F-O-C-U-S: 5 Key Factors of Anesthesia Success

Howard Greenfield, MD, and Robert Stiefel, MD, principals of anesthesia and perioperative consulting firm Enhance Healthcare, discussed the benefits and challenges of a co-managed anesthesia model as an alternative to outsourcing anesthesia services in a recent webinar presented by Becker's Hospital Review.

In the webinar, titled "Anesthesia Contract Costs Have You Sweating? Stay Cool With a New FOCUS on Anesthesia Employment," Drs. Greenfield and Stiefel presented a new framework hospitals can use when thinking about anesthesia services. The framework they described uses the acronym FOCUS. The approach outlines five key factors affecting the success of operating room performance and how anesthesia plays a significant role. The FOCUS areas are financial, operational, clinical quality, utilization and strategic integration. This model can help hospitals predict the value of employing an anesthesia group in light of health reform legislation that is pushing the industry toward increased quality and efficiency and reduced costs.

Financial: What is the direct cost of anesthesia services?

One question hospital leaders should ask when evaluating anesthesia is "What is the direct cost of anesthesia services?" according to Dr. Stiefel. He says approximately 80 percent of hospitals pay an anesthesia subsidy. While subsidies remain a significant expense for hospitals, Drs. Greenfield and Stiefel have seen subsidies begin to level out and in some cases decrease in the last few years.

An employed anesthesia model can offer greater transparency, the control of key expense drivers and the opportunity for revenue cycle optimization. Under an employment model, hospitals can more easily align their goals with those of the anesthesiologists and create incentives for meeting common goals. For example, rewarding anesthesiologists for an increase in first case on-time starts can allow the hospital to schedule more cases, generating increased revenue.

In a case study Dr. Greenfield presented, a three-hospital system with 30 anesthetizing locations in the Midwest realized a 12 percent revenue increase from contracting and an 8 percent revenue increase from billing improvements after they moved from an outsourced anesthesia model to a model of employment co-managed by a service line expert. In addition, the system saw a 5 percent decrease in anesthesia expenses and a 30 percent decrease in subsidies paid to the anesthesia team. The hospital achieved these improvements by linking anesthesiologists' compensation to quality and performance and renegotiating payor contracts, among other changes.

Operational: Is anesthesia a net positive or a net negative relative to driving cases to or from the facility?

"The ability of anesthesia to attract or repel cases can have very large financial implications for the hospital," Dr. Stiefel says. In an employed model, anesthesiologists can have more clearly defined leadership roles and align goals to increase surgical cases.

In the case study, when the hospital redefined anesthesia physician leadership and aligned the OR and hospital on goals of patient safety, surgeon satisfaction and quality, the anesthesiologists were able to spend more time running the board and providing value-added services in the management of the service line.

Clinical quality: Does the anesthesia group strive for consistency?

Standardized practices in the OR can lead to improved outcomes, while inconsistent practices can cause delays and reduce OR efficiency. In an employed model, the hospital can develop a common quality improvement/quality assurance program through alignment between the hospital and the anesthesia group and incentives for reaching quality benchmarks.

In the case study, the hospital put more emphasis on postoperative pain management and implemented an anesthesia-specific outcome tracking module to enhance quality. These changes resulted in improved performance in quality metrics and in patient and surgeon satisfaction.

Utilization: How does the anesthesia staffing model affect OR utilization?

The anesthesia staffing model can significantly affect OR utilization through its ability to appropriately allocate resources for each step in OR processes. Anesthesiologists' efficiency in PAT, on-time starts and postoperative pain management all influence OR utilization. In a co-managed employment model, a hospital can develop analysis tools to conduct an ongoing assessment of utilization to identify and target areas of inefficiency.

The hospital in the case study restructured its staffing model to increase the number and scope of CRNAs, which allowed the hospital to increase OR utilization. Specifically, this new staffing structure resulted in improved OR throughput, a 15 percent increase in on-time starts and an 8 percent increase in prime time utilization.

Strategic integration: Is the anesthesia group a true partner to the hospital in pricing, strategy and attempting to move the OR in a positive direction?

Anesthesiologists are involved in OR processes from beginning to end, having an integral role in PAT, intraoperative care and postoperative pain management. In a co-managed employment model, hospitals can include anesthesiologists in OR governance so they play a key role in OR decision-making and can guide the OR strategy.

In the case study, the hospital restructured its governance to include a professional anesthesia practice manager reporting directly to the hospital COO, which allowed anesthesia to help direct a multidisciplinary integrated OR initiative.

"A hospital employed anesthesia model encourages all stakeholders to move in the same direction to synchronize the OR," Dr. Greenfield says.


Download a copy of the presentation by clicking here (pdf).


Download a copy of the presentation by clicking here (.wmv).

More Articles on Enhance Healthcare:

6 Strategies for Improving OR Performance Through a Hospital-Employed Anesthesiology Model
6 Steps for Anesthesia Practices Considering Selling

How Preoperative Preparation Can Drive OR Performance

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