Anesthesia providers in surgery centers should be involved in efforts to realize cost savings while maintaining a high level of quality.
Neil Kirschen, MD, is the chief of pain management in the department of anesthesiology at South Nassau Communities Hospital in Oceanside, N.Y., and the medical director for the Pain Management Center of Long Island in New York. He is board-certified in anesthesiology, pain medicine, acupuncture and massage therapy. He has practiced anesthesia for more than 28 years.
Dr. Kirschen contracts with an ambulatory surgery center, where he has worked to eliminate inefficiencies and work as cost-effectively as possible without compromising safety.
Here are Dr. Kirschen's five tips for cutting anesthesia costs in ASC.
1. Prevent anesthesia side effects. Patients experiencing side effects to anesthesia can be a major driving force behind anesthesia costs in ASCs, Dr. Kirschen says. When patients experience side effects, such as nausea and vomiting, they require additional care and cannot be discharged as quickly.
"You need to treat them and visit them more frequently in the post-anesthesia recovery room," he says. "You also need to use different medications that can be rather expensive to counteract the nausea."
Anesthesiologists in ASCs should work to prevent side effects in order to reduce time in the PACU and move cases along more quickly. Dr. Kirschen recommends using minimal amounts of opioid narcotics for pain relief and opting instead for sedative hypnotics and prophylactic antiemetics.
"Preempting is the best way to hand those situations," he says. "Certain surgeries are notorious for causing nausea, such as gynecology and cosmetic procedures. Treat those patients properly and avoid side effects later on."
2. Move cases through quickly. Patient must be prepped, treated and discharged efficiently to get the maximum number of cases through the surgery center, resulting in maximum revenue. The speed of discharge often depends on how quickly an anesthesiologist works.
Anesthesiologists must be accustomed to working in ASCs because the process is different than in inpatient settings, Dr. Kirschen says. ASC patients require different techniques for faster discharge, such as more local anesthesia injections and nerve blocks. Short-acting sedatives should also be timed for the length of the procedure.
"As soon as a procedure is over, a patient should be waking up and ready to have a conversation," he says. "Proper pain killers allow a patient to ambulate sooner and be discharged and more street ready than in a hospital."
He stresses the importance of moving cases through quickly. "You can't bring another patient into the recovery room if all the beds are filled. Timing needs to be such when cases are going in, patients are being discharged."
3. Schedule efficiently. Dr. Kirschen recommends assigning specific anesthesiologists to cases depending on how quickly a specialist can turn the case over.
Splitting up staff members can also increase efficiency. If you have staff members who are not as quick at turning over cases, assign them to stay with and monitor a patient. Assign faster personnel to prep the next patient and more quickly rotate cases through.
"Assign an anesthesiologist who is equipped for a quick turn over of cases," Dr. Kirschen says. "Choose the appropriate personnel to move the most quickly."
4. Create an environment of cost awareness. Anesthesiologists are typically trained to be cognizant of costs, Dr. Kirschen says, but not all physicians are inclined to think in this vein.
"We [anesthesiologists] have been brought up to try to be conservative in our use of equipment," he says. "Surgeons are not always as cognizant of how much things cost."
Working to create a cost-conscious environment can encourage other surgeons and staff members to look more closely at what is being spent. Anesthesiologists can set a good fiscal example in their ASCs by getting the most use out of equipment and stretching dollars.
5. Cut costs only in appropriate areas. Major anesthesia equipment savings are often hard to come by without compromising safety. Rather than looking in places where costs shouldn't be alleviated, focus on getting more cases each day through the center, Dr. Kirschen says.
He encountered an ASC that wanted to use less of the expensive oxygen tubing, but he put his foot down because the supply is necessary for proper care.
"Patient safety is never compromised," he says. "Make up for it by working faster and allowing more cases through. Never compromise patient safety."
