By Puja Trivedi, DO
Hospital acquisitions and mergers, changes in insurance reimbursement rates and misinformation about our training have led to increased scrutiny of anesthesia groups and questions about our value. Most internal practice changes to improve safety, efficiency and cost reduction remain unseen by hospital administrators unless we can find an effective way to clearly communicate the group’s contributions to high quality patient care.
This is why creating a value proposition is critically important in this volatile market. A value proposition is a statement of the distinctive benefits your anesthesia group provides to your patients, surgical colleagues, and the hospital, and clearly conveys your value to key stakeholders. It is a powerful negotiation tool that can be used strategically during contract renewal, stipend discussions or as a response to a Request for Proposal (RFP) for anesthesia services by hospital administration.
The ASA RFP toolkit is an easy-to-follow guide to assist your practice in creating a value proposition by honing in on measurable high-yield areas of contribution such as leadership, service contributors, and by providing examples of key quality and efficiency metrics.
The comprehensive toolkit deepens understanding and empowers physician negotiators by highlighting the following topics:
· Understanding compensation
· Productivity benchmarking
· Demonstrating efficiency of your workforce
· Defining Request for Proposals (RFPs)
· Understanding your customers in preparing your response
· Legal considerations (for both the RFP and the contract)
· What to do after you are awarded the contract
The RFP toolkit was created to assist anesthesiologists on a national level so there are a few caveats specific to our region.
California Non-Compete Legislation
Unlike other states where a hospital can enforce a non-compete clause, effectively preventing a physician from working for another hospital system or geographical location for a specified time period in the event of resignation or termination, this clause is not enforceable in California.
Neal Butala, a California lawyer specializing in contracts, said, “California Business and Professions Code Section 16600 prohibits employee non-competition agreements with very few exceptions. Despite this I have come across non-compete clauses embedded within many contracts but remind my clients that this is not enforceable. A variation that I commonly see is the ‘no moonlighting’ clause. California Labor Code Section 96(k) prohibits employers from punishing employees who engage in moonlighting in their free time as long as they maintain their job performance.”
California Specific RFP Anesthesia Group Model Points
Given the expansion of anesthesia management companies and the increasing utilization of nurse anesthetists in California, former CSA Practice Management Chair Dr. Christopher Tirce recommends including specific language addressing why RFP’s from competing models that utilize these midlevel practitioners or from management companies may not be in the best interest for a hospital, and to be wary of advice from these potential competitors. For private practice groups to which this applies, it may be beneficial to highlight that anesthesia management companies often strategically utilize nurse anesthetists or combination service packages (i.e., bundling emergency medicine contracts utilizing anesthesia as a loss leader) that can sacrifice safety and quality in order to improve profit margins typically for investors and/or executives.
It is equally important to underscore that hiring unsupervised nurse anesthetists creates additional malpractice liability for their surgeons and other proceduralists like gastroenterologists, who would become medically accountable for any bad outcomes caused by the actions or inactions of the nurse anesthetist, and the absence of a physician providing anesthesia care.
A malpractice attorney brings up another important issue. If a surgeon hires an independently practicing nurse anesthetist with a DNP or Ph.D. degree and they choose to introduce themselves as “Doctor [insert name],” this potentially constitutes deception and may have legal repercussions for the surgeon.