Becker's ASC Review

12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Business of Spine - call (800) 417-2035 33 hospital setting where this technology may not be offered to the ASC setting. By increasing the case volume, the increased expenses can be offset by the increased revenues and most importantly, patient care and safety are improved. of any situation. A lot of it is also being a troubleshooter. We want our physicians, nurses and staff members to be happy and for patients to be safe and get the highest level of quality care. Interestingly, there was a commercial insurance carrier in Maryland that recently established a different professional fee schedule for ASC-based procedures. Historically, if you did a procedure in a hospital or in an ASC, the professional fee reimbursement was the same. The insurance company did this because they understand the value to the patient as well as to themselves. This is not just monetary. We know that procedures can done in a safe environment with a lower cost to them. They may serve as a potential incentive to certain physicians to do more cases in the ASC setting rather than in the hospital. One of the more difficult issues is dealing with physician behavior issues. In every ASC, you deal with some physician behavior issues, and you have to deal with it immediately and directly. I try to work face-to-face and avoid emails as much as possible. Email is very open to interpretation and can be taken out of context. When you're face-to-face, you can hear them out and develop a corrective action plan that they agree to. Q: What are some benefits of being a physician owner? BL: My biggest challenge is how to balance my obligations to my patients in the office and in the hospital in addition to all the ambulatory surgery center issues including the clinical, operational, financial and regulatory issues. It's a balance. You have to figure out how to manage your time, and it's not easy to do. It is still an evolving process, trying to strike the proper balance. BL: As a physician and a fellow surgeon, I can understand my fellow surgeons and possible difficult situations better. On the flipside, it also takes a special kind of person to deal with your peers when it comes to disciplinary action or proprietary actions. I've been clear with physicians that we can't use 50 different types of gauze or gloves. I always tell my doctors, if you feel an existing product compromises patient care and safety, let me know. But if you want to change from brand A to brand B because you like it more but brand B is more expensive and doesn't bring better care, we would not want to make that change. Physicians have their preference and idiosyncrasies. Part of working with other physicians is learning how to be a good communicator and to figure out the best way to communicate with them so they understand both sides New OIG Advisory Opinion: 13-15 Further Hardens Line on Anesthesiologist Relationships By Scott Becker, JD, CPA & Carrie Pallardy T he Office of Inspector General just released an advisory opinion which may further discourage relationships whereby non-anesthesia providers can profit from anesthesia relationships. In Advisory Opinion 13-15, the OIG refuses to offer a favorable advisory opinion in a situation where a psychiatrist would pay an anesthesia group a per diem rate for coverage. The anesthesia group would then assign their right to bill for the services to the anesthesia provider. Here, the alleged kickback is the right to generate a fee/profit equal to the amount the psychiatry group could bill over the amount it would pay the anesthesia group. The OIG articulates that no safe harbor would protect the per diem amount and no safe harbor would protect the reassignment of billings. The OIG further reasons that the arrangement gave the psychiatry group the right to a portion of anesthesia revenues in exchange for the psychiatry group referrals. The opinion overall may further discourage a host of anesthesia provider relationships. The anesthesia community has become unusually adept at utilizing the advisory opinion process to influence market activity.  n Q: What are some of your biggest challenges? If you are going to be a practicing clinician and have an active role as a medical director, you have to be absolutely protective of your administrative time. One must be sure to set aside days or periods of time to devote yourself to your ASC duties. Trying to co-mingle ASC duties and clinical duties can be problematic at times. A crucial part of my success is the support and hard work of our director of nursing and nurse managers. We all have great working relationships and meet weekly to go over any issues. All of our nurses, surgical technicians and other employees are also such a critical part of a successful ASC. n 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Business of Spine June 12-14, 2014 • Chicago 132 Sessions • 168 Speakers 63 Physician Leaders • 28 CEOs Keynote Speakers: NBA Hall of Famer Kareem Abdul-Jabbar Former Six-Term Governor of Vermont Howard Dean To learn more or register, visit www.beckersasc.com/beckers or call (800) 417-2035

• Cover