Anesthesia Business Consultants: Communique winter10

WINTER2010VOLUME14,ISSUE5
ANESTHESIA
BUSINESSCONSULTANTS
Customer service is a frequently
heard buzz word, the “culture” many ad-
vocate, and, in the final analysis, the true
demonstration of “walking the talk”.
Some will differ on whom they
identify as their “customer” – for some
anesthesia providers the response is
often “the surgeon,” while most acknowl-
edge their customer base includes a
variety of individuals and organizations
– patients, surgeons and proceduralists,
hospital and health system administra-
tors, surgery center directors, vendors,
and members of the payor community.
I submit that all of those listed and any
others you interact with are “your cus-
tomers” – they are whom you serve.
The key is whether these customers
view your practice as customer friendly?
To better understand how your cus-
tomers would rate your group’s customer
service begins with a baseline assessment
as to whether you and your colleagues
are viewed as demonstrating a high level
of customer service.
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➤ INSIDE THIS ISSUE:
A Culture of Customer serviCe . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Customer Satisfaction: A Necessary Element For Group Success . . . . . 2
Customer Service Makes the World Go ’Round . . . . . . . . . . . . . . . . . . . 9
Customer Service in Anesthesia Care . . . . . . . . . . . . . . . . . . . . . . . . . 12
Distinctive Client Service: Five Practices You Can Implement Today . . 15
Traditional IRA: Shall I Convert?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Breach Notification Final Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
The Stark Law’s In-Office Ancillary Services Exception: In-Office Ancillary
Arrangements Remain Viable for Pain Management Practices . . . . . . . . 22
6th Circuit Federal Court of Appeals Affirms Conviction of Pain
Management Physician for Overutilization & Billing Fraud . . . . . . . . 25
Perspectives on Client Service From ABC Senior Staff . . . . . . . . . . . . 26
Event Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Continued on page 6
A Culture of
Customer serviCe
Marshall M. Baker, MS, FACMPE
Physician Advisory Services, Inc., Boise, ID

the Communiqué Winter 2010 PAge 3
transferable to your world — just 99%.
If you were running a store, it would
be obvious, should you take the time
to watch, what your employees are
doing. You could see them on the floor
and observe their interactions, or non-
interactions, with customers.
Granted, it’s a bit harder to watch
your fellow partners or shareholders
and your employed and subcontracted
physicians and other staff members. But
it is possible. And, what they are doing
might just be destroying the future of
your practice.
multiple problems + few
direCt ComplAints = biG
problem for you
It’s no secret that disgruntled
customers tell stories of their poor
experiences and that this results in loss
of business. In fact, a study conducted in
2006 by the Wharton School of Business
and the Verde Group provides proof of
this long-held general belief.
According to the study, which looked
at retail customers,only 6% of disgruntled
customers made a direct complaint.
But 31% of disgruntled customers
told their friends, family or colleagues
what happened. And then those other
people repeated the story, multiplying its
effect. Altogether, the “Retail Customer
Satisfaction Study 2006” found that
for every 100 customers with a bad
experience, a company stands to lose 32
to 36 current or potential customers.
multiple Customers And
multiple points of ContACt
In the retail world it’s easy to identify
your customer. It’s a bit more complicated
in yours.
Anesthesia group “customer”
interactions involve multiple interested
third parties and multiple points of
contact. There’sthepatientandsometimes
the family and other influencers.There are
the surgeons, nursing and other technical
personnel, hospital administration, the
medical staff, and third party payors. As
to each of the customers, the number of
points of contact vary from the single
instance to the continual stream.
And, to complicate things, in some
cases the expectations of one customer
group negatively impact upon another.
Take, for instance, the example of case
turnover time. Surgeons don’t want to
“waste time” between their consecutive
cases, but pressuring anesthesiologists to
pick up the pace might adversely affect
immediate post-surgical patient care
(a key customer service factor if there
ever was one) as well as the pre-surgical
interaction between the anesthesiologist
and the subsequent patient.
settinG the stAGe for the
Customer’s GreAt experienCe
And for your GreAt future
The first step in the solution may
be the hardest: Stop kidding yourself
that the delivery of expert, even world-
class, medical care is sufficient to
guarantee your group’s future. An “A”
in anesthesiology does not automatically
equate to even a “C” in customer service.
Expertise from an anesthesiologist
is simply expected; it’s just the down
payment on your future. Expertise
must consistently be supported with
extraordinary customer service in order
to guarantee that you will thrive.
Of course, this begs the question of
what great customer service is.
On one level customer expectations
are simple to discern: Customers want
to be treated with respect, they want
you to be courteous, they want you to
listen to them (really listen to them) and
to respond fully to their questions and
concerns. They want you to be friendly,
they want you to smile, they want you to
say please and thank you, they want you
to show up on time and they want you to
follow through with what you say you will
do.
In addition to those common
expectations (which are often forgotten
in terms of delivery) you must identify
the specifics of ideal customer service at
your institution, not through your eyes,
but through the eyes of your customers.
As the study discussed above reveals,
you can’t do this simply by relying on
Continued on page 4

The Communiqué Winter 2010 Page 4
Customer Satisfaction: A Necessary Element For Group Success
Continued from page 3
complaints that have been brought to
your attention, as only a small percentage
of disgruntled customers will have ever
informed you of the problems.
Certainly, you can conduct formal or
informalsurveysof yourpatients,surgeons
and other customer service touch points.
In fact, as your group begins to excel in
customer service, surveys, especially those
that reveal high patient satisfaction levels,
have the benefit of not only spurring you
on to even higher levels of performance,
they become an important tool for
leverage in the larger context of group/
hospital relations.
But to begin, I suggest that you
take a more practical, “down and dirty”
approach: draw on your own knowledge
base — not only as physicians in terms
of how you value the interactions your
colleagues have with you, but also with
respect to the interactions you have had
with your physicians when you have
been a patient as well as your interactions
with retail and wholesale establishments,
both in regards to products and services.
Ideally, you are aiming at creating what
I term an “experience monopoly” for
your customers: an experience of such a
high quality that your customers would
not consider obtaining it from any other
source.
Don’t attempt to “benchmark” to
other physician groups; instead, if you
must benchmark at all, aim to compete
with the Four Seasons or the Ritz-Carlton
in terms of the experience that they
provide.
To illustrate, let me provide you with
two examples related to the anesthesia
world, one directly, and the other
tangentially, that describe this concept of
experience monopoly:
In the late 1980s, I had minor
outpatient surgery at a world-class
hospital. More than 20 years later I recall
the experience clearly. From a technical
standpoint, the anesthesiologist must
have been an expert: I felt no pain, had no
complications and was back at work the
next day.
But, shortly after the physician
introduced himself to me in the pre-op
area he walked a few feet away to make a
phone call: several minutes of screaming
at his divorce lawyer about his soon-to-
be ex-wife, whom he did not describe in
particularly endearing terms. He was so
visibly upset that I wondered about his
ability to concentrate on my care. Despite
the fact that everything went smoothly,
I would never consider having another
procedure performed at that facility.
Contrast that with the following
experience:
A few years ago, immediately after
checking out of the Hilton Tapatio Cliffs
Resort following speaking at the ASA’s
Conference on Practice Management, I
met Chester Haymore, the bellman.
Chester greeted me warmly, just as
he did each and every person who passed
him. He asked each person waiting at the
hotel’s entrance if he could help them.
He offered chilled bottles of water and
suggested that people wait in the shade.

He quickly summoned cabs or town cars
and arranged for valet parked cars. He
loaded luggage into trunks and helped
people into cars. He told a particularly
tall man that he would adjust the seat
in his rental car. When he overheard a
man comment that he had cut his finger,
Chester asked if he needed a band-aid!
Chester isn’t just a bellman, he
is a one-man customer service king
with a mission. He elevated the entire
experience of the hotel, which otherwise
was a slightly aging, unmemorable place. 1
Once you’ve examined your
knowledge base of customer service
experiences, my advice is that you look
at each possible interaction between
the members of your group and your
customersanddeviseasetof expectations.
I’m not talking about setting hard and
fast rules for all conduct, as we’re talking
about professionals and, in any event,
you do not want to institute robot-like
performance. However, there should
be minimum expectations and those
minimums should not simply be aimed
at meeting minimum levels of customer
satisfaction, but, rather, at hitting high
levels of service that will delight the
customer.
Next, you need to document your
group’s customer service expectations
and train your group, both physicians
and other staff, in exceeding them.
Importantly, you need to incentivize,
both financially and socially, your group
to take customer satisfaction expectations
seriously. This means that your group’s
compensation plan must take into
account customer service factors in
determining total compensation. It also
means adopting a plan for the recognition
of service excellence.
In order to accomplish these goals,
you must coordinate your customer
service plan with, and into, the
provisions of your group’s organizational
documents, subcontracts, employment
agreements, and compensation plans.
For example, if your partnership
agreement and employment agreement
simply reward production, providing no
incentive for better customer service, then
you have abandoned the legitimate right
to claim to be shocked when your group’s
physicians rush for volume, even with an
eye to patient care standards, but ignore
the quality of customer interaction,
only to have complaints, reported or
unreported, destroy the foundation of
your practice.
Addressing this issue as far as
your physicians go is only a part of the
process. You must take similar steps with
any support and office personnel who
come into contact with any identified
customers. This extends to the employees
of your billing service provider – one
cranky interaction can destroy the
improvement that your group, internally,
has worked to achieve. Your contracts
with, and policies adopted in respect
of, these entities and individuals must
support those requirements and provide
for penalties in the event of breach.
Why Care?
Why do you need to care about
customer service when your group has the
exclusive contract at the hospital? After
all, your customers can’t go anyplace else.
Because customer service is directly
related to customer satisfaction which
is directly related to support from the
medical staff and from administration.
That support is essential in respect of
renewing your exclusive contract and in
obtaining necessary financial support
from the hospital.
Sure, you may be the only game in
town, but if you don’t pay attention to
customer service, someone else will be the
next only game in town.
1
It’s telling that when I wrote a letter to the Hilton following my stay recommending that they make Mr.
Haymore their chain’s customer service excellence evangelist, I didn’t even receive a form letter in response. Of
course, Mr. Haymore, whom I copied on the letter, called me to express his sincere gratitude.
Mark F. Weiss is
an attorney who
specializes in the
businessandlegalissues
affecting anesthesia
and other physician
groups. He holds
an appointment as
clinical assistant professor of anesthesiology
at USC’s Keck School of Medicine and
practices nationally with the Advisory Law
Group, a firm with offices in Los Angeles
and Santa Barbara, Calif. Mr. Weiss provides
complimentary educational materials to
our readers. He can be reached by email at
markweiss@advisorylawgroup.com.

