One of the best things about the summer is that it gives me more time to study health care business trends, in particular health care provider contracting practices. But I didn't have to work at all to find out something about the latest conflict bewteen CMA and Tenet. CMA has publicized its June 16, 2014 letter to Tenet objecting to Tenet's reported plan to end all local provider contracting for hospital based anesthesiology, emergency department, and hospitalist based services at Tenet's 11 California facilities, replacing these providers with "multistate corporations based out of California."
This is an old dispute, in some ways, but it has been intensified in some places by what may be behind-the-scenes negotiations about collaborative practice with nurse anesthetists and anesthesiology assistants. I have no secret information on what is going on between CMA and Tenet but I would be surprised if a move to a team practice making heavier use of less expensive nurse anesthetists and anesthesiology assistants were not part of the discussion. No less than the American Society of Anesthesiologists has noted the move to facility employed anesthesiologists. When this happens, anesthesiologists may be pressed to accept compensation below their billing or reimbursement rate. I have a feeling this may be on the table as well.