Business of Anesthesia Part I
Business of Anesthesia Part I
Business of Anesthesia Part I
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Economics <strong>of</strong> <strong>Anesthesia</strong><br />
Jan Mannino, CRNA, JD
Economics Issues<br />
Knowledge is power<br />
Health care economics key political issue<br />
Get out <strong>of</strong> the operating room<br />
Know where the anesthesia dollar goes
Income from <strong>Anesthesia</strong><br />
Pr<strong>of</strong>essional fees<br />
Supplies -- mark-up<br />
Equipment usage<br />
Subsidy
Statistics<br />
Healthcare Market<br />
1960 -- $27 billion<br />
2004 - $1.5 trillion<br />
Healthcare spending will rise 7.3% annually
Basic Concepts <strong>of</strong> Economics<br />
Medical care is a commodity<br />
Demand for medical care is irregular<br />
Illness instead <strong>of</strong> health<br />
Information imbalance with ethical<br />
overtones (treat me even if I can’t pay)<br />
Uncertainty<br />
Not a clear link between treatment &outcome
Economics and <strong>Anesthesia</strong>
Concept --Scarcity and Choice<br />
Limited resources<br />
Not sufficient resources to meet the<br />
needs <strong>of</strong> all <strong>of</strong> the people all <strong>of</strong> the time<br />
Geographic differences<br />
Economic concerns
Economics <strong>of</strong> Cost<br />
Cost in the decision process<br />
Example<br />
Can a hospital afford to have OB anesthesia<br />
coverage
Supply and Demand<br />
Foundation <strong>of</strong> all economic analysis<br />
What is the demand for anesthesia services?<br />
If the supply <strong>of</strong> practitioners is not adequate<br />
to meet demand, what happens<br />
New practitioners may be developed<br />
<strong>Anesthesia</strong> Assistants<br />
Conscious Sedation Nurses<br />
Respiratory Therapists
Demand for <strong>Anesthesia</strong><br />
Changing demand<br />
Demographics -- aging <strong>of</strong> population<br />
Technology<br />
Patient desires
Competition<br />
Quality <strong>of</strong> service<br />
Price
Self-Interest<br />
The primary motivator <strong>of</strong> economic<br />
decision makers<br />
Nurses generally do not fit this model<br />
Remember self interest in negotiations
Markets and Pricing<br />
Market for anesthesia services<br />
Value <strong>of</strong> anesthesia<br />
Do we make administration <strong>of</strong> anesthesia<br />
look too easy?<br />
Don’t undervalue what we do in anesthesia<br />
Adam Smith’s invisible hand: “Everything<br />
and everyone has a price”
Importance <strong>of</strong> <strong>Business</strong> and<br />
Economics<br />
Practice options<br />
Negotiating reimbursement<br />
Future planning<br />
Medical and surgical<br />
Governmental influence<br />
Anticipation <strong>of</strong> legal issues
Practice Options for CRNAs
Employed<br />
Hospital or Facility<br />
Anesthesiologist group<br />
CRNA group<br />
Surgeon
Self-Employment Option
Self-Employment Models<br />
in<br />
<strong>Anesthesia</strong><br />
Contract work--sometimes called “freelance”<br />
Permanent practice privileges<br />
Combination <strong>of</strong> two or more types <strong>of</strong><br />
models
Changes in Reimbursement<br />
Less employer payment<br />
More self pay, higher deductibles<br />
Patient contributions to health insurance<br />
Boutique medicine<br />
Government involvement<br />
Medicare<br />
Medicaid
Pr<strong>of</strong>essionalism<br />
Perceptions<br />
Representation as a businessperson<br />
Remember -- <strong>Anesthesia</strong> is a clinical<br />
specialty
Getting Help<br />
Accountant<br />
Attorney<br />
<strong>Business</strong> consultant<br />
Other anesthetists
Evaluation and Analysis<br />
Annual<br />
Income<br />
Expenses<br />
Personnel Issues<br />
Growth or retraction<br />
General economic considerations
Roadblocks to Private Practice<br />
Clinical privileges in a hospital<br />
Competition with other practitioners<br />
Licensure issues<br />
Malpractice insurance<br />
Perceptions <strong>of</strong> surgeon liability<br />
Unknown factors
Words <strong>of</strong> Wisdom #1<br />
When They Say It’s Not About Money, It<br />
Usually Is
Words <strong>of</strong> Wisdom #2<br />
There is a perception that Nurses are not<br />
<strong>Business</strong>people
Words <strong>of</strong> Wisdom #3<br />
NO ONE WILL BE HAPPY FOR YOUR SUCCESS,<br />
EXCEPT YOUR MOTHER
Remember<br />
Administering anesthesia is more<br />
difficult than setting up an anesthesia<br />
business--it is just a matter <strong>of</strong> education
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