Time Out for Anesthesia

How does an anesthesia group create and maintain strong relationships with their clients - the facilities they serve? We welcome back Chrystale Cigainero of Metropolitan Anesthesia Consultants to help us explore.

Chrystale Cigainero of Metropolitan Anesthesia Consultants joins us this week to discuss some of the greatest challenges in managing today's anesthesia practice. Chrystale and the leadership of Metro face new obstacles in a post-covid world as professionals in the workplace, anesthesia providers included, re-evaluate their work-life balance. Tune in to see how they are addressing these and more challenges in the ever-changing healthcare landscape.RELATED LINKS:Metropolitan Anesthesia Consultants: https://www.metroanesthesia.com/Physician Partner Track Position:  https://mobile.gaswork.com/post/218519Physician W2 Position:  https://mobile.gaswork.com/post/374855

When shopping software, we've been trained to research the Return On Investment (ROI). There is, however, another dimension that ought to be considered along with ROI: Time To Value (TTV). Daniel Dura of Graphium Health -- always an incredibly valuable guest -- helps us not only explore the concept of Time To Value but also apply it to anesthesia software. Enjoy!

Meet Justin Harvey, CFP,  who is the only Certified Financial Planner that we've come across to date who focuses solely on anesthesia providers and their needs. He is a wealth of knowledge for a community that, we agree, is typically underserved.Justin is further committed to that community through his work on his own podcast, APM Success, where he and his guests discuss financial topics that are vital to anesthesia providers. We highly recommend a listen here: www.APMSuccess.comHere are some other helpful links to connect you with Justin's work:The APM Wealth Financial Advisory website: www.apm-wealth.comAPM Success Podcast Must-Hear Episodes:What Surprise Billing Legislation Means For Anesthesiologists:www.apmsuccess.com/126A Washington State Case Study On The Future Of Anesthesia Employment:www.apmsuccess.com/115Understanding RVU Compensation:www.apmsuccess.com/109

Anesthesia Guidebook is one of the greatest free resources around to help anesthesia providers of all experience levels master their craft. We have its founder, Jon Lowrance, with us on the show this week. You will immediately like him—not only for his great personality, but for his motivation to help improve the life of an anesthesia provider in any way he can.You can check out and subscribe to the Anesthesia Guidebook podcast here: https://anesthesiaguidebook.com/We also reference a couple of episodes to get you started:#12 - Ten Things Every Anesthesia Provider Should Knowhttps://anesthesiaguidebook.com/episode12/ #27 - Total Knee Arthroplasty in the COVID-19 era with Adam Rana, MD & Ryan Mountjoy, MDhttps://anesthesiaguidebook.com/episode27/ Enjoy!

Daniel Dura, CEO of Graphium Health visits the show this week to discuss anesthesia, technology, and the fascinating career path that led him here -- and what has happened ever since. You'll hear familiar names like Macromedia, Fujitsu, Adobe, and more all painting a story of how Graphium & it's suite of Anesthesia software tools were born. Enjoy!

What do anesthesia, technology, and...peacocks have in common? We're convinced that the only way to know is to interview Tom Wilson, VP of sales for Graphium Health - an anesthesia solutions company.Join Tom and us as we discuss his career, the changes he's seen in the healthcare and anesthesia landscapes over the last 9 years. And yes. We'll talk about peacocks.

We welcome Nathan Caldwell, Amazon best-selling author of Empowering Kindness, back to the show to discuss company culture - this time addressing one specific, more difficult subject when it comes to kindness.What does discipline or correction look like inside of a company that has dedicated itself to kindness? Mistakes will still be made--so how do we handle them while, at the same time, promoting a positive work environment?Nathan responds masterfully -- enjoy!----------------Purchase Empowering Kindness by Nathan Caldwell at Amazon.com.

