Tag: business of anesthesia

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Anesthesia Education Business/Finances Personal Finances Preparing for Grad School/Residency

#82 – How Change Management can Build Value with Randy Moore & Desirée Chappell

Randy Moore, DNP, MBA, CRNA and Desirée Chappell, MSNA, CRNA join me to talk about change management in healthcare. They are both on the leadership team with NorthStar Anesthesia, which provides perioperative services at over 200 facilities across 20 states.

This conversation focuses on how leaders can navigate change, develop culture and build successful anesthesia practices. We discuss the challenges facing anesthesia providers right now after 2 years of the COVID-19 pandemic and what market forces are at play including provider shortages, pressure from reduced reimbursement rates and lower surgical volumes. This episode will be relevant for any anesthesia provider who’s looking to build value in their career and especially relevant for those practice managers, owners, leaders & entrepreneurs who want – and need – to know how to navigate change, find sustainable & deliberate growth and develop cultures where providers want to invest their careers.

Desirée Chappell, MSNA, CRNA is the Vice President of Clinical Quality at NorthStar Anesthesia. Desirée has an extensive background in education and quality improvement in anesthesia. She is the managing editor & lead anchor of TopMedTalk, a podcast on anesthesia, critical care & perioperative medicine with nearly 1600 episodes. She is also adjunct faculty for the Acute Pain Management Fellowship at Middle Tennessee School of Anesthesia and serves on the board of directors for the American Society for Enhanced Recovery. Desirée received her Master of Science in Nurse Anesthesia from Texas Wesleyan University.

Desirée Chappell, MSN, CRNA, VP of Clinical Quality at NorthStar Anesthesia

Dr Randy Moore, DNP, CRNA, MBA is the Chief Anesthetist Officer at NorthStar Anesthesia. He recently left his role as the Chief Executive Officer of the American Association of Nurse Anesthesiology and has a long background in organizational leadership. He retired as a Major in the United States Army after 22 years where he served as an active duty CRNA with tours in Afghanistan at Forward Surgical Bases. His doctorate of nursing practice is from the University of Alabama, his MBA from Southern Illinois University and Master of Science in Nursing anesthesia from Bradley University.

Randy Moore, DNP, CRNA, MBA, Chief Anesthetist Officer at NorthStar Anesthesia

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Anesthesia Education Business/Finances Personal Finances Wellness

#81 – How to Navigate the Business of Anesthesia with Tracy Young, MSNA, CRNA, MBA

I caught up with Tracy Young, CRNA, MBA & CEO of YPS Anesthesia Services in Houston back in November 2019 to talk about the business of anesthesia.

Tracy is one of the most sought-after experts on the business of anesthesia not just at CRNA conferences but throughout the healthcare management & business industry.

In this episode we discuss a broad range of topics including anesthesia billing & staffing models, trends in reimbursement, differences between W2 & 1099 work, advice for establishing your first anesthesia staffing contract, how to succeed both in your career as an anesthesia clinician and how to transition into the business of anesthesia, how to maintain balance & wellbeing over the course of your career and other key insights.

Tracy covers the origin and mission of his business, YPS Anesthesia Services, which at the time of this interview (8 December 2019) supports over 450 anesthesia providers to staff over 60 endoscopy & ambulatory surgery centers and hospitals across seven states in the United States.

Tracy Young, CRNA, MBA, CEO of YPS Anesthesia Services

Tracy Young earned his Master of Science in Anesthesia (MSNA) from Texas Wesleyan University in 2000, found YPS Anesthesia Services in 2003 and went on to earn a Master in Business Administration (MBA) from George Washington University in 2008.

Leading YPS Anesthesia Services for nearly 20 years has provided Tracy a wealth of first hand experience in the anesthesia and healthcare business world. He enjoys giving back to the anesthesia community through teaching on business related issues for SRNAs at several anesthesia programs and for CRNAs through private conferences across the United States. Tracy also enjoys developing venture capital opportunities with both businesses in and out of healthcare. Tracy has been a long-time active member of the Louisiana State Association of Nurse Anesthetists, serving 2-terms as the president of the association.

