July 15, 2019
Many anesthesia providers perceive that they occupy the bottom rung of the medical food chain, that they are captive to so many other departments in the hospital for the factors that determine their income and lifestyle. Anesthesia is the quintessential service specialty. Whatever patient gets scheduled they must manage through the trauma of surgery. Again! When asked if they have any influence or control in the management of the operating rooms, most believe they have none. The problem is that this can be a self-fulfilling proposition.
The reality is that most anesthesia practices do not take full advantage of the tools and resources at their disposal. While it is true that most cannot effect dramatic changes in the scheduling of the operating rooms, the types of patients being treated or the efficiency of surgeons, sometimes one must focus more on gradual and incremental changes. Given the scope of the typical anesthesia practice and its critical role in the overall functioning of a hospital there are always opportunities to influence the strategic planning and business decision-making of the institution. As in so many domains it is just a matter of earning a place in the hierarchy of authority.
What are some good examples of the tools anesthesia practices possess? There are at least three primary areas in which anesthesia plays a unique and potentially influential role in the running of a hospital or healthcare facility. First, anesthesia possesses better data that is more readily accessible about what actually happens in the operating rooms and delivery suites than any other department even when the facility may have implemented a comprehensive electronic medical record system (EMR). Second, anesthesia providers play a more significant role in ensuring a safe and comfortable surgical and obstetric experience than surgeons and obstetricians; amnestics have a very powerful impact on a patient’s perception of reality. Third, because anesthesia providers actually manage patients through the entire peri-operative continuum of care they are acutely tuned into operational inefficiencies and potential solutions to enhance the effectiveness and efficiency of the entire facility.
In today’s medical environment timely and reliable data is critical. Anesthesia has mastered the ability to use data to make critical clinical decisions effectively. The anesthesia record, especially when it is automated, represents an impressive array of critical data elements essential to a dynamic assessment of the patient’s responses to the trauma of surgery and the impact of the drugs and agents being used. It has been said that a patient is at much greater risk driving to the hospital than undergoing anesthesia in the operating room. But the value of the anesthesia database goes well beyond this. Because a department must generate a bill for every case and procedural intervention, its billing department knows exactly when each case starts and ends and how efficiently the operating rooms are being utilized…or not.
Unfortunately too many practices do not take advantage of this invaluable trove of data. However important it is to be appropriately paid for the valuable clinical services performed, this is only one aspect of effective practice management. The utilization metrics mined from this data provide the basis for an invaluable strategic conversation with administration. The key is knowing how to package and present the information so that it is actionable. It is a mistake to assume that hospital administrators have reliable utilization data or that they know how to use it effectively. The anesthesia data opens up a huge opportunity to educate and advise the administration and, we are increasingly seeing good examples of how this can work all across the country.
Pay for performance and quality have become the buzz words of the day. No one knows more about this than anesthesia providers. Many would even argue that it is thanks to advances in anesthesia that the quality of surgical and obstetric care has increased so dramatically over the past few decades. Up until recently, quality was taken for granted but now we are making serious efforts to quantify it more consistently. Clearly anesthesia is on the forefront of these efforts.
The development of a robust clinical database may be seen by many as an unnecessary exercise in compliance but the potential is significant. Not only does the development of clinical pathways make care safer and more effective, but it can also make it more efficient and profitable. We have a perfect example in the use of nerve blocks for the management of post-operative pain. The increased use of nerve blocks takes us to the front line of our dealing with the opioid crisis.
Anesthesia providers are trained to work through clinical decision-trees: if x then y. They are trained to be vigilant in the identification of variances between the desired effect and the actual effect. In other words, they are trained as problem-solvers of the first order. Historically, the focus of the anesthesia provider was that crucible of experience created in the operating room but the time has come to pull back the lens and start to consider the complex set of processes that cause patients to end up in the operating room.
The key to gaining a leadership role in any organization lies in the ability to identify and diagnose problems and implement effective solutions. Often the process starts small but with commitment it can lead to significant results if the administration starts to see and appreciate the value of the contribution. There is no better proof of this than those practices which have achieved a seat on the board of directors for the facility.
It is easy to become overwhelmed by the dramatic changes sweeping healthcare; they can be very disruptive and demoralizing. Let us not forget that one man’s challenge is another’s opportunity. We at Medac are excited about the future of American medicine and the invaluable role our clients can play in shaping the future. If you want to know how we can help you reposition your practice just give your account executive a call. We are here to help you secure your own future.