Obstacle #1: Independence

Anesthesiologists in private practices continue to be plagued by the decision of whether to sell their practice to an anesthesia practice management corporation or remain independent. Those in a private practice setting fall into three categories.

  1. Anesthesiologists who enjoy the autonomy they have within a private practice.
  2. Anesthesiologists who welcome the differences employment can provide.
  3. Anesthesiologists caught somewhere in between, unsure of which path is best.

If you fall into the undecided category, this could be the year you have to face this obstacle head on. When conversations and decision-making regarding the possibility of selling to anesthesia practice management companies begin, you’ll need to have an opinion formulated and be able to articulate your stance on the topic so you can contribute to the discussion.

5obstaclesThe first advice we’ll give you is to take a step back. Before evaluating the pros and cons of independence verses employment, define what your professional and personal goals are. What kind of work/life balance do you desire? Thinking outside your clinical practice, what is it you do and do not enjoy at your current practice? Then begin your list of pros and cons and see how they match up to your goals.

As an anesthesia practice, you are not limited to the current status quo. You can increase revenue and grow your practice in a number of ways. A good practice management team can help you determine your options and put strategies in place to help achieve your goals as a practice.

If active discussions are taking place with an anesthesia practice management corporation, do your homework. You are potentially switching to a very different environment then you are accustomed to. Become your own expert on the proposed compensation package, benefits, 401K and contract details presented. After all, it’s your paycheck and your goals on the line. A quick word of caution, some may think, “if I don’t like it I’ll just leave.” A non-compete clause is almost always tied into the contract so simply walking away may not be as easy as it sounds. Weigh all your options as a practice and consider the big picture.

Obstacle #2: Rising Payor Power

Payors are flexing their muscles and there is some strength behind those muscles. We have identified four reimbursement obstacles taking place by payors.

  • 40% of hospital and provider commercial in-network payments are value-oriented. This means they are designed to reduce waste or tied to performance. Only time will tell whether health care improves and becomes more affordable as a result. Over 50% of these value-oriented payments put physicians at financial risk.
  • Pre-authorization actions by payors threaten to take decisions on patient care away from physicians. Likewise, denials for coverage also undermine physician decision-making. Patient satisfaction and quality of care are affected as a result.
  • Narrow, limited networks are another strategy payors use to in an attempt to control costs. Physician evaluations become necessary for the payors in order to make their selections on a more narrow or limited network.
  • Anesthesiologists are seeing an increased amount of audit requests. Medicare and meaningful use, are just two examples where audits are prominent. Medicare audits can stem up to 10 years back. A meaningful use audit could result in findings that could potentially cost the practice money. Although there are few anesthesia practices that could participate at this time, we know CMS is moving towards rules that would allow more practices to be eligible.

Obstacle #3: Patient Satisfaction

An obstacle rising to the top for many anesthesiologists in 2015 is balancing quality medicine with positive patient feedback

Physician Quality Reporting System (PQRS) puts great emphasis on patient satisfaction scores, but as an anesthesiologist how are you influenced by the need to have high patient satisfaction scores but also provide the best medical care? Since performance is one way an anesthesiologist is evaluated, you may find yourself modifying your actions to drive higher scores.

Numerous reports have shown high patient satisfaction scores when patients received additional tests or prescriptions such as antibiotics or painkillers that were not really medically necessary.

Obstacle #4: Liability Dodgeball

Medical malpractice claims are an obstacle all anesthesiologists want to avoid. There have been an increased number of medical malpractice claims and the Affordable Care Act is taking some heat. Some are linking the inflow of new patients hand-in-hand to the increase in malpractice claims. Reports show hospital general liability per bed and average general liability claims will increase in 2015.

Like in any other specialty, anesthesiologists are cautious. Added diagnostic procedures and tests are one way doctors use caution. Findings from RAND Health and RAND Institute for Civil Justice show that physicians may be on auto-pilot when it comes to ordering extra tests and procedures.

RAND studied three states with raised standards for malpractice liability. In these states, paitents filing a malpractice claim must prove the need to use “reasonable care” was knowingly disregarded by the physician. Their findings show there was little decrease in the volume of procedures and tests ordered even though the physicians were more protected.

Obstacle #5: Mountainous Paperwork

Anesthesiologist may be feeling like they are scaling the Mount Everest of paperwork. The Practice Profitability Profitability Index shows 70% of physicians spent more than one day per week in 2014 on paperwork. This is a 12% increase from 2013.

Anesthesiologists and other physicians are finding have conveyed that a large obstacle in their day is that they spend the majority spending much of their time with charting and documenting rather than providing care to patients. Documents tied to payors and programs like ICD-10, PQRS and meaningful use contribute to the large mountainous volume of paperwork. A 2011 study by Health Affairs estimated interaction with payors cost physicians an average of $83,000 per year.


abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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