Anesthesia Associates of Ann Arbor Newsletter

March 29, 2021



2021 looks to bring new opportunity to A4 while at the same time we see the continued impact of COVID-19.


Given the impact of COVID through the majority of 2020, 2019 was used as the basis for developing the 2021 budget. Volume is the common theme that we continue to see almost universally across our sites. Most sites have volume at 90-95% of pre-COVID levels.  


We must be diligent in watching our expenses and making sure staffing is adjusted to volume where possible. This is a critical step so we can manage the bottom line until volume ramps back up.

In 2020, the organization did a good job in managing expenses so we are ready for what 2021 brings. In my opinion, we have done this better than many other organizations within healthcare and outside. It has been tough, but we are starting to see opportunities.


-Greg Bock


Myocardial Injury After Non-Cardiac Surgery

We were honored to have Dr. Daniel Sessler give a lecture on 3/3/2021. For those that participated, we hope you enjoyed the lecture and hope you have some take-aways from the lecture. 

For those that were unable to attend, we are sorry you could not participate live, but we recorded the lecture for all to listen to!


Objective of Lecture:

(1) The incidence, presentation, & mortality of postoperative myocardial injury after non-cardiac surgery (MINS), & the difference between MINS & 4th Universal Definition myocardial infarctions.

(2) The efficacy & safety of potential prophylactic measures & treatments.

(3) The importance of preventing hypotension during & after surgery.



Maria Johnston, CRNA

Toledo Eye Center


Andrew Proctor, CRNA

Center for Digestive Care


Allison Frederick, CRNA

Center for Digestive Care/Forest Health


Michael Chait, MD

Joining the A4 Team at St. Joe Mercy Oakland on July 1, 2021. He is completing his residency at Wayne State University.


Alexandra Taylor, MD

Joining the A4 Team at St. Joe Ann Arbor on August 1, 2021. She is completing her residency at Henry Ford Hospital.

Ian Worden, MD

Joining the A4 Team at St. Joe Ann Arbor on August 2, 2021. He is completing his residency at the University of California.


Joseph Mierzwa, DO

Joining the A4 Team at St. Joe Ann Arbor on August 15, 2021. He completed his residency at Henry Ford Hospital and is completing his Acute Pain/Regional fellowship at the University of Pittsburgh.


David Maerz, MD

Joining the A4 Team at St. Joe Ann Arbor in the fall 2021. He completed his residency at Mount Sinai in New York and his Adult Cardiothoracic Anesthesia fellowship at the University of Pittsburgh.


HR Initiatives

HR implemented a sustainability “green” initiative at the corporate office to reduce our environmental impact/carbon footprint. This includes the reduction of printing material and use of electronic documents over hard copy and increasing the recycling of paper, cardboard, and batteries by providing recycling bins.

We are hopeful that these initiatives will make a difference over time not only on the environment, but on our corporate expenses.


HR conducted engagement surveys to our Physicians, Administrative Staff, CRNAs and NPs. Thank you to all of you that took the time to provide feedback. The information is being reviewed and we will be addressing your concerns in the upcoming months.



Laura Zanchetta HR Director


Steve LeiningerSr. HR Generalist – Onboarding, Payroll, Benefits


Karen KnappCredentialing and Compliance Manager

Cari TurmanPhysician Recruiter – Recruiting for clinical providers including physicians and CRNAs


Brandy Tyson Scheduling Coordinator

As always A4 is hiring and is looking to add new talent to the group. If you have someone that is interested in pursuing opportunities with A4, please have them contact Cari Turman at


Reimbursement Rates:


In 2021, Medicare decreased their fee schedule on Anesthesia payments as well as other specialties. While Medicare was going to decrease payments by 10% in 2021 due to COVID and the loss of revenue providers saw in 2020, they decided to only reduce payments per unit by around 3%.


The new fee schedule for Michigan in 2021 shows a loss of .70 cents per unit in the Detroit region and .68 cents per unit for the rest of Michigan.




During the month of April, the Finance Team will complete a reconciliation of all physician hours and draws received through March 31, 2021. We do this to ensure draws are appropriately set.  Our goal is to identify any physicians in a significant deficit or surplus situation to avoid any surprises for the physician at year end. Every physician will receive a Q1 Reconciliation Summary in late April or early May.


Physicians that appear to be trending in the negative may be contacted to determine if a draw adjustment is necessary or if it's a temporary situation as a result of extended vacation, LOAs, or GAS assignment in Q1 and is expected to correct itself over the coming months. We will work with you to determine the best course of actions.


We will also make the physician aware if they have a significant surplus as they may want to increase their draw or take a one-time extra draw. I know many of the physicians like to get a large lump sum at year end, but we like to keep you aware of surplus amount for tax planning purposes.


Once you receive the Q1 Reconciliation Summary, reach out to Allison Frame ( if you have questions or if you would like to propose any changes in your draw.


A4 has been providing temporary staffing to a Genesis hospital in Zanesville, OH and to an ambulatory center in Novi, MI. This is a great opportunity for staff to visit other facilities to see how they operate and for the A4 name and reputation to spread. We continue to earn more interest than we can accommodate from organizations. 


Please let us know if you are interested in participating in our staffing company - physicians and CRNAs are welcome. 


A4 began providing service at the Toledo Vision Center in Sylvania, OH on March 15. Other opportunities include staffing the Toledo Clinic ASC in Sylvania, OH, McLaren Lapeer Hospital and Dickinson Hospital.