Making the leap from fee-for-service to value: Q&A with NAPA's Dr. Vincent Vilasi

With the healthcare industry undergoing change at breakneck speed, hospitals and health systems are faced with the choice of adapting quickly or being left out of the equation. Administrators who are agile and have the ability to come up with creative, innovative solutions to stay ahead of the curve are the ones who will successfully lead their hospitals from a fee-for-service to a value-based world.

At the Becker's Hospital Review Annual CIO and CEO Roundtables in Chicago, Nov. 4 and 5, a number of hospital and health system leaders came together to discuss how they are dealing with the transition from fee-for-service to value.

Vincent J. Vilasi, MD, MBA, CEO of North American Partners in Anesthesia's Mid-Atlantic division, discusses the session and his thoughts regarding the future of the health care industry.

Question: What do you think is biggest takeaway from the roundtable session?

Dr. Vincent Vilasi: We're in the midst of a difficult time as we transition from fee-for-service to value-based services. The reimbursement systems are moving from reimbursing on a volume basis to paying for value, which focuses on incentives related to quality, outcomes, exceptional patient experience and cost reductions. Incentives will now make up a portion of physician compensation. It used to be that only bonuses were at risk, but now base compensation is part of the equation as well. To further reinforce this model, hospitals are implementing specific quality scorecards to measure performance standards.

Another important aspect that these hospital leaders are concentrating on is keeping the operating room busy. The OR is the economic engine of the hospital and typically delivers more than half of the hospital's profit. It is essential that we cater to our customers to deliver a high quality experience. This not only includes patients but our surgeons as well.

The last key takeaway from the session was the power of utilizing technology to completely break the mold and make a quantum leap forward. Implementing technology improves the level of safety, customer service and efficiency that can be delivered in the OR. This is an area where NAPA has helped hospitals achieve great success by implementing our proprietary remote video auditing program, Peak Performance2, which audits compliance with sign-in, timeout and sign-out protocols. This process improves throughput leading to the creation of new revenue opportunities for hospitals and ASCs.

Q: In your opinion, what are some of the most interesting practices hospital and health system leaders are implementing to assist the shift from fee-for-service to value-based care?

VV: Among the interesting practices were bringing preoperative testing in-house. A hospital leader discussed how this practice resulted in a decrease of cancellations and delays leading to enhanced patient satisfaction levels in addition to cost reductions in lab expenses. Another leader shared the concept of ghost scheduling for OR block time, serving as a solution to match growing surgical demand without adding substantial incremental resources.

Q: Are there areas healthcare leaders are neglecting that are important to ensure a smooth transition?

VV: Not many hospital and health system leaders spoke about bundled payments or capitation at the session. On the East Coast, we aren't quite as far down the road on that front as healthcare organizations are in California. They did speak of the need to establish a partnership between the OR staff and the anesthesia team with the physician chair of anesthesia leading the cultural change on the ground daily. This concept is not employed in many organizations around the country today, particularly within anesthesia groups that see their role solely centered around patient care.   

Q: How important is the implementation of technology for this transition?

VV: If you look at what we have been able to do with technology in the last 10 to 15 years, it's amazing. However, in healthcare the adoption has been much slower than in the business world. If we look to technology as a solution, it plays a central role in addressing a number of issues such as access, value and cost. It's increasingly being incorporated into almost all processes from patient registration to data monitoring and beyond. Ultimately, this streamlining of access to data and analytics will serve as a strong catalyst for clinician engagement as we move to value.

Read more about change management, particularly as it relates to the perioperative service line, here.

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