A Culture of Customer Service
What is the level of satisfaction your
customers have with your services?
Satisfaction surveying is encouraged
and, while approaches vary, the goal is to
better understand how you and your group
are viewed (and rated).
Surveying techniques include
telephone, focus group, written question-
naires, and the disciplined recording of
“feedback” as it is received.
Some types of “satisfaction surveying”
include:
• Patient Satisfaction (with the experi-
ence with their anesthesia provider)
• Surgeon/Proceduralist Satisfaction
(with your service, responsiveness)
• Staff Satisfaction (both anesthesia
group and delivery site (hospital, ASC,
Endoscopy Center, birthing center,
etc.) – about their experiences work-
ing with you (as clinical support or
administrative support staff for you)
• Payors (what’s the “temperature of the
water” when you or your staff interact
with payors and their staff?)
Assessment is one tool that will pro-
duce information to either reenforce that a
high level of satisfaction exists, or alert you
to areas (and individuals) where there are
opportunities for improvement. Examples
of surgeon and patient satisfaction surveys
appear on pages 7 and 8.
In addition to “after the experience”
satisfaction surveying, customer service
initiatives should be proactive. Here there
are a variety of actions or initiatives the
group might consider to build a loyal and
supportive following. Two that I found
produced positive results:
(1) The anesthesiology group I was as-
sociated with instituted a “thank you card”
program – our anesthesia providers would
leave a card at the patient’s bedside when
making post-op/post-procedure rounds.
The card read:
THANK YOU for allowing us to be of
service to you. We are committed to a
healthy community.
If you have questions about the care
we provided – call: XXX-XXXX
If you have questions about payment
of our charges – call: YYY-YYYY
Anesthesia Consultants, PC
The key here was two-fold, to genu-
inely thank the patient and to reinforce
that we had been involved in their care
– patients always remember their sur-
geon/proceduralist; but seldom recall the
name of their anesthesia provider or the
group that provided the anesthesia. In
fact, many challenge the charges when re-
ceived and it’s not uncommon to receive
a call with the patient stating, “I never saw
that doctor”. The card (with the anesthe-
sia provider’s business card enclosed) can
minimize those types of calls.
(2) Another proactive approach we
took was the recognition of every surgeon’s
birthday – sending a card and a small gift
(e.g. – one year it was a mag-lite flashlight,
another a small tool kit, with our logo em-
blazoned on the item).
First, the surgeons were impressed –
one remarking, “my mother doesn’t even
remember my birthday”.
But the really positive result was when
we were battling with insurance companies
for payment for post-op pain management
and consultation, and the payors threat-
ened to reduce the surgeon’s allowable
charge to pay for pain management.
The surgeons rose to our defense (a
new behavior in our community where re-
lationships between anesthesiologists and
surgeons often disrespect). Because of our
positive relationship building activities
(only one of which was the birthday gift),
they advised the payors that requesting a
“pain specialist” for their patient was no
different than requesting a consult from
any other sub-specialist, and such consul-
tation and service was NOT a part of the
surgical or procedural event.
Beyond surveying, cards, or gifts the
theme you want to communicate to your
customers is the way you and your col-
leagues treat people.
When there is an inappropriate behav-
ior, how does your practice address it?
Like all communication, it is how the
individual interprets your words or ac-
tions; and whether such disruptive and
inappropriate behavior is viewed as such
by you as well as by the customer.
Paramount to such a disruptive or in-
appropriate behavior is how your group
responds. Is such behavior allowed to
continue without intervention?
I would suggest a NO tolerance policy
for outbursts,“scream-fests”, or deliberate
disregard for “driving outside the lines” of
established group culture and behavior.
The development of a disruptive behav-
ior protocol will be important to assure
there is no misunderstanding about what
is expected.
When an event occurs, there must be
immediate action, and a process to coach
the individual toward a change in behavior,
with understanding of the consequences
if there is no demonstrated change and
improvement. To ignore these types of
misbehaviors can result in a potential loss
of business, damage to the group’s reputa-
tion, or worse, litigation.
Customer service should be a hallmark
for your practice, and taking the time to
craft a customer service program and in-
still a culture that is readily recognized as
“customer friendly” for your organization
will be a cornerstone to the long term suc-
cess of your practice.
Mr. Baker is an
experienced health-
care executive,
administrator, educa-
tor, and consultant.
His practice focuses
on strategic position-
ing; compensation
design; practice struc-
ture/formation; and
management and governance structure.
He is a Past President of Ohio MGMA,
New Mexico MGMA, the American College
of Medical Practice Executives, Ambulatory
Surgery Center Assembly (MGMA),
and the New Mexico Heart Institute.
He may be reached at 208-577-8869 or
mbaker@physervinc.com

Please indicate your response to the following questions: Yes No N/A
1. Do your patients undergo appropriate pre-operative evaluation?
2. Are you routinely informed if a patient has not been cleared for surgery due to medical reasons?
3. Is the reason for cancellation or delay appropriately communicated to you?
4. Do you feel that our physicians are helpful in facilitating pre-operative clearance for surgery?
5. Are you satisfied with the quality of care provided by the anesthesiologists in the Anesthesia
Service?
6. Do you believe that our physicians provide good care for your complex and sick patients?
7. Are you pleased with the level of technical expertise (i.e., regional blocks, intubations, invasive
monitoring) practiced by our physicians?
8. Do you believe that our anesthesiologists offer an appropriate range of subspecialized
anesthesia expertise (i.e., outpatient, pain management, etc.)?
9. Do you believe that subspecialized care benefits your patients?
10. Does the Anesthesiologist communicate appropriately with you concerning any problems during
the case and the conditions of your patients at the end of surgery?
11. Does the Anesthesiologist provide appropriate and timely care to your patients post-operatively
in the recovery room (i.e., pain management, respiratory or cardiac difficulties)?
12. Do our physicians communicate appropriately with you concerning problems encountered by
your patients in the recovery room?
13. Does the Anesthesiologist treat you, your patients and their families in a courteous and
professional manner?
14. If you need to contact an Anesthesiologist, is their response accomplished in a timely and
appropriate manner?
15. Overall, are you satisfied with Anesthesiologists’ clinical care, technical skills, responsiveness
and professionalism?
16. Would you continue to utilize the services of our Anesthesiologists over those of other anesthesia
groups if the anesthesia service operated under an “open staff” model?
17. Do you have any suggestions for our practice?
Comments:
18. Overall, how would you rate our current Anesthesiologist’s clinical practice and service level?
On a 1 - 5 scale, with 5 being the highest rating?
Surgical Staff Evaluation of Anesthesia Services
In an effort to monitor how the Medical Staff perceives the anesthesia services provided by__________________________________
Anesthesiology and Pain Management, we would appreciate your completing this survey and returning it in the enclosed stamped
appropriate manner?
15. Overall, are you satisfied with Anesthesiologists’ clinical care, technical skills, responsiveness
and professionalism?
16. Would you continue to utilize the services of our Anesthesiologists over those of other anesthesia
groups if the anesthesia service operated under an “open staff” model?
17. Do you have any suggestions for our practice?
Comments:
envelope.
POST ANESTHESIA SURVEY FOR PATIENTS
PATIENT’S NAME (Optional) ____________________________________________________________________________________
DATE of surgery/procedure _____________________________________ HOSPITAL/ASC ________________________________
TYPE OF SURGERY/ PROCEDURE ________________________________________________________________________________
___________________________________________________________________________________________________________
Please “mark” the appropriate response below.
1. Before your surgery/procedure, did you speak to an anesthesiologist/nurse anesthetist?
Yes  No 
If yes, were you satisfied with the courtesies extended by this anesthesia provider?
 1) Very Dissatisfied  2) Dissatisfied  3) Satisfied  4) Very Satisfied  5) Excellent
Did he/she explain your anesthetic in terms you could understand to your satisfaction?
2. Were you informed to your satisfaction of what to expect BEFORE your surgery/procedure?
a. Were you informed to your satisfaction of what to expect DURING your surgery/procedure?
b. Were you informed to your satisfaction of what to expect AFTER your surgery/procedure?
3. Was the “start” of your anesthetic satisfactory?
4. How was your stay in the Recovery Room (Post Anesthesia Care Unit – PACU)?
5. Please explain any problems associated with your anesthetic: ______________________________________________________
________________________________________________________________________________________________________
6. What was the best thing about your anesthetic: _________________________________________________________________
7. Overall, how would you rate the anesthesia we provided for you?
Example of a Surgeon and Patient Satisfaction Survey (Courtesy of Mr. Baker)

