by Christopher G. Tirce, MD, FASA
How do we help California anesthesiologists in a meaningful way that ensures we not only survive but thrive on an individual, practice, and statewide level? Unfortunately, we may have ignored our greatest assets—ourselves.
It has been my experience that, though the vast majority realize the value of cooperation, practices and anesthesiologists in California often do not engage each other. More to the point, however, is the lines of communication and collaboration that would allow the development of these relationships are simply not there. What if the CSA could provide just that—a collaborative infrastructure that could enhance our responses to everything from small, day-to-day operational entanglements to some of the higher impact, controversial issues you face as a California anesthesiologist?
As Chair of the Practice Management Division, I spend a lot of time thinking about where our collective practice will be in California in the next five to ten years. California is the fifth largest economy in the world, with over six thousand anesthesiologists and health care spending totaling nearly $300 million annually. We are the largest state chapter of the American Society of Anesthesiologists, and a prescient augury for national trends in healthcare (just look at the current congressional out-of-network billing debate). With stakeholders including physicians, nurses, surgeons, payors, administrators, patients, and now corporations and private equity, we sit amidst a sea of interests that force us to address many questions - some economic, some legislative, some operational, and still some philosophical.
In 2009, nurse anesthetists were granted independent practice rights in California (upheld in 2012). A year after that decision was upheld, Sheridan Healthcare, Inc. (now Envision Healthcare) acquired Northern California’s Medical Anesthesia Consultants in a controversial purchase, ushering in the first large anesthesia management company purchase of a California anesthesia practice. Envision, Somnia, Team Health, Premier Anesthesia and some smaller companies all have strong footholds in several California markets now. In response, consolidation and strategic integration have accelerated across the state. Multi-specialty physician conglomerates like Vituity (formerly CEP) are gaining traction. Hospital systems are expanding and acquiring more property, facilities, and contracts and, in some cases, making employees of their physicians—including anesthesiologists! Broad independent contractor legislation (“Dynamex”) has created a situation in which the employment structure for nurse anesthetists within a practice may incur greater costs to stakeholders and change the economics of whether and how we utilize nurse anesthetists. Assembly Bill 72 has led to an ongoing and as yet incompletely realized reimbursement dilemma, as the “average contracted rate” is already becoming weaponized by insurance companies to drive down reimbursements well below actual commercial rates. And the specter of a single payor system still looms.
How we respond to these situations will depend, in part, on our mode of practice. The Kaiser physician’s answer will surely be different from the private practice physician’s, as his or hers will be from the academic’s. But how we answer these questions will very much determine if we can succeed and prosper in California, as the nonclinical aspects of providing our care continue to affect our ability to provide that expertise. And as we move along these common paths, it is more effective for us to work together rather than to go up against the same problems in separate “pill boxes.” We need to make connections, share resources, leverage solutions, and augment our influence to ultimately create our best future.
The Practice Management Committee of the CSA is launching a new website that is designed to connect anesthesiologists all across the state. The streamlined user experience will offer a more collaborative interface that will keep members engaged, informed, and better able to lead their practices through challenging times. New sections including case studies, op-eds, headlines, practice resources for graduating residents, message boards, and a “top issues” center will bring stories, noteworthy news, implementation tools, collective experience, and collaborative knowledge to the front line—you, the California anesthesiologist.
Our vision within the Practice Management Committee is to empower our members to become better leaders, as we navigate the realities of practice beyond direct patient care. New and individually significant changes will continue to arise, but they also provide us with an opportunity for reasserting the strength and security of the physician anesthesiologist. It is essential that we shape what the nonclinical aspects of our practices look like rather than relegate ourselves to be reluctant subjects to them. Log in to the new Practice Management website, visit often, and join the conversation.
Connect. Collaborate. Lead. Together.