We were able to sit down with Nathan Caldwell, Amazon Bestselling author of Empowering Kindness: Why unlocking power in others will be your greatest success. While it's a bit of a departure from our typical Anesthesia-centric content, Graphium Health (who powers this show) is passionate about positive company culture, and Nathan's thoughts and words are solid gold. Empowering Kindness has tools that every thought leader, executive, and human being can employ to improve the world around them.  Enjoy!You can check out the book here: https://amzn.to/3tvc0yy

Let's face it: Healthcare has a hard time with Technology. But in today's advanced era, how is the anesthesia patient experience affected by the right kind of technology implementation? We welcome back Courtney Franco of Imagine Software to discuss!More About Courtney:Courtney Franco, Vice President of SalesCourtney joined Technology Partners, LLC in 2013 and is the Vice President of Sales leading the direct sales team across the country. Courtney came to ImagineSoftware with 15 years of sales experience after working in pathology billing and selling self-funded health and welfare plans for third party administrators. She successfully reconciled over $2M in errors while in pathology, and currently works with our partners and vendors to strategically grow relationships and provide ongoing guidance and education. Courtney graduated from Belmont Abbey College with a degree in psychology and currently Co-Chairs the membership committee for EDPMA.You can check out Imagine Software at https://www.imagineteam.com/

We welcome Courtney Franco of Imagine Software as we discuss the importance of accuracy, efficiency & reporting in healthcare at large and for anesthesia providers specifically. Courtney is a great wealth of knowledge and a really cool personality.More About Courtney:Courtney Franco, Vice President of SalesCourtney joined Technology Partners, LLC in 2013 and is the Vice President of Sales leading the direct sales team across the country. Courtney came to ImagineSoftware with 15 years of sales experience after working in pathology billing and selling self-funded health and welfare plans for third party administrators. She successfully reconciled over $2M in errors while in pathology, and currently works with our partners and vendors to strategically grow relationships and provide ongoing guidance and education. Courtney graduated from Belmont Abbey College with a degree in psychology and currently Co-Chairs the membership committee for EDPMA.You can check out Imagine Software at https://www.imagineteam.com/

Part 2Dr. Zavaleta & Graphium's VP of Engineering, Matt Oldham, continue to discuss the data from the Anesthesia record that can be used to create an OR Utilization report. We also walk through the OR Utilization Dashboard and view the reports from 3 different perspectives. You'll be shocked at how much can be revealed using relatively few data points.

Part 1Dr. Zavaleta & Graphium's VP of Engineering, Matt Oldham, discuss the data from the Anesthesia record that can be used to create an OR Utilization report. We also walk through the OR Utilization Dashboard and view the reports from 3 different perspectives. You'll be shocked at how much can be revealed using relatively few data points.

It's now 2022. We have the internet, new space programs, electric vehicles...but anesthesia providers still struggle, at times, to get the simplest report like, "How many minutes of anesthesia were performed today?" Still less are they able to benefit from deeper dives into analytics.On this episode, Dr. Zavaleta and Graphium Health VP of Engineering, Matt Oldham, discuss advanced analytics and their potential impact on the practice of anesthesia. The possibilities are both exciting and endless.

When Graphium first started, there was a lot of hesitation in the marketplace about automation - especially when it came to something like tracking vital signs, which had always been done by a human. Giving that trust over to a computer can be, understandably and respectably, a challenge for a clinician who is responsible for a life in the OR. But now that technology has progressed to its current level, we've seen a shift to a more positive outlook. What are some factors that may lead users to adopting more automations and integrations in their workflows?Time Out for Anesthesia welcomes back a show favorite: Bobby Wong with Neximatic to discuss automations & integrations in the world of anesthesiology.

We've come to the part of onboarding when all of the pre-work is done. We followed our project plan, we have integrations in place, we have demographics flowing across them, forms are in the instance, people have their iPads in their hands. Now the real fun begins with training and going live with the Graphium Anesthesia EMR.

As we continue our deep dive into all the sections of the onboarding, we circle back to the integration conversation. Integration is one of the big beating hearts of our system. And one of the wonderful things about our system is not only how we can integrate with so many various systems, but also how many amazing things we can accomplish with those integrations.