Example of a Surgeon and Patient Satisfaction Survey (Courtesy of Mr. Baker)
envelope.
POST ANESTHESIA SURVEY FOR PATIENTS
PATIENT’S NAME (Optional) ____________________________________________________________________________________
DATE of surgery/procedure _____________________________________ HOSPITAL/ASC ________________________________
TYPE OF SURGERY/ PROCEDURE ________________________________________________________________________________
___________________________________________________________________________________________________________
Please “mark” the appropriate response below.
1. Before your surgery/procedure, did you speak to an anesthesiologist/nurse anesthetist?
Yes  No 
If yes, were you satisfied with the courtesies extended by this anesthesia provider?
Did he/she explain your anesthetic in terms you could understand to your satisfaction?
2. Were you informed to your satisfaction of what to expect BEFORE your surgery/procedure?
a. Were you informed to your satisfaction of what to expect DURING your surgery/procedure?
b. Were you informed to your satisfaction of what to expect AFTER your surgery/procedure?
3. Was the “start” of your anesthetic satisfactory?
4. How was your stay in the Recovery Room (Post Anesthesia Care Unit – PACU)?
5. Please explain any problems associated with your anesthetic: ______________________________________________________
________________________________________________________________________________________________________
6. What was the best thing about your anesthetic: _________________________________________________________________
7. Overall, how would you rate the anesthesia we provided for you?
8. Please give us your suggestions for improving the care we provide to patients:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________

Well, even if it does not necessarily
make the world go ’round, good customer
service certainly makes the journey less
bumpy. We can all easily identify poor
customer service – just think back to the
lastbadexperienceinastoreorrestaurant.
Defining what comprises good customer
service is a much more difficult task.
Most agree that customer service is
an organization’s ability to meet their
customers’ wants and needs. However,
many believe that good customer service
is an organization’s ability to constantly
and consistently exceed the needs of their
customers.
Though our customers’ expectations
and needs may differ according to our
fields of service, the general rules of good
customer service pertain to all of us. As I
was preparing to write this article, I asked
personnel in different areas of our office
two questions: “Who do you consider to
be your customers?” and “What do you
do to provide them with good customer
service?” I then analyzed their answers,
incorporated them into my current
research and arrived at the following
common elements of good customer
service:
• Be available – This element
covers everything from answering
your phone to returning emails.
Customers want to be heard.
Customers desire to reach a human
being when they are trying to make
contact with your organization. If
at all possible, phone messages and
emails should be returned within
24 hours – even if it is just to let the
customer know that their message
was received.
• Listen – Focus on what the customer
is saying to you, be attentive, and
show that you are listening to them
by responding appropriately. Ask
questions in order to understand
their wishes and carefully listen to
their answers to make sure you are
meeting their needs.
• Keep your promises – Before you
make any promises or commitments
to a customer, make sure you can
fulfill them. Keep appointments and
meet deadlines. Being reliable is a
key element to excellent customer
service.
• Manage expectations – Many times
what is perceived as poor customer
service is simply a disappointed
customer whose expectations
were not met. This can be avoided
by managing the customer’s
expectations in order to have them
match what you are able to deliver.
Reiterate what you understand
to be your commitment prior to
completing the encounter with your
customer. Your goal should be to
exceed your customer’s expectations.
• Make customers feel important and
appreciated – Customers are very
sensitive and can sense whether you
really care about them. Use their
name (though not excessively) and
take every opportunity to thank
them for their confidence in you and
for the opportunity to serve them.
• Be honest and sincere – Do not take
advantage of your customers. Be
truthful and keep what is in the best
interest of the customer as your goal.
People value honesty, integrity and
sincerity and these traits engender
confidence in you. Customers like
dealing with people they can trust.
• Address complaints quickly –
Nothing can ruin a positive customer
service experience more than a
complaint that is perceived to be
ignored. Acknowledge a complaint as
soon as possible and let the customer
know that it is being addressed. If
the customer is upset or angry,
calm them with words and actions
Customer serviCe mAkes the
world Go ’round
Marie Walton, CMPE
Vice-President, Client Services iMed Group, Houston, TX
President-Elect, MGMA-AAA
Continued on page 10

that show you take their complaint
seriously. Once the customer is
satisfied that their complaint is being
addressed,make sure you thank them
for bringing the problem to your
attention. Let the customer know
what you have done to resolve their
complaint. Complaints should be
viewed as opportunities to improve
processes, policies and procedures.
• The customer is always right – While
they may not technically be right,
the customer believes that they are
right. It is important to remember
this when communicating with them
and to avoid implying that they are
wrong.
• Know how to apologize – When
something goes wrong, apologize.
Customers appreciate it, it is a simple
thing to do, and it can defuse a
potentially damaging situation.
• Be helpful – Assisting someone, even
if it is not your job or will not reap
you immediate benefits, can be a sure
way of keeping existing or acquiring
new customers. Help your customers
understand terms and processes
inherent to your organization.
• Go the extra mile – If you want to
provide excellent customer service,
make that extra effort. Do not just
tell the customer who can help
them, offer to contact them on the
customer’s behalf. Customers notice
when people make the extra effort.
• Use the power of “yes” – Always
look for opportunities to accede to
a request. Even when the answer is
“no,” find a way to not have to say
so directly. If possible, let the “no”
decision be made by an entity other
than your organization. Even if you
already know that the answer to the
customer’s request will be “no,” offer
to inquire on their behalf and then
let the customer know that the other
party has denied their request. After
all, there is always the possibility
that something has changed and the
answer will be “yes.”
• Train your staff often – Many people
think customer service is instinctive
but good customer service needs to
be taught. Talk about what good
customer service is and go over
examples of both good and bad
customer service and point out the
differences. Use complaints you have
received as teaching opportunities.
Have your staff demonstrate good
and bad customer service through
scenarios or skits. Provide your
staff with sufficient information
and empower them to be able to
make decisions that lead to excellent
customer service. Your staff needs
to be as concerned about your
customers as you are.
The final element of good customer
service does not directly relate to
customers but it is an integral part of an
organization’s success in exceeding the
customer’s wants and needs.
• Treat your employees well –
Employees are your internal
customersandneedtobeappreciated.
Treat them with respect, thank them,
let them know how important they
are to you and they will treat your
customers in a similar manner.
Regardless of what responsibilities
you have within your organization, you
can apply these elements of customer
service to improve your customers’
experiences. First, determine who your
customer is, and then determine the
process by which your organization can
deliver its services or products in a way
that allows the customer to access them
in the most efficient, fair, cost effective,
and humanly satisfying and pleasurable
manner possible. Thus, you will be
providing excellent customer service.
Additional training tools and
information on this subject may be found
in the Medical Group Management
Association (MGMA) website at www.
mgma.com by entering “customer
service” in the search box.
Marie Walton, CMPE
is Vice-President for
Client Services of
iMed Group, a medical
practice management
company where she
has worked for almost
10 years. Currently,
she serves as President-
Elect of the Medical Group Management
Association Anesthesia Administration
Assembly (MGMA-AAA). She has made
many anesthesia business presentations for
MGMA-AAA and Anesthesia Administrators
of Texas(AAT). Ms.Waltonmaybecontacted
at mwalton@imedgroup.com.
Customer serviCe mAkes the world Go ’round

Mr. Baker kindly provided the model employee code of conduct below, offering a direct means of
drawing anesthesia group personnel’s attention to specific components of the excellent customer
service discussed in Ms. Walton’s article on page 10.
Customer Service Code of Conduct
As an employee of “medical group name”, I agree to abide by the following code of conduct. I will always remember that we are
in the healing business. Many of our patients come to us not feeling well and they have a right to expect us to do everything
in our power to help them. We may not be able to fix their problem, but we must make doubly sure that we are always
compassionate and gracious to them.
Professional behavior is demonstrated by the following actions.
I will always take responsibility for my own actions. I will not blame others or make excuses. If I have a bad day at home that
is no excuse for me to come to work and take it out on others. The true test of a person’s character is not how they act when
everything is going great, but how they act when nothing is going great.
I will use “please” and “thank you” as much as possible when asking a patient or staff to do something. For example, “please
sign in, please step on the scale for me, Thank you for coming today.” If my provider is running more than ½ hour late I will
apologize to the patient for the delay. For example,“Ms. Smith, thank you for your patience, I apologize for the delay in seeing
you.” If I room a patient, I will check back with them within 15 minutes if my provider has not seen them yet.
I will address a patient formally by their first and last name or last name when calling them to the back. I will wear my
nametag and smile and introduce myself to each patient (For example, “good morning Ms. Smith, my name is Betty, please
come this way.”) I will look a patient in the eye when speaking with her.
I will not shout at a patient or staff member, whether calling them to the front desk or announcing their name in the waiting
room. I will not shout down a hallway. I will keep my voice at a conversational level when talking with patients or other staff.
I will not engage in loud conversation, laughing or virtual communication with anyone in the presence of patients. I will not
use cell phones either verbally or by texting during work hours.
I will always do my job to the best of my ability. If I am aware of a problem or issue I will take ownership and address the
matter until resolved or until a physician or management reassigns responsibility. I will not say “I can’t help you.” I may not
be personally able to solve a problem but I will seek out someone who can. I will not waste company time, but will take care
of my own responsibilities efficiently and effectively, and if I am not busy I will inform management or I will volunteer to
assist others.
I will dress appropriately and be well groomed. I acknowledge that my speech and appearance make an impression on
patients and I want the impression to be positive.
I will always treat patients and staff, regardless of circumstances, the way I would like to be treated.
I agree to abide by the“medical group name’s”Customer Service Code of Conduct.
Employee Signature _____________________________________________________________ Date _______________

