Bridging the Gap Between Hospitals' Needs and Anesthesia's Capabilities

In this era of accountable care, healthcare providers are forced to work closer together to achieve efficiencies and coordinate care to improve quality. Integrating physician groups with hospitals — parties which historically have not had a close relationship — can be challenging for healthcare leaders. One of the barriers to full integration and successful collaboration stems from a lack of communication between the two groups. A lack of communicating can result in a mismatch between the hospital's and physician group's expectations and abilities, which can create conflict. This mismatch may be particularly challenging when it involves anesthesia teams, because they are key providers in the hospital's operating room, which can be a driver of hospital revenue and costs. Robert Stiefel, MD, and Howard Greenfield, MD, principals of Enhance Healthcare, explain how hospitals can create a closer and more productive relationship with their anesthesia group by aligning needs with capabilities.

Hospitals' needs and expectations

As hospitals are under mounting pressure to increase quality and reduce costs, they need to establish systems to monitor and improve quality metrics and identify areas to cut costs. Hospitals are thus increasingly expecting their anesthesia teams to provide what Drs. Stiefel and Greenfield call "value-added services" — services beyond anesthesiologists' intraoperative care. Here are three needs of hospitals and the accompanying value-added services hospitals expect anesthesia teams to provide.

1. High HCAHPS scores. In the future hospitals will become more accountable for patient satisfaction, measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. In CMS' Value-Based Purchasing Program, hospitals' HCAHPS scores will be one of the metrics that decide hospitals' portion of shared savings. Many hospitals expect anesthesiologists to enhance patients' experience by ensuring an efficient transition from pre- to peri- to postoperative care and by providing postoperative pain management.

2. Efficiency. Hospitals need to find ways to decrease costs and increase revenue to balance reduced reimbursement. Improving efficiency in the operating room and improving patient flow can result in increased patient volume and the associated revenue. Many hospitals expect anesthesiologists to help optimize OR utilization by ensuring cases start on time, reducing turnaround time and making changes to the daily schedule as needed.

3. Competitive edge. Hospitals also need to be competitive to gain and retain market share. One way many hospitals try to meet this need is by opening additional anesthetizing locations, regardless of the existing OR's capacity. Hospitals often expect anesthesia providers to staff more OR locations while maintaining their performance at existing sites of care.

Anesthesia's capabilities
While anesthesia providers can provide many value-added services to hospitals, they are often not compensated for these services, according to Drs. Stiefel and Greenfield. "The challenge is hospitals are increasingly held accountable and have hard dollars at stake related to some of the outcomes of value-added services," Dr. Stiefel says. "It's an area where anesthesia providers find themselves being asked [to provide] escalating levels of intensity of services, and they're finding that that comes with a significant incremental expense with little incremental revenue."

1. Increase patient satisfaction. Anesthesiologists can affect patients' satisfaction by overseeing preoperative preparation, ensuring the patient understands the process for the day of surgery and managing postoperative pain.

2. Drive efficiency. Anesthesiologists can drive efficiency as directors of perioperative care. They are well-placed to fill this position as they are constantly in the OR and are familiar with all the processes. They can establish policies to increase the rate of first-case on-time starts, manage the board to optimize scheduling and implement best practices to shorten turnaround time.

3. Provide a competitive edge. Anesthesia can provide hospitals a competitive edge, but in order to be financially viable, may not be able to staff as many anesthetizing locations as hospitals want. Adding new OR sites without concurrently adding more anesthesia staff can be unfeasible. "Many hospitals are requiring anesthesia groups to cover more services than they are able to presently cover," Dr. Greenfield says. "Hospitals have a big disparity between their wants and needs in coverage, and often hospitals have to be really careful to evaluate their own OR function, structure and utilization and understand that in many cases they need to pay for the extra capacity that they want." Instead, anesthesia providers can make the hospital's OR competitive by driving efficiency, because an efficient OR attracts more surgeons and more patients.

The bridge: Communication
Regular communication between hospital administration and anesthesia leadership is essential to aligning hospitals' needs with anesthesia providers' capabilities. "Both parties need to come together and bridge the gap between the needs and requirements of the hospital and the realities from a financial and resource perspective of anesthesia groups," Dr. Stiefel says. Hospitals need to understand anesthesia providers' operational and financial constraints, while anesthesia groups need to understand the regulatory and market pressure hospitals face.

Dr. Greenfield recommends monthly meetings with key stakeholders, such as OR nurses, surgeons, anesthesiologists and hospital administrators, to understand each other's needs, expectations and capabilities. "Meeting face-to-face with hospital leadership is incredibly important," Dr. Stiefel says. "Often they meet only when there's a problem. It makes more sense to be proactive and identify problems ahead of time."

Through open communication, hospital leaders and anesthesia providers can align incentives so the anesthesiologists are rewarded for meeting the hospital's expectations. "Both sides need to work to try to understand the issues that the other is facing and realize that each party can't survive without the other. They need to develop mechanisms to be more efficient and identify goals and a common direction," Dr. Greenfield says.

Linking value-added services to specific metrics can help hospitals measure anesthesiologists' performance of these services and determine whether the hospitals' needs were met. For example, the OR can measure first-case delays, all case delays and cancellations, which should reflect anesthesiologists' performance in overseeing preoperative preparation and meet hospitals' need for efficiency and competitiveness. The OR can also measure turnover time and HCAHPS scores or patients' pain levels, which are affected by anesthesiologists' postoperative pain management and meet hospitals' need for high patient satisfaction.

More Articles on Enhance Healthcare:

Hospitals' Top 10 Expectations of Anesthesia Groups
5 Steps for Anesthesia Practices Preparing to Sell

How Anesthesia Staffing Can Affect OR Utilization

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