Anesthesia groups will likely see the recent surge of practice acquisitions begin to slow in 2016, according to a McKesson expert. At the same time, new opportunities are expected to emerge for groups seeking to play a more central role in the management of the operating suite. And all physician specialties will face new expectations for reporting quality metrics to the Centers for Medicare & Medicaid Services (CMS).

Laine Dowling, executive director, client management for anesthesiology with McKesson Business Performance Services (McKesson), said the wave of acquisitions that has swept through anesthesiology over the past several years appears to be easing as national companies expend their available capital or complete their footprint objectives.

An increasing number of anesthesia groups have opted to sell out to large national companies since the passage of the Patient Protection and Affordable Care Act (ACA) in 2010. In 2014, 27 practices were acquired by 14 separate purchasing companies, according to Anesthesiology News.1 Buyers included multiple private equity firms and several large, publicly held corporations.

Dowling said sellers have sought to capitalize on the premium prices offered by purchasers while gaining greater market clout and additional operational resources. In the uncertain aftermath of the ACA, aligning with a larger entity has been viewed as a means of ensuring participation in accountable care organizations and shared savings programs, and gaining access to capital and stronger contracting capabilities.

“The trend is definitely slowing down, and some people are worried that they may have missed the boat,” Dowling said. “But there are still opportunities to be acquired by hospitals. And while they’re unable to pay premiums above fair market value due to Stark regulations, they can pay operational stipends going forward, and that’s one way groups can still monetize their practices.”

A changing role

Beyond driving consolidation, healthcare reform also has spurred changes in the role anesthesiologists play in the hospital environment, Dowling said. Increasingly, anesthesiology groups are taking a central role in perioperative care and operating room (OR) management.

“They’re gaining greater control over the inner-workings of ORs,” Dowling said. “They’re in charge of assessing and scheduling the cases, maintaining the block schedules, determining whether rooms are opened or closed.”

Dowling said groups also are extending their capabilities to include quality outcomes assessments, post-discharge pain management, critical care and palliative and hospice care.

“As competition from national companies increase, a lot of groups are concerned about the stability and security,” Dowling said. “So one thing they can do is try to solidify their role and make the practice into an irreplaceable asset in the eyes of the hospital administration.”

He added that one key to success in extending the role of the practice is to identify a group member who can serve as the primary liaison with both the hospital and surgical teams.

“To really make it work, you have to have someone who understands the politics and the issues, and who can judicially say no and effectively say yes,” he said. “It’s really not only about intelligence but personality.”

PQRS

For all physicians, the Physician Quality Reporting System (PQRS) now includes both claims and registry reporting. The qualified clinical data registry (QCDR) reporting mechanism was introduced for the Physician Quality Reporting System (PQRS) beginning in 2014. A QCDR will complete the collection and submission of PQRS quality measures data on behalf of individual eligible professionals (EPs).2

A QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care provided to patients. Individual EPs who satisfactorily participated in 2015 PQRS through a QCDR may avoid the 2017 negative payment adjustment (-2.0%). To be considered a QCDR for purposes of PQRS, an entity must self-nominate and successfully complete a qualification process.

The 2015 Medicare Physician Fee Schedule (MPFS) Final Rule includes the finalized, detailed information regarding this reporting mechanism. Please note: A QCDR is different from a qualified registry in that it is not limited to measures within PQRS; CMS has posted a criteria toolkit for entities that are interested in becoming a 2016 QCDR.

The 2016 PQRS: QCDR Criteria Toolkit includes detailed information regarding the self-nomination and qualification requirements. Entities wishing to participate as a QCDR in the 2016 PQRS should review the documents in this toolkit. The following documents pertaining to the 2016 QCDR participation are included in the zip file titled 2016 PQRS: QCDR Criteria Toolkit (ZIP, 1.7 MB):

  • 2016 QCDR Criteria – Provides guidance to prospective QCDRs on successfully completing the self-nomination process to become a 2016 QCDR.
  • 2016 QCDR Data Validation Plan Criteria – Assists entities interested in participating as a QCDR with the process of submitting a data validation plan that meet the requirements as outlined by CMS in the 2016 Medicare Physician Fee Schedule (MPFS) final rule.

1 Ted Agres, “Anesthesiology Acquisition Rate Still at Fevered Pace,” Anesthesiology News, July 2015.
2 Qualified Clinical Data Registry Reporting,” CMS Fact Sheet, CMS.gov, Nov. 9, 2015.

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About the author

McKesson Business Performance Services offers services and consulting to help hospitals, health systems, and physician practices improve business performance, boost margins and transition successfully to value-based care.