to be brought to the operating room by 7:30 a.m., even if more time was needed for preoperative evaluation and preparation. The anesthesiologist was occasionally late when attending to a patient’s medical needs or responding to a request for more information. In a meeting, the chief of anesthesia reportedly stressed the importance of having patients in the OR by the deadline, telling the anesthesiologists to “take the patient in with their street clothes on if you have to.”

The anesthesiologist expressed concern to hospital administration when he was assigned to supervise the care of four patients simultaneously. He told them, “I would not want my child to have surgery under that anesthesia model.”

The hospital allegedly breached standards regarding the supervision of CRNAs as well. In an email, the director of obstetric anesthesia asked the anesthesiologists not to go into the OR during cesarean sections unless it was absolutely necessary. The anesthesiologist raised concerns about these instructions, noting that anesthesiologists supervising CRNAs should feel free to be in the OR as they deem necessary in order to provide appropriate supervision and ensure safety.

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Thoughts? Please comment below.
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Study suggests that suprascapular block provides analgesia without compromised pulmonary function. Read this informative article courtesy of Anesthesiology News for more information:
The interscalene and supraclavicular nerves may be the blocks of choice in shoulder surgery, but both present the risk for respiratory distress. Ultrasound guidance provides a third option: the suprascapular block.
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How To Negotiate An Anesthesia Contract Like A Pro

Prior to addressing the main topic of today’s alert, we felt it necessary to inform our readership of the recent proposed changes made by the Centers for Medicare and Medicaid Services (CMS) in its CY 2017 Proposed Physician Fee Schedule (PPFS). In the CY 2016 PPFS, CMS proposed reexamining the anesthesia codes reported in conjunction with colonoscopy procedures (i.e., 00740 and 00810) as potentially misvalued. In the CY 2017 PPFS, CMS continues to maintain that 00740 and 00810 are misvalued and it “look[s] forward to receiving input from interested parties and specialty societies for consideration during future notice and comment rulemaking.” Moreover, CMS notes that although sedation services are included in certain endoscopic procedures, that anesthesia is being separately reported. As such, “[i]n the CY 2017 PFS proposed rule, CMS is proposing values for the new CPT moderate sedation codes and proposing a uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure. CMS is also proposing to augment the new moderate sedation CPT codes with an endoscopy-specific moderate sedation code, and proposing valuations reflecting the differences in physician survey data between gastroenterology and other specialties.”1 As always, we encourage our readers submit comments to CMS or to reach to their professional associations and encourage them to submit comments. CMS will accept comments until September 6, 2016.

In September of 2010, we issued an alert entitled, Using Your Inner Child to Negotiate Anesthesia Contracts. In that alert, we provided some useful tips and tactics on how anesthesiologists could use their skills to successfully negotiate contracts on their, or their groups’, behalf. Because the topic of negotiating contracts is never a stale one, we thought to revisit the issue with some more tips and strategies on how you can take your negotiation technique to the next level.

In our previous alert, we reviewed negotiating strategies presented by Bill Adler and Ron Shapiro. While we continue to maintain the importance of the strategies presented by those experts, we provide you with some more strategies that can be added to your toolbox:

1. Rank What is Important to You

Oftentimes, each side has a deal breaking item on which it cannot budge (e.g., compensation). Instead of approaching negotiations from the perspective that the deal hinges on compensation, both sides should consider ranking what is important to them and sharing with the other side their list of priorities. What they may learn is that, while compensation is of utmost importance, services or obligations making up the compensation may be less important and may be negotiable, thereby opening up the compensation issue for negotiation.

2. Honesty and Truthfulness Can Go a Long Way

It is not uncommon to approach negotiations by keeping your hand very close to the chest. However, revealing something at the outset of negotiations can open the door for optimal outcomes. That something need not be material to the negotiations, but discussing general hopes or concerns, or a little about yourself may be a small effort that can go a long way in making the other party receptive to a discussion.

3. Make the First Offer

This seems counter intuitive because, as with the previous point, many like to keep their hands very close to the chest. However, the first offer is always the starting point of negotiations. More often than not, the party that makes the first offer is closer to its target position at the conclusion of the negotiations.

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Do you have any suggestions on negotiating anesthesia contracts? Comment below.
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Physicians, read this post from Becker's Hospital Review to learn 5 things you need to know about the opioid epidemic:
Amid growing concern over the national prescription opioid and heroin epidemic, President Barack Obama has designated a week to remember those affected and raise awareness of the public health crisis.
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"Success is simple. Do what's right, the right way, at the right time." Arnold H. Glasow
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Did you know? Sevoflurane was clinically introduced as an inhalational anesthetic in 1994!
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"Innovation distinguishes between a leader and a follower." Steve Jobs
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Subscribe to our Anesthesia Industry eAlerts to stay up-to-date on the latest anesthesiology industry information:
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"The quality of a leader is reflected in the standards they set for themselves." Ray Kroc
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The largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Our technology and information management tools are cutting edge.

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.

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.

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.

**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.

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.

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.

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.

**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.

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