Anesthesia groups face a far different world today than the one that existed just 10 years ago. Fading fast is the stability of evergreen hospital contracts, the financial security of comfortable stipends and the long-standing, industry-wide expectation of limited physician duties beyond the provision of anesthesia care and services.
In the new healthcare paradigm, successful anesthesia groups realize they must significantly expand the scope of their responsibilities to encompass more facets of operating room management. At the same time, they are -- or should be -- continually looking for new ways to deepen, extend and strengthen their hospital partnerships.
"Hospitals expect more from their anesthesia groups than ever before," said David Platt, specialty vice president, anesthesia, for McKesson Business Performance Services (McKesson). "For groups to thrive in this environment, they’ve got to meet or exceed those expectations and become true partners to hospitals, not merely isolated, siloed service providers."
Platt said the transformation underway in anesthesiology reflects many factors, not the least of which is the ongoing cost pressure unleashed by healthcare reform and the slow but steady shift to value-based purchasing. Anesthesiologists also are feeling the effects of a long-term physician supply-and-demand dynamic, Platt said.
In the early 2000s, an anesthesiologist shortage led many hospitals to begin paying significant stipends in order to guarantee coverage and help ensure that groups could meet desired income targets. Over time, however, the lure of this additional compensation pulled more residents into the specialty and prompted a sharp rise in Certified Registered Nurse Anesthetist (CRNA) positions. In addition, national anesthesia management companies began competing for hospital service agreements held by smaller private anesthesia groups.
The national firms focused on hyper-efficient staffing models and consequently were often able to undercut existing practices by foregoing some, if not all, of the stipend, Platt said. Today, established anesthesia practices that rely on stipends find themselves more exposed than ever as competition and cost pressures continue to mount, he added.
"First and foremost, hospitals want self-sufficient groups," he said. "What that means is that the vulnerability of the group increases as the stipend goes up." As a result, he said, practices must closely examine their overall business operations and revenue cycle management to identify opportunities for improving efficiencies and reducing costs.
More broadly, groups can enhance their value to the hospital and strengthen their incumbency by taking greater responsibility for operating room (OR) management and by seeking out other opportunities to boost hospital operations.
"The more you’re involved with your hospital, the less likely they are to put the contract out to bid," Platt said. "You don’t want that to happen, because when an anesthesia contract goes out to bid, roughly 50% of the time, in our experience, it results in a change in the provider."
Platt said groups are optimally positioned to more effectively coordinate between surgeons and anesthesiologists in order to minimize OR downtime and generate more consistent throughput. OR management also can include taking responsibility for surgery scheduling, as well as overseeing the spectrum of peri-operative services and care, from managing the patient pre-assessment process to medication management to post-operative care and discharge planning.
“The anesthesiologist is the one common element you have in the operating room, so they are ideally suited to making sure the process runs smoothly,” he said.
At some hospitals, anesthesiologists also are playing an important part in quality assurance by tracking surgical outcomes. They can likewise be a vital resource for improving patient satisfaction by helping patients recover faster and experience less post-operative pain, Platt said.
Measuring and documenting group performance across metrics like patient and surgeon satisfaction, OR turnaround time, patient outcomes, conformity to best practices and other factors is vitally important in demonstrating the group’s track record and success to the hospital, Platt added.
Broader hospital engagement
In addition to playing a greater role in the operating room environment, Platt said, groups can boost their value to the hospital by seeking out other opportunities to have a positive impact on operations. That means getting involved in anything from medical directorships to quality assurance committees, he said.
“Be on as many committees within the hospital as you can; try to become an integral part of the hospital’s fabric,” Platt said. “The idea is to make yourselves be as indispensable as possible.”
"Not only will you enhance the reputation of the group, but you’ll be in communication with a variety of people in the hospital. Among other things, this will help you keep tabs on developments that could affect the anesthesiology department. Like the old saying goes, `if you’re not at the table, you’re on the table."
Platt added that groups shouldn’t expect the healthcare environment and anesthesiology to return to the relatively comfortable ways of the past.
“You can maintain a reasonable salary, but it’s going to take a lot more participative management,” he said. “You can’t become complacent and expect to just care for patients in an ideal environment provided by the facility. Instead, the anesthesia providers must contribute toward optimizing that environment. That’s the world we live in now.”