In the current economic environment
it is not enough that anesthesia practices
have consistently good outcomes from
the care their practitioners provide. It is a
given that today’s anesthesia providers can
successfully manage any surgical patient
safely, no matter how complicated the
circumstances or medical history, through
surgery and post-operative recovery. This
is the basic service that anesthesia groups
sell and that hospitals and surgi-centers
buy. What matters is not just how well the
anesthesia practice manages the patients’
surgicalexperience,but,ratherhowwellthe
practice manages the broader expectations
of its various customers. Anesthesia has
become a critical cog in a much larger
system. As such, the success or failure of
the relationship depends not only on its
ability to anticipate the needs of individual
patients, but also on its ability to anticipate
the needs of the system as a whole. This is
why customer service has become one of
the most important anesthesia practice
management issues of the day.
Anesthesia training programs do
an excellent job of preparing anesthesia
providers for the exigencies of surgical and
obstetric anesthesia. Most anesthetics take
the provider through a familiar routine
of preparation, induction, maintenance,
emergenceandrecovery. Rareistheclinical
situation that the provider has not already
worked through at least a few times or
where the fundamental physiological and
pharmacological issues are not familiar.
The operating room and the delivery suite
are environments in which expectations
and requirements are, for the most part,
well understood and readily attainable.
There is ample evidence of most providers’
ability to artfully manage the needs of
patient and surgeon. Consistently reliable
feedback of an array of monitors allows
for timely and tactical decision-making.
With experience comes confidence.
Real challenge occurs when these same
clinicians step outside the operating room
into an environment in which they have
neither the same type of reliable feedback
nor the experience to consistently juggle a
seemingly inconsistent and conflicting set
of expectations and requirements.
Marketing consultants love to ask
who is your customer and what does your
customer want? Not only are these tough
questions to answer in anesthesia, but no
two sets of answers will be the same. Too
often the default answer is “it depends,”
which does not really allow for effective
decision-making.Ifcustomerrequirements
cannot be clarified and quantified, service
delivery strategies cannot be formulated
and refined. While the same basic
assessment and decision-making skills that
make clinicians so effective in the operating
room will actually serve them well in the
Board room,the application of the concept
is not always clear in an unfamiliar context.
Anesthesia providers are trained to accept
and rely on digital arrays that indicate how
the patient is responding to anesthetic
agents administered during the case, while
the absence of such reliable monitoring
tools and feedback outside the operating
room makes for confusion and distrust.
It may take some training, but anesthesia
providers must learn to be able to read
their customers like their monitors. There
is no doubt that this is often more art than
science, but it is not less important a skill.
Herein lies both the greatest single
opportunity and quintessential test for the
anesthesia provider. Anesthesia’s value to
the system is that anesthesia providers do
moretodeterminetheoverallqualityof the
Customer serviCe in
AnesthesiA CAre
By Jody Locke
ABC Vice-President of Anesthesia and Pain Management Services

patient’s surgical or obstetric experience
than any other provider involved in the
surgical experience. Because customer
service is about perception, though, if I
do not understand or appreciate how you
are going to anticipate my every need and
guide me safely and artfully through the
potential trauma and stress of my surgery,
then all your training and skill is for
naught.
Surveys have shown that two areas of
greatest concern to hospital administrators
with regard to their anesthesia providers
have to do with outlier providers and pre-
operative communications. Too many
groups suffer the consequences of their
own inability to monitor and manage
their problem providers. It is a curious
phenomenon. So much is at stake and yet
when it comes to monitoring how different
members of the department or group
interface with patients and other members
of the medical staff there is an unfortunate
and, sometimes, fatal tendency to turn a
blind eye. There is a fine line between the
competence of a clinician who can listen
to and evaluate the situation of a patient
effectively and in a way that the patient is
left with a sense that he or she is in good
and competent hands, and the arrogance
of the scientist who does not appear to
need or want the input of the patient. In
other words, today’s patients want what
they get in the salon; they want to be cared
for and not just taken care of.
We all know good customer service
when we experience it. Some intangible
quality bonds us to certain service
providers, even though we may know they
are not the best providers or the cheapest
option. Research suggests it is not the
relationships where nothing goes wrong
that are the strongest, but the ones where
the commitment of the provider to find
solutions and keep the relationship are
evident. If your mechanic does not fix a
problem with your car the first time, you
may be upset but you will give him the
chancetosolvetheproblem.If theproblem
is resolved then your stock in him goes up
but if he does not demonstrate an attitude
of caring, compassion and contrition you
will not go back.
The reality of today’s increasingly
complicated reliance on technology
is that not all solutions are evident or
easily identifiable. This is especially true
of medicine. A hospital is a forum for
collaborative problem-solving where
teams of providers and administrators
work in partnership to achieve two related
goals: higher quality care and stronger
balance sheets. It is normally assumed
that if they accomplish the first, the
second will follow. Given the vagaries of
the market, however, there is not always
a clear connection between the two and
sometimes the latter supersedes the
former.
Eachofthefollowingfivestakeholder’s
perspectives on the surgical experience is
defined by his or her own requirements,
expectations and history. It is not unlike
the parable of the blind men and the
elephant. Each one sees the relationship
only from his or her perspective. Typically,
none of the participants is willing to look
at the relationship through any other lens.
It is easy to see why anesthesia providers
become so exasperated with their
interactions in the operating room suite;
no one else sees what they see.
• Patients want amnesia and the
confidence that they will be pain-
free and safe.
• Surgeons want availability so that
they can get their cases done in
a manner that allows them to be
productive
• Hospital administrators want
affordability because they are
always struggling with the bottom
line
• The Operating Room staff and the
nurses, by contrast, want affability
because they have to deal with a
variety of personalities and complex
clinical situations
• Meanwhile the members of the
anesthesia department or group
want acknowledgement for their
hard work and tireless service.
It would be easy to say that what is
needed is for all the stakeholders to take
a step back so they can see the whole
elephant, but this is easier said than done;
they are too busy trying to satisfy their own
interests. It is also unlikely and unrealistic
to assume that the paradigm will change
from without, although occasionally
hospitals do take dramatic and draconian
steps to shake things up.
It would be equally naïve to assume
that any of the stakeholders is willing to
acknowledge the potentially pernicious
impact of his or her pursuit of self-interest.
No commuter leaving home at 8:30 in the
morning is willing to take responsibility for
the traffic jam that results when hundreds
of thousands of people do the same thing
so they can get to work and provide for
their families. This is the nature of system
problems. Our roles and responsibilities
are all defined by a system over which we
have little influence and no control.
The specific vulnerability of the
anesthesia practice is defined by its
replaceability. Contrary to popular belief,
the anesthesia practice is the most readily
replaceable of the five stakeholders listed
above. There is no more compelling

evidence of this fact than the growth
of staffing companies such as Sheridan
Health Care, NAPA, Sonos, Premier, etc.
Many of the nation’s largest anesthesia
practices have also become active players
in responding to Requests for Proposal
(RFPs) and in accepting contract
agreements for the provision of services
outside their primary catchment area.
This explains why customer service
has become both a challenge and an
opportunity to the typical anesthesia
group practice. The challenge is survival,
but the opportunity is security. Both
are defined by clear evidence of and a
compelling commitment to customer
service. What makes so many group
practices vulnerable is the perception
on the part of the O.R. staff and
administration that they “don’t get it
about customer service.”
No service relationship is perfect
and it is unrealistic to think that there
will not be some disagreements or
miscommunciations in the relationship
between an anesthesia group and the
management of the operating room. The
strength of the relationship can best be
measured in three areas. The first is the
consistency of care provided and the
perception of the medical staff. Contrary
to popular opinion, superior clinical
care is an essential pre-requisite. The
second is the way the organization deals
with its shortcomings and problems;
a perception that a practice is willing
to accept its shortcomings and a pro-
active approach in addressing them is
essential. It is never a good sign when
the hospital administrator has a list of
“problem” providers. The third and final
factor is the management of the practice;
practices that have strong leadership and
which speak with one voice are always
preferred over those that function as loose
confederations of independent providers.
A lot can be learned from the hospital
administrator. Practices that do not have
regular interactions with administration
are generally more vulnerable than those
that do.
It is these same three qualities that
define the practices with the best and most
secure relationships with their hospitals. A
commitment to excellence in execution is
essential and best practices are continually
striving to anticipate clinical needs of
the institution. The second quality that
creates and engenders confidence is strong
internal monitoring and peer review. Best
practices not only do various forms of
continuous quality improvement but will
identify opportunities to have additional
staff improve their skills or learn new
techniques. There is obviously no one
right way to run a hospital or its operating
room suite. Because the anesthesia
department inevitably has more and better
data about what actually happens day to
day there is an expectation that anesthesia
can be a strong contributor to the
ongoing improvement of operating room
operations. But by far what distinguishes
the strongest relationships is the way
administrations interact. If leadership
of the anesthesia practice has a good
rapport with administration that allows
for collaborative problem-solving and
strategic planning, then almost nothing
else matters. There is no clearer evidence
of this that the level of participation in
hospital committees. The practices with
the tightest relationships to their hospitals
are those that are willing to share data and
ideas and which make it a point to offer
solutions rather than to complain about
problems.
It is a sad reality that those practices
afraid of losing their franchise probably
will. Unfortunately, there are many others
that don’t even realize just how vulnerable
they are. Not a week passes but that some
anesthesia group president is surprised
to learn that his hospital administrator
has decided to send out an RFP. The
lesson here is that those groups that fail
to take the feedback they are getting from
administration seriously are doomed
to be victims of their own ignorance.
Every organization can be improved and
every relationship can be made stronger
through communication. The fact is that
those organizations that are confident they
are providing the best possible care and
creating value for the institution and have
evidence to prove it will likely enjoy long
and profitable relationships. Customer
service in the world of anesthesia is all
about partnership; the more you commit,
the more you benefit; but it is an all or
nothing proposition You either get it
about customer service or you don’t.
Mr. Locke is respon-
sible for the scope and
focus of services pro-
vided to ABC’s largest
clients. He is also re-
sponsible for oversight
and management of
the company’s pain management billing
team. He will be a key executive contact for
the group should it enter into a contract for
services with ABC. He may be reached at
Jody.Locke@anesthesiallc.com
Customer serviCe in AnesthesiA CAre

