AnesthesiaReviews Blog

Anesthesia Services: The Smoldering Fuse

  

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• Be very quiet and sit still, it will go away
• Plan, we don't need no stink's plan
• What's an RFP?
• My brother-in-law is the accountant, my uncle provides the benefits, and my sister does our billing. (She's not very good, but the subsidy makes up the difference)
• Meeting, what meeting?  I was busy in the OR
• How come the administration keeps changing?
• JC, ACA, MSO, SCIP, AMC, PPMC……..they're not acceptable words on my Scrabble App
• The wireless network sucks, I can't watch Hulu on my iPad
• Isn't good quality enough?
• A registered letter from administration!  Must be good news!
• No, we don't accept that insurance and we never will
• Does our contract even have a termination period?
• Negotiate?  Now that's an interesting concept?
• Haven't had a group meeting in six months and plan never to have one, if we can avoid it.
• They're consultants; they're here to help.
• The facility has been bought by……?
• Let's sell the practice; what can go wrong with that?
• Who's that and why are they doing in scrubs in the OR
• Literature on operating room and anesthesia group operations?  None of that applies to us.
• Is it time for Sleepy, Grumpy, or Dopey to run the board?
• County Medical Society, State Medical Society, State Anesthesia Society, ASA…….no thanks, I'm not a joiner.
• Replace me……..with [ fill in term] you must be kidding
• Accountable….for what? to?  you must be kidding
• Expectations ….for what? to? you must be kidding
• Consequences …. for what? to? you must be kidding
• You want me to do what?  Where?  Sorry that's not in the OR
• If Sleepy, Grumpy, or Dopey aren't running the board, can they go to OB and endoscopy?
• Budget?  Just who exactly does that apply to?
• Drug count isn't right?  Why is that my problem?
• Control costs?  My way is the safe way and the only way (those 100 other places that do it differently must be unsafe and wrong).
• Where's the JC surveyors?  I've got a few things to tell them.
• We're doing great…..our administrative costs for last year $6.13
• This is the way I've always done it and this is the way I will always do it.
• This is the way we've always on it and this is the way we'll always do it
• Hey, isn't Sleepy, Grumpy, or Dopey's turn to be Chief?
• Egalitarian, yup, that's what we are, totally, completely, irrationally egalitarian……no matter what the consequences.
• Democratic, yup, that's what we are, totally, completely, irrationally democratic……no matter what the consequences
• Hmmm……around here they seem to pat you on the back until they put a knife in it.
• I've seen the future and I'm not here
• Why does security have my stuff in that box
• It's the end of times

• Tick, tick, tick…….
• Eat or be eaten
• Rearranging the deck chairs on the Titanic
• What were you thinking?

Given the mindset above, it is easy to understand that changing an anesthesia service is the most delicate operation performed in any operating room.  Very few organization do it well because they lack a fundamental understanding of the process.  More to follow….

Take Home Points:

• Given the mindset in some anesthesia services, change is difficult and has a high failure rate.
• Very few organization makes changes well because they lack a fundamental understanding of the process.
• Removing an incumbent anesthesia service with anesthesia management company ("AMC") or physician practice management companies ("PPMC") is not creative destruction.  It is just plain destructive to the long-term goals of the facility unless important changes are made.