10 Tips for Partnering With an Office-Based Anesthesia Practice
Much surgery is now being done in the office rather than the hospital or ASC, providing new opportunities for anesthesiologists, according to a report by the American Society of Anesthesiologists' Committee on Ambulatory Surgical Care and the Society for Ambulatory Anesthesia's Committee on Office Based Anesthesia. The report offers the following tips on partnering with an office-based surgery practice.
1. Understand what surgeons want. Surgeons like office-based surgery because it allows them control, convenience and financial opportunity. They want from partnering anesthesiologists excellent clinical care, an affable manner, availability, flexibility, reliability and a reasonable price.
2. Find the right surgeon-clients. Clients should be reliably on time and be prepared to establish a long-term relationship. An undependable client base is expensive and inefficient. In addition to excellent care and reliability, focus contract negotiations on availability, price and extra services provided.
3. Consider the right size of service. A solo anesthesiologist cannot easily accommodate last-minute changes, vacations and illnesses. Larger anesthesia groups can offer more flexibility, but they may not always be able to place the same practitioner in the same offices, as clients tend to prefer.
4. Make sure your malpractice policy covers you. Check with your professional liability insurance carrier to confirm coverage in any new office-based setting.
5. Determine whether Medicare will pay. Contact the CMS intermediary to find out whether a CMS-participating anesthesiologist would be reimbursed for professional services rendered in an office as opposed to an ASC. Find out the CMS reimbursement rate for anesthesia to get an accurate picture of the payer mix of the office-based arrangement.
6. Don't commit to all insurance plans. Committing upfront to all contracted insurance plans of the facility could be risky. Instead, consider inserting language into the contract with the surgeon stating the anesthesiologist will "agree to negotiate in good faith with all insurance companies."
7. Provide extra services. Because the efficiency of the facility affects the their income, anesthesiologists are well positioned to take on other duties. Provide extra services or a price, such as ordering drugs and supplies, providing staffing and assuring compliance with accreditors. Or simply offer to take over management of the facility or offer a turnkey approach by providing a wide array of services, such as setting up the facility, as well as daily management.
8. Recognize the implications of extra duties. By taking on medical director responsibilities, for example, the anesthesiologist is responsible for ensuring that arrangements do not violate rules and regulations. Also, the anesthesiologist's services must be provided at "fair market value" and must not be construed as a "bonus" service to facilities.
9. Address non-billable downtime. If the surgeon finishes early or is tardy, the anesthesiologist may be stuck with non-billable down time. The contract should address whether there is compensation on these occasions. The contract might set a percentage of surgical time that must be used. Organizations such as the ASC Association can provide utilization benchmarking data.
10. Decide how to charge payors for services. Base and time units are widely used when billing to third-party payors. An alternative is charging the patient, facility or physician by case, but one must first consider volume of cases and the speed of the surgeon. Or one can bill by the hour, which means defining the expected number of hours for surgery and whether there should be a minimum number of hours guaranteed.
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