By Tom Mullaney
Anesthesiologists are expert at putting people to sleep. Now, a group of approximately 120 such specialists are generating some wake-up news. Chicago’s Midwest Anesthesia Partners (MAP) is the result of three independent suburban practices that consolidated in 2013. The group practice, in its short life, has achieved the nation’s best perioperative morbidity/mortality safety ratings.
While it is common for internists and cardiologists to join forces, a large anesthesiology group practice is relatively rare. MAP is likely the largest physician-owned and -operated anesthesia group in Illinois, according to David Rosen, MD, the network’s immediate past president who now serves as board secretary. He cites several reasons that members decided to go the group route.
First, the Affordable Care Act is forcing hospitals to tighten costs and performance targets. It rewards doctors more for keeping patients well rather than ordering more medical tests. Thus, hospitals are busy expanding their provider network and gobbling up independent practices. Even private equity firms, like Sheridan and Mednax—even Goldman Sachs—see smaller practices as profit centers that can be squeezed for cost savings and increased efficiency.
These new actors promise more favorable billing rates due to their larger numbers. Such a claim is false, Rosen contends, since Medicaid rolls are expanding and Medicaid will only reimburse hospitals and group practices set amounts based on 2015 ICB procedure coding. Rosen sees independence and the practice’s ability to set its own rates as the preferred choice for anesthesiologists. Is this beneficial to the patient, too?
Next, by aligning with a large group practice, members gain a professional management service that handles many of the office procedures that an office manager provides, like billing and regulatory paperwork, saving an expense that can be 50 percent of an office’s operation.
Third, Rosen cites higher quality care. “I truly feel it’s possible to provide the best quality care when you’re independent. When you take away the productivity pressure of a hospital-run practice, the treatment is better. Doctors can spend more time with patients explaining procedures more thoroughly.”
Hospitals are the network’s largest client base. MAP provides hospitals with anesthesiology coverage on a 24-hour basis at no cost to the hospital, maintaining the most efficient use of such services. Anesthesiologists, instead, bill patients directly.
Leo Kelly, MD, vice president of Medical Management at Advocate Lutheran General Hospital speaks highly of MAP and its help in managing efficiencies in the operating room and other patient procedures.
“They are a very talented anesthesiology group that is highly regarded by the medical staff. We look to partner with them in trying to provide high-value care at low cost,” he says.
Since 2007, anesthesiology payment reimbursements have declined 20 percent due to expanded public-aid rolls, according to Rosen. He says consolidation helps prevent further declines in salary levels.
Currently, MAP serves four hospitals in the north and northwest suburbs: Advocate Lutheran General Hospital in Park Ridge, Advocate Condell Medical Center in Libertyville, Northwest Community Healthcare in Arlington Heights and Vista Medical Center East in Waukegan.
MAP also provides anesthesiology coverage at eight offsite surgery and sports medicine facilities such as Gold Coast Surgery Center in Chicago, Golf Surgical Center in Niles, Illinois Sports Medicine Orthopedic Surgery Center in Morton Grove and United Therapies in Park Ridge.
The practice’s 120 current members are divided among general anesthesiologists and a number of fellowship-trained subspecialties. Pediatric anesthesiologists are the largest category, followed by obstetrics, cardiac, critical care and pain management specialists.
Group practices larger than 100 doctors are able to invent new treatment protocols and best practices, says Rosen, through analyzing larger patient databases to achieve better treatment options. MAP holds a weekly meeting in which all surgical procedures are discussed, and any less-than-excellent patient surveys are analyzed to improve patient satisfaction.
“We take a 360-degree view of the whole process. The surgical home model encompasses a patient’s experience from the time of scheduling the procedures to 30 days post-op and provides evidence-based best practices to decrease complications, length of stay and costs,” says Rosen.
There is strong interest among other independent practices to join MAP. Steven Marquardt, MD, MAP’s current president says, “We are in negotiations with three other independent practices that can add between 40 to 50 additional practitioners to MAP by the end of the year. Now that the Affordable Care Act is a reality, the prior institutional inertia has been overcome, and there is strong interest in joining.”