1. Even though the impact of managed care plans has waned somewhat, various iterations still exist and have ongoing impact on anesthesiology practice.
2. Prospective Payments. In this arrangement, each group of providers in the managed care organization receives a fixed amount per member per month and agrees, except in unusual circumstances (“carve-outs”), to provide care.
3. Changing Paradigm. There is an emerging trend for private contracting organizations to tie their payments for professional services to the government's Medicare rate for specific CPT-4 codes.
4. Pay for performance is the concept supported by commercial indemnity insurance carriers and the Centers for Medicaid and Medicare Services to reduce health care costs by decreasing expensive complications of medical care.
   1. Accountable Care Organizations were created by the Patient Protection and Affordable Care Act that was signed into law in 2010. To ensure the importance of preoperative care of the surgical patient in these provisions, the ASA is advocating a “surgical home” model of care.
   2. Management Intricacies. The complexities of modern medical practice have spawned management consultants that offer their services to anesthesiology group practices.

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