Re-Imagining the Anesthesia Care Model

Disruptive innovation is all the talk in healthcare today. You’d be hard-pressed not to see a headline or 10 in your daily reading about how some new mobile application or alternative delivery model promises to transform the way healthcare services are provided to patients.

It’s not difficult to see why everyone is pursuing ideas that will disrupt the status quo. The status quo is expensive, and it’s certainly too expensive for the value it’s delivering to patients and payers.

Anesthesia services are no different. Anesthesia services today have never been safer. Access to safe anesthesia services has never been greater. But their cost makes anesthesia services fertile ground for transformation. The challenge for innovators and entrepreneurs is to develop disruptive innovations that continue to provide access to safe anesthesia care but do so in the most efficient and productive manner possible.

I would argue that one of the most effective ways to transform anesthesia services is re-imagining the anesthesia care model. To understand why, let’s start with a bit of living history. On the conservative edge of our profession is the traditional view that anesthesia services should be provided and overseen solely by physicians—the anesthesiologists. On the liberal edge is the non-traditional view that anesthesia services should be provided and overseen solely by nurses—the certified registered nurse anesthetists, or CRNAs. Some would describe the situation as an all too typical economic turf war between licensed healthcare professionals that’s plagued the U.S. healthcare system for years.

The truth lies in the center of the debate, and at the center should be patients. The needs of patients should drive the composition of the anesthesia care model at a specific hospital or ambulatory surgery center in a specific community. What are the demographic and clinical characteristics of the facility’s patient population? What surgical services does the facility provide to that patient population? What intensity of anesthesia services is required to provide access to safe surgical care for those patients at that facility at the lowest possible cost? It’s about qualifications, not credentials.

If those criteria determine the composition of a facility’s anesthesia care model, the model can take many forms, not just the two espoused by the polarizing factions in our profession.

At NorthStar, for example, our anesthesia care models at our sites fall into five different types, each with a different mix of physicians and nurses. We have some made up of all anesthesiologists. We have some made up of all CRNAs. The other three models are at some point in between, depending on their ratio of anesthesiologists to CRNAs.

Tailoring the size and composition of the anesthesia care model to the specific patient population at a specific facility in a specific community is the disruptive innovation that will transform our profession. When that happens, we will be able to continue to provide access to safe anesthesia care and do so in the most efficient and productive manner possible.