Think back to a recent service
experience. This service could have been
provided by anyone from an accountant,
to a lawyer, to a car mechanic. Ask
yourself the following questions about
that experience and consider:
Did the provider…
• Listen carefully to your needs and
try to understand what was unique
about you?
• Communicate in understandable
language and explain in advance
what they were going to do and why?
• Keep you sufficiently informed on
progress and make sure they were
accessible when you needed them?
• Deliver on time and keep their
promises?
• Offer help or proactive ideas beyond
the specifics of the service provided?
• Show an interest in you beyond the
specific task at-hand and make you
feel that you and your business are
important to them?
If you answered ‘yes’ to most of these
questions,chances are you were extremely
satisfied with the service you experienced.
Grant Thornton LLP is the U.S.
member firm of Grant Thornton
International Ltd, one of the six global
audit, tax and advisory organizations.
At Grant Thornton we provide training
to help individuals know that it takes
providing personalized attention and the
highest quality service to build lasting,
loyal client relationships. Here are some
of the basic components to client service.
Client serviCe best prACtiCe:
don’t Assume you AlreAdy know
the Client’s expeCtAtions—
they’re AlwAys ChAnGinG
How does one personalize their
service approach? It starts with
understanding the client’s expectations.
As a partner at Grant Thornton, I
believe that our personalized service
sets us apart because we embrace a
common philosophy about what it
means to provide exemplary service.
Our philosophy is fundamentally client-
centric, and our service methodology
reflects this: the very first thing we do
with each client, at least once a year, is sit
down in person to listen and ascertain the
client’s expectations, even with clients we
serve repeatedly—because expectations
are always changing. This conversation
helps us hear what’s most important to
each client—in their words. So we may
distinCtive Client serviCe:
five prACtiCes you CAn
implement todAy
William Kingsley
Grant Thornton, LLP, Southfield, MI

tailor a service approach that fits—not
just for the project at hand, but for the
relationship overall.
Client Service Best Practice:
Be A Student Of The Client’s
Industry And Business
Having a deep knowledge of what
makes each industry segment unique is
critical to exceeding clients’ expectations.
Doing the necessary research and
homework up front to have a working
knowledge of current trends, hot topics,
and challenges not only shows credibility
but a genuine interest in the issues
important to the people you serve—but
don’t stop there. Be sure to also speak
directly with your clients and ask them
how they would like you to learn more
about them and their business. Then,
take their advice. They will know better
than anyone else and give you an efficient
roadmap for making the most of your
time and efforts.
Remember that clients appreciate it
when their advisors can ‘talk shop’ with
them, and when conversations aren’t
laden with jargon they don’t understand.
Using terms that are relatable and within
the context of their everyday world is an
important part of establishing effective,
trusted communication—the backbone
of every successful relationship.
Delivering Your Service Is
The Prime Time To Add Value,
Demonstrate Expertise
Having served a broad range of
clients over the course of 25 years, I
know first-hand that there is no better
time to shine than during the day-to-day
management of a project or service, when
client interactions are frequent: Service
providers must demonstrate flexibility
in the way they operate, in the ways
they communicate, and in the kinds of
solutionsthattheyofferinordertoprovide
a unique, personalized service experience.
When you’re interacting with a client, you
have many opportunities to identify ways
they might improve or optimize their
position. When you think about how you
can provide value to a client, especially
to a key influencer or decision-maker,
it really is in the area of questions. Not
just answering the questions they ask,
but being able to surface ideas and advise
what questions they should be asking—
and then helping to answer those. When
you can bring something extra to the
conversation and help expand the client’s
own thought process so they can look even
farther ahead to choices that wouldn’t
otherwise have been on their radar, you
become a trusted advisor to that person
and organization.
After years of serving a number and
variety of clients, you have invaluable,
first-hand perspective and knowledge to
share that isn’t a commodity. When you
proactively share insights from your past
or current experiences, it is perceived
as adding value and your service is seen
as more comprehensive. This is why
clients expect more than just technical
expertise. They want a provider that
focuses on the relationship and strives to
help their overall organization improve.
Collaboration Is Key—Throw
Away The Cookie-Cutter
It’s not often that service is delivered
solely by one person. Usually, it takes
a team to create a superior service
experience. Teamwork means close
coordination and collaboration by
everyone, from the receptionist to the
lead supervisor, to get the job done.
Clients expect the left hand to know what
the right hand is doing. If they perceive
silos in how you operate their confidence
declines and their risk of dissatisfaction
increases.
Teams that collaborate don’t try to fit
clients into an answer that they may have
already given to somebody else. When
teams and clients craft answers together,
there is a united focus and commitment
that ensures a successful outcome.
Feedback Is A Gift—Use It
For Continuous Improvement
Every great service organization and
professional needs candid feedback to
improve and grow.Whether you choose to
seek feedback formally through a survey
or informally through a one-on-one client
conversation, the only way to know how
well you are performing is to ask.
Take what you learn—both what
you do well and what you can do to
improve—and take action. Follow up
and thank clients for their feedback
and communicate what you will do
in the future to continuously improve
their service experience. Don’t try to fix
problems or complaints in the moment or
become defensive. Just listen, take notes,
and commit to following up. This gesture
alone helps strengthen relationships and
as you see trends start to emerge in your
findings, your ability to hone in on the
practices that mean the most important to
your clients will serve your business well.
Demonstrating these practices
repeatedly will not only enhance your
clients’ experience but will establish your
reputation as a trusted professional—and
that is something only the most satisfied
clients can do for you and your business.
William Kingsley
is a tax partner with
Grant Thornton, LLP
27777 Franklin Rd.
Ste 800, Southfield,
MI 48034-2366. He
may be reached at bill.
kingsley@gt.com.
Distinctive Client Service: Five Practices You Can Implement Today

As a result of legislation passed under
the Bush administration, the $100,000
gross income limit for an individual
to convert a traditional individual
retirement account (IRA) to a Roth
IRA will be lifted in 2010. As a result,
regardless of gross household income
level, you will be eligible to convert your
IRA to a Roth IRA. The only question is
“Shall I convert?”
Before discussing the reasons “why”
or “why not,” let’s review the elementary
differences between a traditional IRA
and a Roth IRA. Even though both are
forms of a retirement account, they have
their own distinct characteristics.
WithatraditionalIRA,pre-retirement
contributions can be tax-deductible.
The tax-deductibility is dependent on
the individual’s income level and the
availability of an employer-sponsored
retirement plan for the spouse. The
assets within a traditional IRA grow tax
deferred until withdrawn at retirement.
Each withdrawal is subject to federal
income tax. Conversely, contributions
to a Roth IRA are made with after-tax
money. There is no tax deduction for the
contribution. Like a traditional IRA, the
assets grow tax deferred until retirement.
However,because contributions are made
with after-tax money, the withdrawals at
retirement are not taxed. This in a sense
makes a Roth IRA a tax free retirement
asset.
The traditional IRA also has
required minimum distributions (RMD)
beginning at the age of 70½. Once
you reach this age, you are required to
withdraw a certain percentage of the
account value on an annual basis and
pay the associated federal income taxes.
The Roth IRA on the other hand has no
RMD and any withdrawals are tax-free.
As noted, this is due to the contributions
of a Roth IRA being made with after-tax
money.
When deciding to convert a
traditional IRA to a Roth IRA, you
need to consider multiple factors. Many
people mistakenly believe, given the
opportunity, they should convert. They
assume they will be better off having a
tax free asset at retirement in the form of
a Roth IRA than they will with a taxable
asset in the form of a traditional IRA.
To make the correct decision, people
should consult their tax advisor and be
cognizant of the following:
Current inCome tAx rAte vs.
expeCted inCome tAx rAte At
retirement:
All other things being equal, the rule
of thumb is if you believe your income tax
rate at retirement will be less than your
current income tax rate, you should not
convert. This is because when you convert,
you pay income taxes on the total market
value of the traditional IRA in the year in
which you convert.Consider the following
example. Dr. Tom, an anesthesiologist
with 25 years of experience, currently
has $100,000 in a traditional IRA, and
his federal income tax rate is 30%. If he
converts to a Roth IRA,he will pay $30,000
in federal income taxes this year due to the
trAditionAl irA: shAll
i Convert?ScottThompson
and Jon Koteski, CFA
Oakmont Capital Management, LLC, Oakmont, PA