All of this experience, coupled with Tracy’s easy-going Louisiana style, makes him one of the most sought-after expert presenters on the business of anesthesia. His presentations on business related topics are really some of the best I’ve heard. The power behind his talks comes from his deep personal knowledge coupled with an ability to communicate the relevance of business topics to practicing clinicians, both those working in employed W2 settings and those working in 1099 practices. But it’s not just this deep knowledge and keen teaching ability that Tracy brings to his talks. Perhaps the most powerful aspect of his ability to communicate is his character & integrity and emphasis on professionalism as a key to success in business.

Tracy often talks about the 3 A’s of Anesthesia.

The Three A’s of Anesthesia:

Amicable + Affable + Available

He encourages providers to understand that you’re in the service industry and your clients are diverse: it’s not just the patients, but the surgeons, the OR nurses & techs, the hospital administration and other staff. You’re in a service-oriented industry and embracing a positive attitude (being amicable & affable) while being available and supporting the delivery of efficient, high quality anesthesia care are critical aspects of developing a successful anesthesia practice or business.

I’m so glad you’ve found this podcast… it’s just an amazing conversation and I think you’re really going to enjoy it.

If you want to hear more from Tracy Young, I’ve linked in the show notes to another interview he did on the business of anesthesia with podcast host Jason Duprat of the Healthcare Entrepreneur Academy.

I should also mention, if it’s not obvious already, that Tracy is always recruiting physician anesthesiologists & CRNAs to join one of his many clinical sites or expand into new contracts. So if you’re looking for a great team to join with competitive benefits & compensation and flexible work schedules, be sure to drop them a line on their website at YPSAnesthesia.com.

Quotable moments:

“Some days you’re the bug & some days you’re the windshield.” – Tracy Young

“Trust takes a long time to build – 6 months, a year, multiple years to build that trust – but it only takes 5 seconds to loose that trust by one bad decision.” – Tracy Young

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Anesthesia Education Business/Finances Personal Finances Wellness

#80 – How to do 1099 Anesthesia Work with Sandry Gaillard, MSN, CRNA

What’s up yall, this is Jon Lowrance with Anesthesia Guidebook. This is episode 80 – how to do 1099 anesthesia work with Sandry Gaillard, MSN, CRNA. This is the second episode in a short series on the business of anesthesia. I’m gonna do a little run of interviews and topics on the business of anesthesia in the next few weeks. In the last episode you heard from Navin Goyal, MD & Saket Agrawal, CEO, both with OFFOR Health on how physician anesthesiologists can expand their careers beyond their clinical practice. In upcoming shows you’ll hear from Tracy Young of YPS Anesthesia in an episode covering lots of topics on the business of anesthesia and another episode with Randy Moore & Desirée Chappell of NorthStar Anesthesia on change management & leadership in anesthesia.

These conversations are incredibly valuable for anyone in anesthesia even if you have no interest in running your own business or becoming a practice manager or leader. These podcasts are relevant for every staff CRNA, physician anesthesiologist & anesthesia resident because they help you understand the contexts that we all work in. A mentor shared with me that there’s four pillars of anesthesia: your clinical practice, which everyone has at least initially in your career, education & research, advocacy work & the business of anesthesia. While you might anchor yourself solely in your clinical practice as your primary or even only professional interest, it’s helpful to have a basic understanding of the other domains – education & research, advocacy & policy and the business of healthcare – so that you can be a more informed provider and adept at navigating your career.

This episode was first released on 14 February 2015. At the time, Sandry Gaillard, MSN, CRNA was working as an independent CRNA in a 1099 practice in rural Western North Carolina.

This episode was released as part of the initial launch of From the Head of the Bed, the podcast that preceded Anesthesia Guidebook. It’s an interview between Kristin Lowrance (formerly Kristin Andrejco) who at the time was a SRNA at Western Carolina University. Kristin and I both worked with Sandry while we were SRNAs at WCU and Kristin invited her on the show to talk about the basic difference between working as a W2 employee and 1099 contractor, as well as some of the unique characteristics of working in a small, rural independent CRNA practice.

Sandry clearly outlines the key differences between working as a W2 employee and working as a 1099 independent contractor. Her and Kristin discuss the financial & business considerations including filing taxes, hiring an attorney & accountant, setting up a business structure and insurance considerations. They also discuss the personal leap it takes to transition from working as a W2 employee to 1099 work where you have to learn to manage you finances & certain aspects of your career in much greater detail. Sandry shares her story of making this transition and gives some wonderful encouragement for others who might be considering making the switch.

