Seeing Beyond the Operating Room

Welcome to NorthStar Anesthesia’s new blog. My name is Brian Woods and I’m NorthStar’s chief medical officer. I look forward to being a regular contributor to this column as do other NorthStar-affiliated anesthesiologists, certified registered nurse anesthetists, and anesthesia services experts.

The goal of this blog is to provide insight and add perspective to the myriad of financial, clinical and regulatory issues affecting medicine generally and anesthesia specifically. This is about our field and how we should think about it in the context of all the issues affecting our future.

I attend many conferences and events throughout the year and do a fair share of public speaking. One of the most frequent questions I get asked after presentations and during breaks is what I think is the biggest healthcare issue or trend impacting the field of anesthesia. Without a doubt, the No. 1 issue is cost. The desire and need to bend the cost curve is creating downward pressure on reimbursement, and that pressure is manifesting itself in financing models that fix payments, reduce payments or put payments at risk.

If you’re running a hospital or an ambulatory surgery center, the natural business response to this reimbursement pressure is to look at your cost structure. If revenues are put at risk, surely the only way to maintain margin is by controlling or reducing expenses. A big part of the required self-examination is asking: Who are we paying? How much? And what exactly are we paying for and getting back for our money?

Those are three questions that clinicians who provide anesthesia to hospitals or ASCs must answer today in a positive, solution-oriented and enterprise-wide way. Historically, many anesthesiologists and CRNAs may have thought they didn’t even have to answer these questions let alone respond appropriately. They defined the totality of their job as entering the operating room, administering and monitoring anesthesia, exiting the operating room and getting paid a subsidy while collecting professional fees.

Today’s anesthesiologists and CRNAs must see beyond the operating room. They must see themselves as important contributors to the overall clinical and financial success of facilities they work in and as essential components and leaders of the overall patient experience.

One way anesthesiologists and CRNAs can fulfill that expanded role is by contributing to the efficiency of business operations while in the clinical operating rooms—efficiency in time and materials. In terms of time, we’re talking about things like correct and medically necessary pre-operative testing to avoid delays and cancellations, appropriate scheduling, matching manpower to ever fluctuating clinical needs, clean clinical documentation and timely billing.

In terms of materials, we’re talking about becoming judicious users of resources like pharmaceuticals, IV catheters, anesthesia gases, epidural and central line kits. Anesthesiologists and CRNAs must demonstrate their value to their hospitals and ASCs by doing their part to reduce costs, and giving sight to the willingness and ability to be good stewards of the facilities resources.

As bundled payments, outcome-based care and other value-based reimbursement systems focus their attention on patient experience as a key performance metric determining hospital or ASC payments, anesthesia must show the ways we can help their cause.

For example, Medicare’s Hospital Value-Based Purchasing program includes doctor-patient communication, hospital staff responsiveness, pain management and patient medication education as variables in its payment formula.

A new day is here and the question is no longer if clinicians who provide anesthesia can influence those four variables but how can we help? The new playing field in healthcare is being forged by cost pressures and new reimbursement schemes and demands that anesthesiologists and CRNAs see themselves in this new role. And it helps if they work on a team that encourages them to flourish in their new role.

Do you have the right vision to make it happen? Write me at [email protected]  and let me know what you think.