The Communiqué Spring 2008 Page 18The Communiqué Winter 2010 Page 18
realization of $100,000 in taxable income.
If Dr. Tom leaves the $100,000 in the
traditional IRA and doesn’t convert, he
will pay taxes when he takes distributions
at retirement. If at this time his tax rate
is 20%, he will pay 20 cents in federal
taxes on every dollar he withdraws. This
lower tax profile suggests it may not be
beneficial for him to convert today.
Conversely, if Dr. Tom is a young
resident and just beginning his career, it
may make sense for him to convert. This is
because there is a good chance his current
tax rate may be less than what it is going
to be when he retires. But obviously, there
is no guarantee.
Ability to Pay the Additional
Income Tax Associated with
the Conversion:
If you do not have the excess cash to
pay the additional taxes generated from
the conversion, it may not be feasible for
you to convert. If you use cash from your
traditional IRA to pay the additional tax,
you may also be subject to a 10% penalty
due to it being an ineligible withdrawal.
This penalty is in conjunction with
any taxes generated. Furthermore, the
conversion may put you in a higher tax
bracket, especially if you file jointly and
both you and your spouse decide to
convert. It may make sense to only convert
an amount that will permit you to remain
in your current income tax bracket or
develop a plan in which you do a multi-
year conversion with manageable dollar
amounts each year. For calendar year 2010
only, if you convert, you can spread the
realized taxable income over 2011 and
2012.
Estate Planning:
For certain estate planning purposes,
a Roth IRA may be more attractive relative
to a traditional IRA. Assets of both
transfer to the beneficiary tax deferred,
however, the beneficiaries of a Roth IRA
do not have to pay federal income taxes
on future withdrawals regardless if they
are retired or not. This is not the case with
a traditional IRA.As result, a Roth IRA is a
simple way of transferring an income tax-
free asset to a spouse or heir. Secondarily,
the value of the estate is reduced by the
income paid due to the conversion. This
lowers the overall estate tax liability at
death.
Stock Market Dynamics:
Since the tax liability of the conversion
is directly related to the market value
of the assets of the traditional IRA, it
advantageous to convert when asset
values are depressed. This usually occurs
during or after a market crisis, similar to
one we experienced in 2008 and the first
part of 2009. It is especially attractive if
you have a significant amount of time
until retirement and you can benefit from
multiple market cycles through a proper
investment strategy.
Re-characterization:
If you convert today and an exogenous
event occurs preventing you from
having the means to pay the additional
tax liability, the IRS will allow you to
“unconvert” or re-characterize your Roth
IRA back to a traditional IRA. You can do
this up until you file your tax return for
the year in which you initially converted.
You may also consider re-characterizing if
the market value of your Roth IRA assets
drops significantly after the conversion.
This will allow you to convert in the future
at a more attractive market value.
“How does the actual conversion
process work?”Relatively, it’s quite simple.
It’snomoredifficultthanopeningatypical
brokerage account and transferring assets
into it. Some brokerage firms will even
allow you to do the conversion online. If
you already have a Roth IRA in place, you
may not even need to open a new account.
You can refer to IRS Publication 590 for
more details on the intricacies.
“Shall I convert?” is not an easy
question to answer. There are many
factors that weigh into the decision. Some
have been discussed in this article and
others have not. An improper decision
or assumption regarding these factors
can significantly affect the amount of
assets you have at retirement. Do your
homework and consult your tax and
investment advisors prior to walking down
the conversion path. Converting may not
always be in your best interests...
You may e-mail the authors at
sthompson@oakmontcap.com and
jkoteski@oakmontcap.com

Sources:
The Vanguard Group, Inc.
Morningstar, Inc.
BlackRock, Inc.
Traditional IRA: Shall I Convert?

breACh notifiCAtion finAl rule
Abby Pendleton, Esq.
Jessica L. Gustafson, Esq.
The Health Law Partners, P.C., Southfield, MI
In compliance with Section 13402
of the Health Information Technology
for Economic and Clinical Health
(“HITECH”) Act, on August 24, 2009,
the Department of Health and Human
Services (“HHS”) issued an interim final
rule with comment period (“Final Rule”),
which requires covered entities and their
business associates to provide notification
of breaches of unsecured protected health
information (“PHI”). The provisions of
this Final Rule were effective September
23, 2009. There are several main
components of the Final Rule, which
must be considered individually. These
considerations, which will be addressed
each in turn by this article, include the
following:
• Which entities are governed by the
Final Rule?
• Has a “breach” occurred?
• If yes, did the breach involve
“unsecured protected health
information”?
• If yes, to whom must notification
be provided, and what information
must be provided?
whiCh entities Are Governed
by the finAl rule?
The breach notification provisions
of the HITECH Act and the Final Rule
are applicable to “covered entities” and
their “business associates,” as these terms
are defined by the Health Insurance
Portability and Accountability Act
of 1996 (“HIPAA”) Administrative
Simplification regulations, codified at
45 C.F.R. § 160.103. Pursuant to these
regulations, a covered entity includes a
health plan, health care clearinghouse
or health care provider that transmits
health information in electronic form (an
anesthesia practice that submits a health
care claim electronically is an example of
a covered entity). A business associate
is a person or entity that performs
functions on behalf of a covered entity
that involve the use or disclosure of
protected health information. Examples
of business associates include billing
companies, transcription companies,
legal counsel and entities performing
management or administrative services
for covered entities who require access
to protected health information.
“Protected health information” (“PHI”)
is defined to include, with certain
exceptions, individually identifiable
health information held or transmitted
in any form or medium by HIPAA
covered entities and business associates.
Anesthesia and pain management
practitioners are “covered entities” with
access to “protected health information”
as defined by the regulations and thus
are subject to the HITECH Act and the
corresponding provisions of the Final
Rule.
hAs A “breACh” oCCurred?
In cases where a covered entity
discovers a disclosure of PHI, the first
consideration is to determine whether
such a disclosure constitutes a “breach”
as defined by the HITECH Act. Section
13400 (1) of the HITECH Act defines
“breach” to mean, generally, “the
unauthorized acquisition, access, use, or
disclosure” of [PHI], which compromises
the security or privacy of such
information. The Final Rule clarifies that
“unauthorized” means “impermissible
use.” The Final Rule clarifies that a use or
disclosure impermissibly involving more
than the minimum necessary PHI may
constitute a breach; on the other hand,
a use or disclosure resulting from an
otherwise permissible use or disclosure
involving only the minimum necessary
PHI and occurring despite reasonable
safeguards would not qualify as a breach.
The Final Rule specifies certain
exclusions to the term“breach,” including
the following: disclosures made to an
unauthorized person, where such person
would not be reasonably able to retain
such information, and further excludes
certain unintentional acquisitions, access
or uses of information made by employees
of a covered entity or business associate,

persons acting under the authority of a
covered entity or business associate, or
individuals otherwise authorized by the
covered entity or business associate to
access the PHI.
In summary, when determining
whether a “breach” has occurred,
covered entities and business associates
must consider the following three
matters: (1) whether there has been
an impermissible use or disclosure of
PHI under the HIPAA Privacy Rule;
(2) whether the impermissible use or
disclosure compromises the security
or privacy of PHI (i.e., is there a risk of
financial, reputational or other harm to
the individual as a result of the use or
disclosure); and (3) whether the incident
falls into one of the exclusions of the term
“breach” as defined by the Final Rule.
did the breACh involve
“unseCured proteCted heAlth
informAtion”?
Section 13402(h) of the HITECH
Act contains the general requirements
regarding breach notification, and
specifies that such requirements relate
only to breaches of “unsecured protected
health information.” If PHI is not
“unsecured,” breaches are not subject to
Section 13402(h) of the HITECH Act
and the corresponding provisions of the
Final Rule. The law defines “unsecured
protected health information” as PHI
“that is not secured through the use of a
technology or methodology specified by
theSecretaryinguidance.” Thelawfurther
requires that such guidance describe
those technologies and methodologies
rendering PHI “unusable, unreadable,
or indecipherable to unauthorized
individuals.” Such guidance originally
was published April 27, 2009 at 74 Fed.
Reg. 19006, and listed encryption and
destruction as the two technologies
and methodologies used to render PHI
unusable, unreadable or indecipherable
to unauthorized individuals. This
guidance was clarified with respect to
specific encryption processes to employ
by way of the Final Rule, beginning at 74
Fed. Reg. 42742.
Significantly, the Final Rule does
not modify any existing requirements
of the HIPAA Security Rule (which
is technology neutral), and does not
require that covered entities and their
business associates encrypt all PHI. The
requirements of the HITECH Act and
Final Rule relate only to a covered entity’s
and/orbusinessassociate’sresponsibilities
in the event of a breach of unsecured PHI.
• By way of clarification, under the
HIPAA Security Rule, encryption is
an “addressable,” not a “required,”
implementation specification. This
means that a covered entity must
assess whether encryption would be a
reasonableandappropriatesafeguard
in the entity’s environment; however,
the covered entity may choose not
to implement the specification
based upon its internal assessment,
if it documents the reason and
implements an equivalent alternative
measure, if such alternative would be
reasonable and appropriate. Thus, a
covered entity may be in compliance
with the HIPAA Security Rule even if
it reasonably decides not to encrypt
electronic PHI and instead uses an
alternative method to safeguard
information. In this scenario, in the
event that a breach of PHI occurs,
even though the covered entity or
business associate is in compliance
with the HIPAA Security Rule, the
covered entity or business associate
nonetheless will be required to
provide the requisite notification
pursuant to the HITECH Act and
corresponding provisions of the
Final Rule, as the PHI is “unsecured.”
• On the other hand, if the covered
entity or business associate chooses
to encrypt PHI as part of its
safeguarding of electronic PHI
under the HIPAA Security Rule, and
provided that such encryption is in
compliance with published guidance
in the Final Rule, in the event of a
breach, the covered entity or business
associate will not be required to
provide notification under the
HITECH Act and corresponding
provisions of the Final Rule, as such
information was not “unsecured.”
A breACh of unseCured pHI
hAs oCCurred. to whom
must breACh notifiCAtion be
provided,And whAt informAtion
must be provided?
Notice to Each Individual
Following the discovery of a breach
of unsecured PHI, a covered entity must
notify each individual whose unsecured
breACh notifiCAtion finAl rule

