Discussion With Anesthesia Physician and Entrepreneur

-->April 14, 2017Magazine

    Guest Author: Dvid E. Bergman, DO, Chief Executive Officer, Epreop, Inc.


    When and why did you start ePreop?

    It was 2008 and I was an anesthesiologist within St. Joseph Health. I had a large number of patients who were not being fully optimized, and there were significant issues that would subsequently appear on the day of surgery. Things like case delays and cancellations, and either unnecessary or missing preoperative tests were a daily occurrence. There are a lot of reasons these things happen: fear of liability, concern over a delay or cancellation, and lack of clarity or awareness around what is required are just a few. These problems still occur at most facilities across the country. The end result is a poor patient experience and provider dissatisfaction. Luckily, St. Joseph Health is a really forward thinking organization and they emphasize “Patient Respect” as one of their core principles. When I brought them the idea of standardizing the patient experience for surgery to eliminate these problems, they were quickly engaged.

    Can you describe any challenges and rewards from starting the company?

    We needed to provide guidance within the workflow. Any process improvement had to decrease provider burden, and that meant we needed integration with their electronic health record. We actually ended up integrating with their Allscripts, Picis, and MEDITECH systems in order to provide guidance at each step of the process. We were able to deliver accurate patient instructions and appropriate testing recommendations to our patients. We decreased avoidable cancellations by over 80% while decreasing total preoperative testing by nearly 70%. Most importantly, the patient now knows exactly what to do with their medications and procedure preparation.

    What is your company’s focus today?

    Our integration strategy has served us well over time, and we are now integrated with almost every major EHR, including Cerner and Epic. We provide an expanded set of surgical care coordination tools, and we also focus on helping anesthesia groups meet MIPS and MACRA requirements. We provide a large number of services directly to these anesthesia groups that are intended to help them with things they see in their daily practice. Last year we partnered with the American Society of Anesthesiologists and are working closely to help groups and advance the specialty.

    How do you see quality reporting progressing with the new administration?

    First, it is clear Dr. Price understands the burden that has been placed on physicians over recent years. I imagine he will be focused on ways to ease this administrative burden, so physicians can focus on care. This is in line with our company mission. It is a balance; we need quality and outcome data, but we want to be sure we are capturing the right things. Many of the quality and value-based initiatives fall underneath MACRA, which was passed with an overwhelming 92 to 8 vote in the senate. It is different than the Affordable Care Act and, regardless of what the replacement act contains, we see a consistent move toward value-based care.

    As a company focused on meeting CMS quality mandates and value-based care models, what advice would you give to anesthesia groups?

    Anesthesia practice is under a lot of pressure today. More facilities are conducting RFPs, and this trend will continue. The administrative requirements are increasing. Consolidation has had a huge impact in recent years and is still growing. These large groups all articulate the MACRA quality and value-based care vision when speaking with hospitals and competing in RFPs. Many small-mid-size groups are still trying to determine how it all fits. Most of the anesthesia groups seem to fall into strategies of either trying to hold onto their current contracts, merging with similar entities to get bigger, or trying to make themselves attractive for an acquisition with one of the national groups. The pressure will only increase in the coming years, and there are some basic steps they can start taking. Group leaders need to learn how to articulate the value-based care vision, show their groups’ quality, have access to the outcome data, and act as partners with their facilities. The last one seems obvious, but hospitals and health systems need help today. Groups should be engaging and offering ways to help well before an RFP comes to the table. The hospital’s executives also see uncertainty with change, and having an engaged anesthesia group to lead the perioperative initiatives is invaluable.