Beyond discussing the financial & business considerations of working as a 1099 independent contractor, they discuss the unique characteristics of working in a small, rural CRNA-only practice.

It’s important to recognize that you can work as a 1099 “independent contractor” while still working in a group or with an anesthesia care team or with a larger company, whether that is a larger CRNA-only or physician-only group or an anesthesia care team model that includes both CRNAs & physicians. Filing taxes as a 1099 doesn’t mean you work in a CRNA-only or physician-only group. It’s simply a different business structure for your professional life and means you’re not a W2 employee. Working as a 1099 contractor brings certain tax benefits – as well as additional financial responsibilities – that W2 employees don’t have.

The bottom line is there are lots of opportunities for setting your work life up depending on what your interests and goals are. Many people prefer the relative ease of working in a W2 setting where an employer offers a benefits & compensation package including health insurance, retirement and professional liability insurance as well as a lot of other administrative support. Others prefer the flexibility and tax advantages of working in a 1099 setting. Layered on top of each of these fundamentally different financial & tax arrangements is the decision around whether you work as an independent provider or as part of an anesthesia care team or group.

This episode unpacks all of these considerations and is a great place to start if you’re wondering about what kinds of career opportunities or business structures are available for CRNAs and physician anesthesiologists.

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Anesthesia Education Business/Finances Personal Finances Wellness

#79 – The Future of Healthcare with Navin Goyal, MD & Saket Agrawal, CEO with OFFOR Health

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I’m really excited to bring you this episode on the future of healthcare with Dr Navin Goyal and Saket Agrawal of OFFOR Health.

This is episode 79 of anesthesia guidebook and it’s coming out on June 24, 2022.

This is one of the most interesting conversations I’ve had with contributors to this show.  Navin & Saket are here to discuss what the future looks like – or what it could look like – for physicians in healthcare.  They hit on something that’s not talked about very much in medical school or residency programs or every around the OR amongst your colleagues, which is “what more can you do” as a physician anesthesiologist?  What else is out there?  Graduating from medical school and completing your residency is really just the beginning – or as Navin puts it – fills one particular bucket in your career.  But there are other possibilities out there and now more than ever, he and Saket want to share with you how physicians can engage in new ventures and roles both in the healthcare sector and beyond as a way to leverage the value you bring as a highly trained clinician.

They unpack this story and create this invitation to look beyond your clinical practice through sharing the story of OFFOR Health and the path they’ve been on as business partners. 

So let me tell you a little about each of them and then we’ll get to it…

Navin Goyal, MD

Navin Goyal, MD is a physician anesthesiologist and a co-founder of SmileMD, a mobile anesthesiology startup that is aiming to change the accessibility of anesthesia to small practices. He is also a co-founder of Loud Capital, a venture capital firm that provides financial support to early-stage startups as well as value-added services such as business development and guidance in scaling sales operations.

Navin received his MD from the University of Cincinnati College of Medicine and trained in anesthesiology at the University of Chicago Medical Center.

Saket Agrawal 

Saket is the CEO of OFFOR Health, a company that brings access to specialists closer to home by partnering with local dentists and medical offices to deliver specialized care. Saket became CEO of OFFOR Health in 2016 after working for years in the technology space in Silicon Valley. 

Sakate graduated from The Ohio State University with training in computer science and engineering, earned his MBA in North Carolina, and worked in tech in San Francisco for nearly 10 years before SmileMD’s mission drew him back to Columbus.

So one of the contextual frameworks we worked off of in planning this discussion was physician anesthesiologist burnout.  Navin is going to share with you his own story of being over a decade into his clinical practice at a large academic medical center when he began to feel bored with the daily grind and started wondering what else was out there.  We talked before we recorded this about the MedScape 2022 Physician Burnout & Depression survey.  Now this is a survey I’ve been following for several years and sharing in my own talks at anesthesia conferences on wellness.  Each year, Medscape surveys around 13-15,000 physicians across 29 specialities and reports data on burnout, what contributes to burnout and how to mitigate it.  In their 2022 survey, they reported that 47% of physicians reported feeling burnt out last year.  

