1. The “job market” for anesthesia professionals is being influenced by the number of residents being trained, the geographic maldistribution of anesthesiologists, and marketplace forces as reflected by managed care organizations and the real and potential impact on the numbers of surgical procedures.
2. Types of practice include academic practice, private practice in the marketplace, private practice as an employee, practice as a hospital employee (rather than subsidize an independent practice), practice for a management company, and practice in an office-based setting.
3. Billing and collecting may be based on calculations according to units and time, a single predetermined fee independent of time, or fees bundled with all physicians involved in the surgical procedure.
   1. All practices should have detailed compliance programs in place to ensure correct coding for services rendered.
   2. Billing for specific procedures becomes irrelevant in systems with prospective “capitated” payments for large numbers of patients (a fixed amount per enrolled member per month).
   3. The federal government has issued a new regulation allowing individual states to “opt out” of the requirement that a nurse anesthetist be supervised by a physician to meet Medicare billing requirements.
4. Antitrust Considerations
   1. The law is concerned solely with the preservation of competition within a defined marketplace and the rights of consumers.
   2. The market is not threatened by the exclusion of one physician from the medical staff of a hospital.
5. Exclusive service contracts state that anesthesiologists seeking to practice must be members of the group holding the exclusive contract.
   1. In some instances, members of the group may be terminated by the medical staff without due process.
   2. Economic credentialing (which is opposed by the ASA) is defined as the use of economic criteria unrelated to quality of care or professional competency for granting and renewing hospital privileges.
6. Hospital Subsidies. Modern economic realities may necessitate anesthesiology practice groups to recognize that after overhead is paid, patient care revenue does not provide sufficient compensation to attract and retain the number and quality of staff members necessary.
   1. A direct cash subsidy from the hospital may be negotiated to augment practice revenue to maintain benefits while increasing the pay of staff members to a market-competitive level.
   2. The ASA's Washington, DC, office maintains lists of consultants to help anesthesiologists and groups dealing with hospital subsidies.

Scope of Practice

1. Administrative Components of All Anesthesiology Practices
2. Practice Essentials
3. Evolving Practice Arrangements
4. Health Insurance Portability and Accountability Act
5. Expansion Into Perioperative Medicine, Hospital Care, and Hyperbaric Medicine
6. Operating Room Management