Webinar Discusses Impact of Regional Anesthesia on Quality, Cost and Patient Satisfaction

Hugh Morgan, director of quality assurance for Somnia Anesthesia, and John LaFratta, corporate training specialist, pain management, for B. Braun, recently presented a webinar titled "Impact of Regional Anesthesia on Quality, Cost and Patient Satisfaction: Minor Changes, Immediate Impact."

Anesthesia Quality Under Healthcare Reform

Mr. Morgan began the webinar by discussing how anesthesia will impact cost, quality and satisfaction following the enactment of healthcare reform. He said while anesthesia has acted as a "pioneer of sorts" in patient safety and quality, it has only been eight years since hospitals started reporting anesthesia-related measures to Centers for Medicare and Medicaid Services (CMS). He discussed the progression of anesthesia compliance since 2003, including the introduction of a CMS Physician Quality Reporting Initiative that included two anesthesia measures in 2007 and the inclusion of anesthesia in the CMS Conditions of Participation in 2010.

In July 2011, CMS will begin its value-based purchasing program, which will capture measures based on prospective claims data. The implementation of this program will tie anesthesia outcomes to hospital revenue and reward hospitals for improving quality in anesthesia services.

Mr. Morgan said for the next five years, CMS has given high priority the prevention of avoidable complications that result in increasing costs and projected $100 million in savings on hospital-acquired conditions. In addition, CMS Conditions of Participation will be enforced through Joint Commission and State Department of Health surveys. At the same time as they comply with these "known" regulations, however, hospitals must grapple with the unknown — namely the relationship between accountable care organizations and anesthesia. Mr. Morgan predicted that accountability, transparency, market-sensitive costs and partnerships will be essential to the success of anesthesia programs under ACOs.

Impact of Regional Anesthesia Program on Cost, Quality and Satisfaction
In light of the increasing need for cost savings and quality improvements, Mr. LaFratta addressed the question, "How can a medical device supplier help support healthcare quality, cost containment and satisfaction?" He said as hospitals meet the era of ACOs and increasing transparency, partnership with a quality supply partner is essential for success. A good supply partner can assist a provider in the ongoing search for cost reductions and ways to improve patient outcomes.

He said in order to improve quality, hospitals and other providers should ask themselves, "Is regional anesthesia safer than what I am doing today?" He explained that rates of deep vein thrombosis, surgical site infections and catheter-related UTIs are significantly lower when facilities use regional anesthesia as opposed to opioids. Regional anesthesia can also help prevent pain, post-operative nausea and vomiting and other undesirable side effects, decrease over-utilized time, nurse interventions and use of "rescue drugs" and improve throughput, time to discharge and other factors that impact length of stay.

As healthcare providers are well aware, length of stay has a direct impact on hospital profits or losses, and providers should take steps to decrease length of stay in order to cut costs, Mr. LaFratta said. According to Mr. LaFratta, pain and post-operative nausea and vomiting are the top two reasons for extended PACU stays. The cost of PONV can erode profits up to 89 percent per case, adding up to $57,708 in cost per year. The cost of pain can erode profits up to 54 percent per case, resulting in $45,360 in additional cost per year.

Mr. LaFratta also pointed out that regional anesthesia can impact patient satisfaction and thereby affect the provider's reputation in the community. He said in a survey that assessed "patient likelihood to repeat/refer" their provider, 70 percent of patients cited "how well pain was controlled" as a factor that influenced referrals or repeat visits. This was the second most-common answer, following "staff worked together for care."

Why Anesthesia Providers Must Choose High-Value Suppliers
According to Mr. Morgan and Mr. LaFratta, anesthesia operational costs of care can be broken down into three basic groups: anesthetic gases (volatile agents), anesthetic drugs and anesthesia supplies. Gases represent around 30 percent of total anesthesia operational costs, while drugs represent 20 percent and supplies represent another 20 percent. These costs can be affected by various factors, including:

• Supply knowledge, availability and preference
• Provider competency training
• Provider competency assessment

Despite the effect of anesthesia providers on cost of anesthesia operations, a study by the Advisory Board Company found that only 54 percent of hospitals have policies and procedures in place to evaluate competency of anesthesia providers. Only 53 percent of hospitals have installed a formal process for raising performance of physicians falling out against measures.

According to Mr. Morgan, the "CMS Guiding Principle of Reform" suggests that substandard care combined with poor outcomes leads to increased costs. He says this principle applies to anesthesia: For example, an infected labor epidural leads to unnecessary increased length of stay and increased costs.

Mr. Morgan and Mr. LaFratta explained that because anesthesia affects many areas in a medical facility, reducing anesthesia cost and improving quality can have a tremendous impact on overall cost, satisfaction and outcomes. In order to improve quality and reduce cost, anesthesia providers should continuously track, record and analyze data, internally profile physician performance and outcomes and align their measures with those published by the American Society of Anesthesiologists.

Developing an "Accountable Anesthesia Organization"

According to Mr. Morgan, an "accountable anesthesia organization" acts as a transparent, collaborative partner in the delivery of high-quality anesthesia care. The AAO transitions a facility from an old "silo" model, in which care is episodic, anecdotal and independent, to a new "connected" model, in which care is integrated, quantifiable and interdependent.  

The AAO includes on-site clinical and non-clinical leadership that work to align the AAO's goals with the facility's goals; existing IT infrastructure and ability to document policies and procedures; benchmarks that assess how the AAO is performing; centralized scheduling; patient surveys and outcome tracking; and a process to capture data.

To download the presentation, go here.

Learn more about Somnia Anesthesia.
Learn more about B Braun.

Related Articles on Anesthesia:
Automated Alerts May Increase Anesthesiologists' Use of Low Tidal Volume
ASA Joins Obama Administration's 'Partnership for Patients'
10 Recent Anesthesia Findings

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