How to maintain independence in anesthesiology

Nishant Shah, MD, practices in a small anesthesia group — Midwest Anesthesia Partners — that is still autonomous, and sees opportunities for independent groups to maintain their autonomy in the future despite many physicians signing hospital contracts or joining larger corporate entities.

Market dynamics allow Dr. Shah and his partners to remain independent for yet another year, and that’s the way he prefers it.

"If you practice on your own, you control your contracts, the practice schedule and how you perform," he says. "When deciding whether to consolidate with others, you have to look at your process and gauge the pluses and negatives on your balance sheet. Talk about how your personnel will be transferred and whether there will be new hires, vacation policies and other changes at the basic level."

After joining a group, physicians may not be able to make decisions quickly anymore, or without asking for approval from the overarching leadership. The anesthesia companies or groups can help leverage contracts, but that doesn’t mean the insurance companies won’t have the upper hand in contract negotiations going forward.

"I think our independent model is sustainable; we haven’t been acquired yet and nothing is in the works," says Dr. Shah. "We have contracts we maintain and nobody has qualms with the service we provide. We are able to provide surgery center services, OB, pediatrics and offsite anesthesia. We also head the ICU at the hospital so critical care is a big portion of the care we provide."

Dr. Shah’s group has a pain management team for outpatient care and are able to staff every niche the hospital asks. There haven’t been patient satisfaction issues and his group found ways to help the hospital evolve. Surgeons are happy with the service as well.

"You have to show your worth and the ability to provide service with great efficiency, great ability for patient satisfaction while effectively maintaining relationships with all the different parties involved," says Dr. Shah. "We are able to do all those things and are taking on leadership positions at the hospital."

The group has many individuals on different hospital committees, including new initiatives at the hospital to optimize patient care. That relationship with the hospital allows the anesthesiologists to remain independent and continue to create value.

"The anesthesiologists are part of a larger hospital care team that takes care of patients for weeks before they arrive at the hospital as well as cares for patients after the surgery is completed as part of a new initiative called the perioperative surgical home," says Dr. Shah. "We aren’t there for every part of the care, but we’re deeply seated in the process. We are helping to supply the personnel and protocols for the initiatives along with surgeons, physical therapists, nurses and other healthcare professionals."

Financial issues and insurance factors drive healthcare decision-making today. Anesthesiologists and groups that are caring for the patient from the beginning to end can help the patient recover better and provide a better experience with integrated care.

Bundled payments also encourage collaboration; payers deliver payment in one lump sum and the hospital divvies up each provider’s portion.

"The healthcare model has become one whole package and we are figuring out who does what," says Dr. Shah. "Medical professionals are always striving to provide better patient care, and I think bundled payments will encourage everyone to prove their worth and earn their piece of the pie."

The providers who prove they’re worth a larger percentage of the overall payment will see bigger reimbursement. Anesthesiologists that can work with the patient before and after surgery and provide leadership on new quality and cost-saving initiatives, develop standards of care and achieve better outcomes will prove their worth.

"It’s really about the patients doing well," says Dr. Shah. "It’s not just about putting patients to sleep and waking them up. We are taking on many more responsibilities and our compensation should reflect that."

Going forward, bundled payment s could drive a higher incidence of ASC procedures over hospital-based surgery because ASCs have a better value proposition.

"With that in mind, anesthesiologists have to be receptive to doing bigger procedures in the outpatient setting on older patients without sacrificing quality," says Dr. Shah. "Anesthesiologists have to become more versatile and accommodating, and flexible in what they do in the outpatient setting. We have to continue to provide optimal care as we have done before and try to improve in any manner we can to maintain top-notch quality."

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