PHI has been (or is reasonably believed by
the covered entity to have been) accessed,
used or disclosed. Under the Final Rule, a
breach is deemed to be discovered either
(1) on the first day the entity obtains
actual knowledge of the breach; or (2) the
day on which the breach would have been
known had the covered entity exercised
reasonable diligence. Per the Final Rule,
the notification to each individual must
be made “without unreasonable delay
and in no case later than 60 calendar
days after discovery of a breach.”
Such notice must be written in plain
language, and must be made either (1)
via first class mail to the individual (or
to his or her next of kin or personal
representative, if such individual is
deceased) at the individual’s last known
address, or (2) via email, if the individual
agreed to receive such communications
via email. The written notice must
include the following elements:
• A description of what happened
with respect to the breach, including
the date the entity discovered the
occurrence of the breach;
• A description of the types of
unsecured PHI that were involved in
the breach;
• A description of those steps
individuals should take to protect
themselves from any potential harm
resulting from the breach;
• A description of the covered entity’s
actions to investigate the breach, to
lessen the harm to the individuals
affected by the breach, and to protect
against further breaches; and
• The contact information for
individuals to obtain additional
information, which should include a
toll-free telephone number, an email
address, a website or a postal address.
In the alternative, codified at 45
C.F.R. § 164.404 (d) (2), the Final Rule
also sets forth requirements for substitute
notice, permissible in cases where a
covered entity has insufficient or out-of-
date contact information for individuals
that are the subject of a breach of
unsecured PHI.
Notification to the Media
In the event a breach of unsecured
PHI involves more than 500 individuals,
the covered entity also must notify
prominent media outlets of the breach.
Such media notification must include
all elements included in the individual
notification, and must be made without
unreasonable delay, but in no case later
than 60 calendar days after the discovery
of the breach.
Notification to HHS
In all cases in which a covered entity
discovers a breach of unsecured PHI, the
covered entity must notify HHS. If the
breach involves 500 or more individuals,
the notification to HHS must be made
at the same time notification to each
individual is made. If the breach involves
fewer than 500 individuals, the covered
entity will maintain documentation of
the breach and provide notification to
HHS no later than 60 days following the
end of the calendar year.
Business Associates
The Final Rule also requires that
business associates notify the covered
entity of any breach of unsecured PHI
that occurs. Such notification must be
made without unreasonable delay and in
no case later than 60 calendar days after
discovery of the breach.
Conclusion
The Final Rule requires that
anesthesia and pain practices adopt
and implement policies and procedures
related to the breach notification
provisions of the HITECH Act and
Final Rule. The Final Rule also
requires that these entities train their
workforce members regarding these
breach notification requirements. As a
practical matter, because the provisions
of the HITECH Act and Final Rule
are rather detailed, covered entities
and business associates should train
their employees to inform the HIPAA
Privacy or Security Officer of any
potential breach, so that the entity’s
management can render a decision as
to what notification, if any, must be
made. This is not an easy task and
will likely require investigation and
coordination with legal advisors.
Abby Pendleton and Jessica L. Gustafson
are partners with the health care law
firm of The Health Law Partners, P.C. in
Southfield, Michigan. The firm represents
hospitals, physicians, and other health
care providers and suppliers with
respect to their health care legal needs.
Pendleton and Gustafson specialize in
a number of areas, including but not
limited to: Recovery Audit Contractor
(RAC), Medicare, Medicaid and
other payor audit appeals, healthcare
regulatory matters, compliance matters,
reimbursement and contracting matters,
transactional and corporate matters,
and licensing, staff privilege and payor
de-participation matters. They can be
reached at apendleton@thehlp.com and
jgustafson@thehlp.com.
Abby Pendleton Jessica L. Gustafson

Recent legislative initiatives to
restrict (or eliminate) the Stark law’s
In-Office Ancillary Services Exception
(the “IOASE”) are, by no means, a new
phenomenon. Rather, over the last
few years, the Centers for Medicare
and Medicaid Services (“CMS”) has
introduced several significant proposals
targeting the provision of certain
ancillary services in the physician
office setting, through proposed
changes to the Stark regulations and
other Medicare reimbursement and
performance regulations. Despite these
proposals, however, the IOASE remains
intact and the prospect of a near-term
wholesale elimination of the IOASE
appears remote. Although for many
pain management physicians the Stark
ban on physician self-referral is not
triggered (if the only ancillary services
provided are certain invasive radiology
procedures such as fluoroscopy), for
many other pain management physicians
who provide physical therapy (“PT”)
or other diagnostic testing in their
offices, the Stark law remains a relevant
consideration and they must stay
attentive to potential changes to Stark’s
IOASE.
This article provides a brief overview
of the IOASE, as it relates to pain
management practices and discusses
the current status of the IOASE, which
permits (and, we expect, will continue
to permit) appropriately structured in-
office PT and other ancillary service
arrangements in the physician (including
pain management practice) setting.
the ioAse- A brief history
The federal Stark law prohibits
physicians from referring Medicare
patients to entities that provide
“designated health services” (DHS)
(including, for example, PT and
diagnostic imaging services) if the
physician (or his/her immediate family
member) has a financial relationship
with that entity, unless a Stark exception
applies. The IOASE is the statutory
vehicle that permits physicians and
group practices to furnish DHS in
the office, with the goal of balancing
beneficiary convenience, efficiency of
services, quality and continuity of care,
on one hand, against the prevention of
abusive sham arrangements that do not
have a bona fide nexus to the physician’s
core medical practice, on the other hand.
A substantial majority of office-based
ancillary service arrangements rely upon
the IOASE to enable referring physicians
to provide these services within their
practices. Specifically, this exception
the stArk lAw’s in-offiCe
AnCillAry serviCes exCeption:
in-offiCe AnCillAry ArrAnGements remAin
viAble for pAin mAnAGement prACtiCes
Adrienne Dresevic, Esq.
Carey F. Kalmowitz, Esq.
The Health Law Partners, PC, Southfield, MI

protects in-office ancillary arrangements
if the services are provided or supervised
by the referring physician or his/
her group, billed by the performing
physician/group (or the group’s wholly-
owned subsidiary), and provided either
in the same building as the physician’s/
group’s office or a centralized building
cite operated exclusively by the group
practice. Notably, the IOASE was
contained in the original Stark statute
adopted by Congress in order to preserve
the long-standing practice of physicians
integrating within their practices those
ancillary services that complement the
professional physician services they
furnish.
Cms’ eArlier proposAls
tArGetinG the ioAse
In recent years, CMS has introduced
various legislative proposals which,
in one form or another, effectively
attempted to restrict (or eliminate) the
IOASE. Most of these original proposals,
however, were either never finalized, or
implemented in manner that did not
substantially affect many common in-
office ancillary service arrangements
involving true in-office integration.
The 2008 Medicare Proposed
Physician Fee Schedule, for example,
contained commentary by CMS
expressing concern that the IOASE was
being inappropriately used for services
that were not closely connected to the
physician’s core medical practice. At
that time, CMS solicited comments on
potentialchangestotheIOASE,including
whether certain DHS should be excluded
from the exception, whether the location
requirements of the exception should
be tightened, and whether the exception
should be available for specialized
services involving equipment owned by
non-specialists. CMS, however, to date
has not introduced a formal proposal to
materiallyrestrictthescopeof theIOASE.
Any revisions to the IOASE will require
a future notice of proposed rulemaking
withprovisionforpubliccomment. CMS
has noted that any future rulemaking will
present a coordinated, comprehensive
approach to accomplishing the goals of
minimizing the threat of program abuse
while retaining sufficient flexibility to
enable arrangements that satisfy the
requirements and intent of Stark.
In a related matter, recently CMS
took a relatively flexible position
when it finalized the Medicare Anti-
Markup Rule (the “AMR”) (which
applies to many common diagnostic
testing arrangements). Although the
original AMR proposals would have
placed restrictive payment limitations
on a significant number of such
arrangements, in the form the AMR
initially was adopted, if a physician
group is willing to exercise certain
operational flexibility, substantially all
of its diagnostic testing arrangements
that are structured to comply with the
IOASE likewise can be structured in
a manner that does not implicate the
AMR’s restrictive payment limitations.
Further, under the AMR, CMS permits
the use of shared space diagnostic testing
arrangements between physicians who
furnish physician services, as well as the
DHS that are the subject of the shared
arrangement, in the “same building”.
CMS did caution that it may issue
proposed changes to the IOASE in the
future, but expressly noted that it had
been asked to consider, and rejected, a
complete elimination of the IOASE.
Recently, CMS has also promulgated
some significant federal Stark
regulatory changes that impact certain
ancillary service arrangements, such as
eliminating the use of “per-click” fee and
percentage-based payments in space and
or equipment leases when the payments
reflect serviced provided to patients
referred between the parties. Notably,
however, these changes do not prohibit
the overwhelming number of common

