1. Insurance membership will take a hit from slow recovery. Few unemployed will take advantage of COBRA while employees, faced with paying more of their health plan premium, will select high-deductible, low-premium PPO plans, hurting HMOs.
2. No easing on payment pressure. Although health plan payments will keep pace with inflation and operating cost increases, they will not make up for declining or stagnant Medicaid and Medicare payments.
3. Patients will postpone care, hurting providers. With high unemployment and underemployment and increased out-of-pocket costs, people will continue to put off treatment, keeping volumes soft at hospitals, ambulatory centers and physician offices.
4. Cost is king. Soft volume, downward pressure on revenues and a deteriorating payer mix with increased bad debt will drive providers to seek more cost savings. However, unions, staffing ratios and regulations will make those cuts difficult. At the same time, health plans will begin to explore and increase the use of tiered networks and stratified payments to encourage use of lower-cost providers.
5. Capital remains elusive. As in 2010, most non-profit hospitals will find it difficult to access capital. Lenders are requiring an increase in days cash-on-hand, coverage ratio, stronger EBITDA and smaller borrowings. Credit rating agencies want to see: 1) physician alignment strategy, 2) clinical integration and cost reduction action, 3) an IT plan, and 4) plans to capture more market share.
6. Physicians will make or break new care models. To improve outcomes and lower costs, hospitals and medical groups will focus on accountable care, bundled payments, patient-centered medical homes and/or clinical integration. Reducing variation in care – primarily by physicians – will be central to any successful strategy. An effective bundled payment strategy, for example, requires specialists to address clinical resource consumption and supply cost and use while standardizing care protocols in conjunction with hospitalists and intensivists.
7. Construction focus is on fast returns. Construction projects will be scaled down, with a focus on regulatory compliance, enhancing throughput, improving care/outcomes and, if possible, capturing additional market share. Providers also will prioritize construction that generates superior returns, such as surgical services and imaging centers. It won’t be surprising to see the growth of freestanding emergency departments to reduce the need for hospitals, increase access and provide capacity for the newly insured.
8. IT becomes more pervasive – or else. Information technology underpins providers’ ability to shift to new care models, so IT moves to center stage with efforts to implement electronic medical records, computerized physician order entry and health information exchanges – provided, of course, medical facilities already have in place e-prescribing, PACS and online results reporting and scheduling.
9. Let’s make a deal. Mergers and acquisitions will be brisk as more hospitals and physician groups acknowledge they lack the resources to invest in information technology, facilities and equipment for new delivery models or the leverage to negotiate effectively with health plans. Given their central role in new models, the value of primary care medical groups will increase. It’s possible that health plans will enter the market to acquire these medical groups.
10. Market share, market share, market share. Hospitals and medical groups have underused assets and must get them busy. Providers also realize that more volume will generate incremental revenue and decrease per unit cost. Hospitals will hunt for new programs to fill empty or underperforming assets.

January 11, 2011 | Molly Merrill, Contributing Editor for The Camden Group

Jeff Hobson, Regional Sales Director for Shareable Ink, agreed to provide some information regarding their product.

Jeff, there are many smaller hospitals, ASCs and Office anesthesia practices attempting to transition to an automated anesthesia record, however we are put off by the cost and the complex nature of the typical Anesthesia Information System. It appears your product attempts to offer a bridge to an electronic record.

http://www.shareableink.com/

The Colorado Medical Society and the Colorado Society of Anesthesiologists yesterday sued Colorado Gov. Bill Ritter Jr. over his decision, announced earlier in the week, to opt out of a Medicare requirement that a CRNA must work under physician supervision for his or her work to be reimbursed. The Centers for Medicare and Medicaid Services gave states this option in 2001, and Colorado is the sixteenth state to exercise it. Most are Western and Great Plains states, where remote rural hospitals may lack an anesthesiologist to supply the supervision.

In their lawsuit, filed in a state circuit court, the Colorado physicians contend that Gov. Ritter’s opt-out decision “will diminish patient safety” and violate the state’s “captain of the ship” doctrine, which puts surgeons in charge of operating room personnel. Seeking a reversal of the governor’s action, the Colorado physicians also contend that the opt-out is contrary to state law, which they say classifies administration of anesthesia by a nurse as a “delegated medical function.”

CRNAs counter that patient care does not suffer when members of their profession work without physician oversight.

“The evidence shows that physician supervision does not have an impact on quality of care,” Paul Santoro, CRNA, and president of the American Association of Nurse Anesthetists (AANA), told Medscape Medical News.

Other states than Colorado that have bailed out of the physician supervision requirement for CRNAs are Alaska, California, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Washington, and Wisconsin. Colorado’s opt-out is confined to critical-access hospitals and specified rural hospitals.

Work arrangements

• 40% of CRNAs and ANs are employed by a single group
• 40% of CRNAS and ANs are employed by a single facility or hospital
• ANs spend more time performing general anesthesia
• CRNAs spend more of their time performing monitored anesthesia care (MAC)
• CRNAs are more likely to be employed by rural facilities

Reimbursement

• ANs work more hours and make twice as much as CRNAs
• Both ANs and CRNAs make more money in a rural setting

Regional Differences

• Western CRNAs are least likely to be employed by a group
• Western ANs are most likely to be employed by a group
• Northeastern ANs and CRNAs tend to work in larger facilities

Shortage/Surplus

• Greatest evidence for a shortage is in the Northeast and in urban areas
• Nationally, the anesthesia market is thought to be equilibrium, while states see mixed statuses
• 25 states show a shortage of ANs currently
• 19 states show a shortage of CRNAs currently
• In absolute numbers, Florida, Alabama and North Carolina exhibit the most shortage of ANs
• In absolute numbers, Pennsylvania, Michigan and Florida exhibit the greatest shortage, while Minnesota, North Carolina and California exhibit the most surplus of CRNAs.
• 2020 national projections exhibit a shortage of ANs and a surplus of CRNAs.  

Rand Health performed this study in 2010 for Ethicon. For copy right reasons I am providing my impression of  the most pertinent findings of the report and not a copy of the reoprt. If you would like a reprint fo the actual report you can request one at http://www.rand.org/pubs/technical_reports/TR688/

Read the entire story of Anesthesia Management aquisitions here.