Franklin Dexter

When negotiating a contract with your anesthesia group, you'll spend considerable time discussing such usual sticking points as compensation, length of contract and how to handle unused OR time. But other, less-apparent issues are as important, chief among them: Does your agreement comply with the federal anti-kickback statute and its regulations?

ASCs must be particularly mindful of their relationships with anesthesia providers regarding staffing, billing and referral relationships. Similarly, anesthesia groups can level the playing field against ASC owners during contract negotiations and protect against one-sided arrangements if they understand the governing laws and regulations. This article examines 3 types of joint-venture arrangements between ASCs and anesthesia groups and considers the level of legal risk associated with each model.

We all know what an OR schedule gone haywire is like. As the waits grow longer, the fuses of surgeons, staff and patients grow shorter. But here's a question you might be overlooking: Are you monitoring tardiness accurately? You're not if you're tabulating the number of cases that start late, instead of the average number of minutes all cases start late. Seems like we're splitting hairs, but as you'll see, there's a big difference between cases and minutes.

So long as there are surgeons who arrive late, cases that run long, nurses who call out sick and ruptured abdominal aortic aneurysms that present at 9 a.m., there will be disruptions in your OR schedule. Yes, things don't always go as planned on the day of surgery.

You must schedule add-on cases. Fill gaps in the schedule. Move cases. Assign staff. Prioritize limited resources and personnel. Prepare patients. Sequence urgent cases. You must adjust on the fly, be comfortable with chaos and sometimes manage by the seat of your pants, by instinct or by intuition.

What if you could integrate decision-making on the day of surgery? After reading this article about OR management on the day of surgery, you'll better understand how to decide what cases to postpone, what cases to move and so forth in response to unforeseen changes in the OR schedule. The goal of all of this is to maximize OR efficiency and minimize patient waiting time.

When numerous demands like surgeon requests, changing staffing requirements and capacity issues compete for OR time and space, the surgical schedule can take on a life of its own. Yet, the surgical schedule doesn't have to be hard to manage. Studies clearly show that schedulers should consider five key guiding principles in the following order: patient safety, access, OR efficiency, patient service and physician satisfaction. In this article, I'll show you how these five principles will help you get your surgical schedule under control.