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Neil Kirschen, MD, is the chief of pain management in the department of anesthesiology at South Nassau Communities Hospital in Oceanside, N.Y., and the medical director for the Pain Management Center of Long Island in New York. He is board-certified in anesthesiology, pain medicine, acupuncture and massage therapy. He has practiced anesthesia for more than 28 years.Dr. Kirschen contracts with an ambulatory surgery center, where he has worked to eliminate inefficiencies and work as cost-effectively as possible without compromising safety.
Here are Dr. Kirschen's five tips for cutting anesthesia costs in ASC.
1. Prevent anesthesia side effects. Patients experiencing side effects to anesthesia can be a major driving force behind anesthesia costs in ASCs, Dr. Kirschen says. When patients experience side effects, such as nausea and vomiting, they require additional care and cannot be discharged as quickly.
"You need to treat them and visit them more frequently in the post-anesthesia recovery room," he says. "You also need to use different medications that can be rather expensive to counteract the nausea."
Anesthesiologists in ASCs should work to prevent side effects in order to reduce time in the PACU and move cases along more quickly. Dr. Kirschen recommends using minimal amounts of opioid narcotics for pain relief and opting instead for sedative hypnotics and prophylactic antiemetics.
"Preempting is the best way to hand those situations," he says. "Certain surgeries are notorious for causing nausea, such as gynecology and cosmetic procedures. Treat those patients properly and avoid side effects later on."
2. Move cases through quickly. Patient must be prepped, treated and discharged efficiently to get the maximum number of cases through the surgery center, resulting in maximum revenue. The speed of discharge often depends on how quickly an anesthesiologist works.
Anesthesiologists must be accustomed to working in ASCs because the process is different than in inpatient settings, Dr. Kirschen says. ASC patients require different techniques for faster discharge, such as more local anesthesia injections and nerve blocks. Short-acting sedatives should also be timed for the length of the procedure.
"As soon as a procedure is over, a patient should be waking up and ready to have a conversation," he says. "Proper pain killers allow a patient to ambulate sooner and be discharged and more street ready than in a hospital."
He stresses the importance of moving cases through quickly. "You can't bring another patient into the recovery room if all the beds are filled. Timing needs to be such when cases are going in, patients are being discharged."
3. Schedule efficiently. Dr. Kirschen recommends assigning specific anesthesiologists to cases depending on how quickly a specialist can turn the case over.
Splitting up staff members can also increase efficiency. If you have staff members who are not as quick at turning over cases, assign them to stay with and monitor a patient. Assign faster personnel to prep the next patient and more quickly rotate cases through.
"Assign an anesthesiologist who is equipped for a quick turn over of cases," Dr. Kirschen says. "Choose the appropriate personnel to move the most quickly."
4. Create an environment of cost awareness. Anesthesiologists are typically trained to be cognizant of costs, Dr. Kirschen says, but not all physicians are inclined to think in this vein.
"We [anesthesiologists] have been brought up to try to be conservative in our use of equipment," he says. "Surgeons are not always as cognizant of how much things cost."
Working to create a cost-conscious environment can encourage other surgeons and staff members to look more closely at what is being spent. Anesthesiologists can set a good fiscal example in their ASCs by getting the most use out of equipment and stretching dollars.
5. Cut costs only in appropriate areas. Major anesthesia equipment savings are often hard to come by without compromising safety. Rather than looking in places where costs shouldn't be alleviated, focus on getting more cases each day through the center, Dr. Kirschen says.
He encountered an ASC that wanted to use less of the expensive oxygen tubing, but he put his foot down because the supply is necessary for proper care.
"Patient safety is never compromised," he says. "Make up for it by working faster and allowing more cases through. Never compromise patient safety."
More Articles on Anesthesia:
Propofol Anesthesia Inhibits Orexinergic Neurons
Tony Mira: A Warning for Anesthesiologists and Pain Physicians About Increased Billings Through Better Technology
45 Statistics on Anesthesiology Compensation