David and John interview Frank Dansby, Graphium Onboarding Specialist about a few ways that new Graphium Customers can prepare their sites for the best user experience possible with Anesthesia EMR™. We discuss best practices for Demo Barcodes, iPad purchases, iPad cases, Printers, WiFi setup, and [optional] Multiple Device Management systems.

As we continue our walk through Graphium onboarding, our team is thrilled to welcome Bobby Wong, founder and president of Neximatics to discuss Vitals Machine Integration.We've been walking through our onboarding project plans for new Graphium Health anesthesia customers. At this point, we've identified the organization and the facility names, which we discussed in our previous episode, which was about the client info pack. The info pack contains a special section that isn't always necessary, but is required when the client needs vitals integration: the Vitals Site Survey.

On this episode, we are joined by Matthew Oldham, VP Engineering at Graphium Health™. Matthew (called Matt throughout the episode) is a primary driving force behind the Graphium architecture and one of the greatest minds in the industry. We'll be discussing another aspect of onboarding an anesthesia team: New Client Info. To see the screen schots referenced throughout, watch the video at the Time Out for Anesthesia YouTube channel or at the Graphium Health Blog.

In this episode of Time Out for Anesthesia, John Lutes (VP Operations, Graphium Health) discusses —at a high level— the five main areas of a Graphium Health onboarding that are covered in a typical kickoff call:the Client Information SectionForm DevelopmentIntegration NeedsSite PrepTrainingEnjoy!

With some very simple--no cost--structural changes, large anesthesia groups can help their providers reduce the amount of income they incur taxes on by $100,000 or more. The best way to move in this direction, though, is for the group's providers to understand the strategy and approach the leadership with it.But this sort of forward thinking from a group's leadership could not only protect their employees' wages, but could also make them a much more appealing employer from a recruiting standpoint.We once again welcome Glenn Henderson, CPA/ABV, CVA, AEP with CCK Strategies, PLLC and appreciate his insights.Mr. Henderson has been a CPA for over 43 years, currently with a company called CCK strategies. He is one of the partners, and has been over their Texas office for four years as of December 1st, 2021. He previously had his own practice for 27 and-a-half years, but saw the opportunity to merge with a forward thinking firm and offer a broader range of services to his clients.

Filing as an S Corporation, forming a C Corporation, and defining "Reasonable Wage" - 3 tax concepts that every small anesthesia partnership & sole practitioner needs to be aware of. A huge welcome to our expert guest speaker: Glenn Henderson, CPA/ABV, CVA, AEP, and partner at CCK Strategies, PLLC.An LLC that Files As An S CorporationOne of the most important things that sole practitioners or small partnerships of anesthesiologists can do is actually become an LLC that files for federal income tax as an S corporation. If they didn't do anything else, that helps to split their income into earned income as well as a return on equity. Put in tax terms, we can avoid payroll taxes on the return on equity while we still pay them what's considered to be a reasonable wage. What we avoid, then, is actually more than just the payroll tax. If your wages are over 250,000, you're required to pay what we call ObamaCare taxes, which are an add-on to your income tax. However, S corporation income is not included in that income that's taxed at a higher rate. That's an additional 3.8%. Although that starts off sounding like a small amount, when some of your income is already unnecessarily being taxed at 19% or 20%, basically already adding 50% to your tax burden. So just with some basic restructuring, we can avoid some of those taxes and reduce your income tax burden by about a third, so that it becomes significant when you add those things up.Forming a C CorporationFor our clients who already have an S corporation, another structural change that we suggest and accommodate is forming a C corporation with a fiscal year end. That C corporation's purpose is to help with the marketing, the strategic planning, and with logistics of an anesthesia practice. Deferral is a significant and important part of this structure. We can defer some of the net income of your S corp into a C corp for up to 11 more months until the tax is due. Then, at the same time, we can also set up some other things and look at some other opportunities, especially for retirement in that new C corp. “Reasonable Wage”And finally, I did wanna tell everybody that you have to have what's called a “reasonable wage” for those that are providing services to the S corp or the C corp. So while we can't eliminate payroll taxes altogether, we can minimize that wage to a reasonable amount, and then everything that exceeds that wage would enjoy the benefits of the reduced tax. And that's really what I would offer as the first advice for any sole practitioners and small partnerships. It's really just some simple structural changes, but they can make an enormous impact by saving about one-third of the tax on a large chunk of the providers' incomes.Questions?If you'd have any questions about taxes and your anesthesia practice, you can reach out directly to Glenn via email at glennh@cckcpa.com.About The SpeakerGlenn Henderson has been a CPA for over 43 years. After running his own practice for 27+ years, Glenn saw an opportunity to partner with a forward thinking practice and expand service offerings to his clients. He merged his practice with the CCK Strategies team and now specializes in mergers and acquisitions as the partner over the Texas office. He has worked successfully with small and large anesthesia practices throughout the years.About CCK Strategies, PLLCCCK Strategies is a Tax and Business Consulting firm that combines a broad scope of expertise with personalized service. With a team of more than 125 people serving clients worldwide, CCK provides innovative solutions and creates value at every stage of a business's life cycle.CCK offers the depth of resources, both domestic and international, required to be successful in today's business marketplace. We are more than a firm, we are your partners.CCK Strategies, PLLC Website: https://www.cckcpa.com/