in-office ancillary service arrangements
that are structured to comply with the
IOASE.
In yet another attempt to target
certain IOASE arrangements, in 2008,
CMS introduced a proposal that would
have required any physician practice
furnishing in-office diagnostic testing
services (e.g., ultrasound, x-ray, CT,
MRI, etc) to enroll as an independent
diagnostic testing facility (“IDTF”),
with the result that these practices’
diagnostic testing services would be
subject to the substantial majority
of IDTF performance standards. If
adopted, this proposal would have
eliminated physician practices’ ability to
share diagnostic testing equipment and
facilities, even if located in the “same
building” as defined under Stark. As a
practical matter, this proposal would
have also resulted in a significant decline
in the number of pain management
practices that furnish diagnostic testing
services to their patients. Ultimately
CMS declined to implement this IDTF
proposal.
The Current State of the
IOASE
In recent years, through a series of
proposals, CMS has heightened its focus
on certain in-office ancillary service
arrangements, including arrangements
structuredincompliancewiththeIOASE.
However, despite these proposals, the
IOASE remains intact as the statutory
vehicle that permits pain management
specialists to furnish both diagnostic
testing services and PT services in their
offices. Pain management specialists
furnishing such in-office ancillary
services should remain attentive to
potential future regulatory changes
that might further restrict the scope of
the IOASE. As a result, parties to such
arrangements should consider inclusion
of well-designed strategies to unwind
or restructure these transactions if
regulatory changes preclude physicians’
participation in such arrangements.
At this point, however, it appears that
a near-term elimination of the IOASE
remains a remote prospect.
The Stark Law’s In-Office Ancillary Services Exception:
In-Office Ancillary Arrangements Remain Viable for Pain
Management Practices
Adrienne Dresevic, Esq. is a found-
ing member of The Health Law Partners,
P.C. Ms. Dresevic practices in all areas of
healthcare law and devotes a substantial
portion of her practice to providing clients
with counsel and analysis regarding Stark
and fraud and abuse. Ms. Dresevic can be
reached at adresevic@thehlp.com.
Carey F. Kalmowitz, Esq. is a founding
member of The Health Law Partners, P.C.
Mr. Kalmowitz practices in all areas of
healthcare law, with specific concentration
on the corporate and financial aspects of
healthcare, including structuring transac-
tions among physician group practices and
other healthcare providers, development
of diagnostic imaging and other ancil-
lary services joint ventures, physician
practice, IDTF and home health provider
acquisitions, certificate of need, compliance
investigations, and corporate fraud and
abuse/Stark analyses. Mr. Kalmowitz can
be reached at ckalmowitz@thehlp.com.
Adrienne Dresevic Carey F. Kalmowitz

On December 1, 2009, the United
States Court of Appeals for the Sixth
Circuit affirmed the conviction of
Ohio anesthesiologist Dr. Jorge A.
Martinez who was charged with illegally
distributing controlled substances, mail
fraud, wire fraud, and healthcare fraud,
including two counts that resulted in the
death of patients.
In 2002, the FBI began investigating
Dr.Martinez’s pain management clinic in
Parma,OHinresponsetoreimbursement
and billing patterns placing him above
his peers for certain procedures. At
trial, the government alleged that from
1998 until 2004, Dr. Martinez engaged
in fraud and endangered patients by
omitting physical examinations of the
patients, ignoring “red flags” of patient
addiction to pain medication, providing
more injections than were medically
necessary or advisable and providing at-
risk patients with treatments that would
likely lead to increased dependence upon
him for additional pain medication. The
government was able to demonstrate
that Dr. Martinez administered far more
injections than his peers (e.g., each of
Dr. Martinez’s patients averaged 64
nerve block injections per year whereas
the state average for pain patients in
Ohio was 2.5 nerve block injections per
year). Moreover, Dr. Martinez saw more
patients per day than other physician in
Ohio, sometimes exceeding 100 patients
during an 8.5 hour timeframe. Witnesses
testified that he frequently spent only 2
to 5 minutes with patients during their
scheduled appointments and performed
little or no physical examination during
these brief visits. The government
also demonstrated that two patient
deaths were reasonably foreseeable
consequences of Dr. Martinez’s course
of treatment which fell far below the
applicable standards of care.
Much of the government’s case
focused on Dr. Martinez’s failure to
comply with the requirements for
billing the highly-reimbursed nerve
blocks he allegedly performed. While
the applicable standards of care
require careful, precise placement of
the injection needle, Dr. Martinez
was seen entering the room, quickly
and repeatedly injecting patients, and
exiting the room—all within a few
minutes. One of the main issues on
appeal concerned the government’s
use of video evidence of a non-witness
physician performing a nerve block
injection in the “proper” manner—
creating a direct visual contrast between
what was labeled as the proper way to
perform the injection and the manner
in which Dr. Martinez performed the
injection. The Appeals Court found
that while the video evidence did
constitute impermissible hearsay, its
admission was harmless in light of
the overwhelming evidence that Dr.
Martinez was not performing medically
necessary procedures and that the
procedures he was performing were not
the same as the ones for which he billed.
In addition to upholding Dr.
Martinez’s conviction, the Appeals
Court also upheld his sentence for
life imprisonment and over $14
million in restitution. The full text of
the case can be found at: http://www.
healthlawattorneyblog.com/U.S.%20
v.%20Martinez.pdf.
Robert S. Iwrey is
a founding partner
of The Health Law
Partners, P.C. in
Southfield, Michigan,
where he focuses his
practice on contracts,
litigation, dispute
resolution, licensure,
staff privileges, Medicare, Medicaid and
Blue Cross/Blue Shield audits and appeals,
defense of health care fraud matters,
compliance and other healthcare related
issues. He may be contacted at (248) 996-
8510 or riwrey@thehlp.com.
6th
CirCuit federAl Court of AppeAls Affirms
ConviCtion of pAin mAnAGement physiCiAn
for overutilizAtion & billinG frAud
Robert S. Iwrey, Esq.
The Health Law Partners, P.C., Southfield, MI

Introduction
Susan Petitt
Manager, Operations
and Client Support, ABC
Customer service is a
reflection on an organi-
zation’s values and be-
haviors, as well as on each individual who
works there. Anesthesia Business Con-
sultants (ABC) embraces the practice and
culture of providing high quality service
to its clients. Effective communications
and interactions are critical to continue to
foster the successful relationships we have
with the more than 8,000 anesthesia and
pain providers we do business with. Our
Western Region staff offer the following
thoughts that can apply to us all:
• Effective listening to our partners’ needs
to ensure we address real issues, while
also working proactively with our part-
ners to maintain strong relationships and
successful results.
• Managing expectations - Understanding
our partners’ expectations of us, while
also clearly communicating our expecta-
tions of our partners.
• Effectively using technology, while inves-
tigating powerful new tools and resources
for greater efficiency internally and in our
partners’ organizations.
• Operating within the philosophy of‘truth
in customer service’. We believe in work-
ing smartly and honestly to instill trust
and alliance with our partners.
Effective Listening
Annie Jaouak
Supervisor, Customer
Service, ABC
Do you really listen? Al-
though we may inter-
change one for the other
in our daily communication, there are cru-
cial differences between listening and hear-
ing. Hearing requires two ears whereas lis-
tening requires both ears and mind. Listen-
ing is work; brain work, and it requires both
sustained and honest effort. “Frustrated”,
“devalued” and “disrespected” are all terms
used to express feelings when we believe
that we have been heard but not listened
to. When we listen we hear with thoughtful
intention to act upon what we have heard.
Additionally, when we actively listen; we
pay close attention to the speaker’s verbal
and non verbal messages. It is this kind of
listening that results in successful and grow-
ing relationships.
Let’s look at some of the most com-
mon causes of non-effective listening.
• It has been said that we have two ears
and one mouth and should use them in
that ratio. A common impediment to ef-
fective listening is that many of us have
conditioned ourselves to fill in the blanks,
surge to the end of a conversation and
conclude a speaker’s thoughts prema-
turely. Doing this shuts down the speaker
and closes off communication.
• Another common impediment is the
non-verbal messages we send. A funda-
mental axiom of communication is also
that we as human beings cannot com-
municate. The impossibility of not com-
municating means that we send messages
even by our absence of intent. Failing to
show up at an event or leaving the room
suggests meanings to others. Because
communication is unavoidable, it is es-
sential that we are continually consider-
ing the unintentional messages we send.
Facial expression, posture, gesture, cloth-
ing, and a host of other behaviors offer
cues about our attitudes.
Those who have acquired the talent of
effective listening have advanced a long way
toward more successful relationships.
Expectations
KD Lowe
Senior Vice President,
ABC
Having worked in hos-
pitals for 19 years and
with physicians for 12
years, and having raised six children with
my wife of 36 years, I have come to appreci-
ate both the danger and value of expecta-
tions. Years ago as I raised my children, I
came to the realization that the majority of
times I felt anger in my life, it was caused by
unmet expectations. I also realized much of
the time those expectations were vague and
undefined, or at least not communicated
clearly to the other party.
We all have expectations of others. Let
me suggest two principles of success tied
to expectations that we should all come to
know.
• Expectations require clarity of defini-
tion. In all our relationships, it is gener-
ally understood that meeting each other’s
expectationsisimportanttoassureagood
relationship. Can we accomplish this if
we don’t understand clearly what those
expectations are? For example, patients
expect high quality, affordable healthcare.
Do we in healthcare understand how
each of our patients might define that?
We may think we do, but experience has
taught me that when I assume that I do,
the risk of being wrong goes way up. Take
the initiative and clearly define your ex-
pectations of others in your own mind,
and in advance, so you are ready when
appropriate to clarify them to others.
• Expectations require communication.
It is also important that at some point in
a relationship, that we take a moment to
communicate with and educated others
on how we define our expectations. Ex-
pectations go both ways, and it is equally
important that both parties understand
Perspectives on Client Service
From ABC Senior Staff

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