CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Emily Methangkool, MD, MPH, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD


For Us, Change Has Arrived

  • Lucas, Shawn, MD
| Oct 27, 2014

The recent ASA meeting in New Orleans, ANESTHESIOLOGYTM 2014, was an outstanding opportunity to hear leaders from across the United States discuss the future of our specialty. As Drs. Sibert and Chamberlin have written, it is a future with a significant amount of uncertainty, but one absolute certainty … change is coming.

Where I practice, at Group Anesthesia Services (GAS), in Los Gatos, Calif., we have been been trying to figure out how to deal with these changes while respecting the values upon which our group was founded: autonomy, ownership, and quality.

Like many anesthesiology groups, GAS has been struggling with how to adapt to the changing health care environment. We spent a significant amount of time talking to fellow Northern California anesthesiology groups, meeting with investment bankers, and speaking with consolidation firms as we tried to find a solution that addressed both the increasingly complex facets of current-day practice management and our core values.

As we worked on how best to deal with the changes in health care, we realized that any solution would not only have to be effective for the problems we are facing, and will face in the future, but would also have to support the values that, as a group, create our identity and history. Therefore, a key part of any solution would be the preservation of our independence, the continuity of the concept of “our practice in our community,” and the quality of our care that creates the pride in our work.

After looking at many options, we decided to create a different model in the field of anesthesia. We will be joining CEP America a multispecialty physician partnership, as the founding partners for their Division of Anesthesiology.

CEP America is a physician-owned partnership that has been around for over 40 years and has specialized in emergency medicine and hospitalist physicians. They share our outlook: that the future of hospital-based physicians increasingly depends on our ability to deal with hospitals, and care for patients, from a multispecialty perspective.

Because we joined a physician partnership, we did not get purchased. For some, the lack of up-front payment would be a hurdle. For us, this addressed a significant value that made it difficult for us to consider selling our practice: the idea of ownership. The owners of CEP are the physician partners in CEP. By joining CEP as partners, not employees, we continue our careers in an organization that is owned, and run, by doctors.

It was also important for us to be part of an organization that shared our perspective on the management of physician practices and local autonomy. As president for GAS, I, and our other physician-leaders, spend more and more of our time managing the group and dealing with the increasing legal, accounting, and technological complexities of health care today. This is not unique. The time requirement for anesthesia group leaders, and the value of that time, is going to increase. Many anesthesia groups are looking for the solution to this problem, among others.

For us, this solution was provided by MedAmerica, CEP’s wholly-owned management services organization. This affiliation will give us access to extensive management services, spreading the costs for those services between the almost 2,500 providers in CEP, while supporting our local independence.

Another challenge that we are dealing with is the shift from “volume” to “value” and the need for anesthesiologists to demonstrate their effect on quality. Like many groups, we recognized that we need to measure our effect on patient outcomes to prove our value, but we were intimidated by the difficulty of creating an effective system. Even for our group of almost 40 anesthesiologists, the time, money, and expertise required to manage this issue effectively seemed overwhelming. Our new partnership will allow to us address these issues as well, with an existing robust data analysis and management system.

As others have written in the CSA blog, the challenges for anesthesiologists are time-consuming and difficult, often requiring a skill set that can take significant experience to acquire. Although our solution may not be for everyone, we feel that it fits our values of autonomy, ownership, and quality. With that in mind, we are excited to meet head-on the future challenges of anesthesiology, and health care.

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