We certainly know the pandemic has created an incredible degree of stress on everyone’s lives – not just healthcare providers – and has served as a huge lever or catalyst for individuals across sectors to re-evaluate what they’re doing and why.  Physician anesthesiologists, along with CRNAs & other healthcare providers, are right in the middle of this cultural upheaval.  

And that’s another reason why I’m so pumped to bring you this talk.  Navin & Saket talk about what motivated them to create OFFOR Health and provide novel solutions – not only for patients in need – but for providers who are looking to shake things up in their own professional lives. 

You may remember back in episode 26 I spoke with Paul Samuels, a pediatric physician anesthesiologist about mobile pediatric dental anesthesia.  In that episode, he unpacked the nitty gritty of what SmileMD is all about – which an OFFOR Health company – along with the specific anesthesia considerations for practicing in mobile, pediatric dental settings.  Be sure to check that episode out if you want to hear a little more on SmileMD.

Stay tuned for lots of amazing things coming your way on the podcast… I’ve got several more shows on the business of anesthesia headed your way in the coming weeks along with one on the McLott Mix for opioid free anesthesia with Mr Jason McLott himself and ton of more content in the editing phase right now.  

As always, I’m stoked to hear from you.  Thank you so much for those of you who have reached out through email, Facebook, Instagram, Twitter – or even in person for all the SRNAs at the University of New England here in Portland, Maine.  

And with that, let’s get to the show!

Resources:

OFFOR Health

SmileMD

Anesthesia Guidebook episode on SmileMD: #26 – Mobile, pediatric dental anesthesia with Paul Samuels, MD

Physician Underdog, a book by Navin Goyal, MD

Beyond Physician – a professional development platform for physicians

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Anesthesia Education Business/Finances Preparing for Grad School/Residency

#63 – Anesthesia Billing Models with Ian Hewer, CRNA

Dr Ian Hewer is the program director of Western Carolina University’s Doctor of Nursing Practice in nurse anesthesia program.  At the time of this interview, Ian had been a CRNA for 20 years, was an assistant professor in WCU’s nurse anesthesia program, held two master’s degrees – one in sociology, the other in anesthesia – and was enrolled in his PhD program at the University of North Carolina-Charlotte.  His PhD is in Health Services Research and the focus of his dissertation was economics & billing practices in anesthesiology.

I originally recorded this interview with Ian back in February of 2015 when I was still a SRNA at WCU and Ian was one of my professors and clinical preceptors.

We discuss the differences in billing models such as medical direction, medical supervision and independent practice in the United States.  We talk about the Tax Equity and Fiscal Responsibility Act of 1982 and how TEFRA – again that’s the Tax Equity and Fiscal Responsibility Act – requirements influence reimbursement and anesthesia practices.  We go over opt out and what that means – how in nearly half of all states, CRNAs are not required to have supervision by any physician, podiatrist or dentist in order to bill directly for their services.  We discuss how market forces such as an evolving payor mix can influence decisions on billing models and practice structure for anesthesia groups, hospitals and individual providers.  We talk about the challenge of studying big data in establishing differences in quality outcomes between CRNAs and physician anesthesiologists. We also discuss the future of anesthesia economics and concrete steps healthcare organizations and providers can take to lower costs and maximize efficiency while maintaining high quality outcomes.

If you want the inside scoop on economics in anesthesiology, start with this podcast. 

I’ll also mention here that Western Carolina University is likely opening their bridge program for Master’s prepared CRNAs to obtain their DNP in the summer of 2022.  So if any of you master’s prepared CRNAs out there are looking for DNP programs, keep WCU on your radar.  

Resources:

Lewis SR, Nicholson A, Smith AF, Alderson P. Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD010357. DOI: 10.1002/14651858.CD010357.pub2

Hewer, I. (2018). ANESTHESIA CARE TEAM TYPE AND HOSPITAL CHARACTERISTICS: ARE INCREASED LEVELS OF SUPERVISION ASSOCIATED WITH DIFFERENT ACUITIES AND OUTCOMES?. (Thesis). University of North Carolina at Charlotte. Retrieved from https://repository.charlotte.edu/islandora/object/etd%3A1088 

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