In this episode:1) A surprise visit from our producer, David Henderson, with some updates about the Time Out show!2) Dr. Z discusses how data, though often overlooked & undervalued, can play a vital role in empowering and modernizing your anesthesia practice.

Anesthesia practices, obviously, need different data points to be able to successfully report compliance, safety, productivity, and all kinds of other meaningful measures. But do they need to enter all of that data by hand?A good portion of that data already exists in the hospital's EMR, and the value of sharing the data is immense. Not only can an anesthesia group objectively evaluate and improve their performance, but individual providers can spend less time entering duplicate values on multiple sheets of paper.BUT: The data would need to be shared.This can get political and roadblocks can appear, seemingly, out of nowhere if the hospital or its IT team don't share a cooperative spirit.In this episode, Dr. Z shares some familiar questions that come up along these lines and how to navigate them successfully.

Not all anesthesia providers track "Anesthesia Ready Time" on the anesthesia record. Adding it to your form, after all, means additional time and effort. Is it worth it?Dr. Z explains the definition of Anesthesia Ready Time and why tracking this one simple measure can make an enormous impact. Check this episode out and let us know: do you track Anesthesia Ready Time? If so, how do you define it? If not, why not?

If anesthesia providers want clarity & assurance that they're making the right calls to establish and grow their practices, they'll need to stop relying on memory and emotion, because, after all, we're all human. The truth is, so much data can be found in the anesthesia record they're already using!In this episode, using just 5 data points from the anesthesia chart, Dr. Zavaleta will deliver information on how to create visuals like heat maps (and other charts) that paint a clear picture of OR Utilization. You won't believe the value that can be uncovered!

MACRA (formerly PQRS...formerly PQRI...) is here to stay. Many anesthesia providers & anesthesia practices have spent time either avoiding it or pushing back against it, but the CMS quality program doesn't appear to be going anywhere any time soon.Sure, non-compliance may mean reimbursement penalties. But have you considered what a proactive approach toward MACRA might mean for your practice?In this episode, Dr. Zavaleta will discuss a more proactive way of thinking about and dealing with MACRA for anesthesia practices looking to turn something painful into something beneficial.

For anesthesia providers, first case on-time starts might be the simplest, yet most powerful data points to record and track. It demonstrates to the hospital administration that you're committed to operational excellence and to improving any deficiencies. It strengthens your brand. It improves patient satisfaction if you can start on time. It improves surgeons' satisfaction knowing that they can start on time.In this episode, Dr. Z will explain how anesthesia providers and practices can track this data and use it to everyone's advantage.