As the landscape of anesthesia continues to shift with new technologies, high demand for services and provider shortages, anesthesia groups are developing new strategies to meet the industry's dynamic needs.
"As anesthesiologists, we do not bring patients to the hospital," Vijay Sudheendra, MD, president of Narragansett Bay Anesthesia in Providence, R.I., told Becker's. "The patients come in for a procedure and we are engaged. So by definition, we are a service specialty. As the service specialty, if you are just here to do your work, that is not enough."
He cited consistently declining reimbursement rates for anesthesia, increased costs of operations and the ongoing staffing shortage as factors adding pressure to anesthesia groups to distinguish themselves and stay afloat.
"Year after year, when we asked the hospitals for more money, because the market is setting itself to a higher level, they asked questions," Dr. Sudheendra continued. "'What am I buying your group for?' 'What else can you do?' Are you going to do things differently than the intubation to extubation paradigm?'"
Building a "perioperative surgical home"
Increased demand for more comprehensive anesthesia services has led Dr. Suhdheendra and Narragansett Bay Anesthesia to shift their practice model to one that focuses on creating a "perioperative surgical home" for patients and providers.
"That means you really have to be adding value in places beyond the operating room," he said. "We are looking at patients hitting the emergency room — how do we make sure that these patients are pain free beyond three to four post-operative days?"
He also noted that as increasingly high-acuity procedures continue to move to the outpatient setting, particularly in surgical specialties like orthopedics, his anesthesia group is focusing on improving post-operative care and pain management for patients 30 to 90 days post-operation.
"[Anesthesiologists] play an instrumental role in this process, and we identified this early on," he said. "We are looking at building what is known as 'transitional pain service.'" This approach emphasizes treating pain within the first 30 days of recovery from a surgery with the goal of avoiding chronic pain in the future.
Utilizing emerging technologies
One vital element of this approach is leveraging new technologies and developments in anesthesia and pain management. For Dr. Sudheendra and his practice, the use of cryoanalgesia is an important tool in developing more comprehensive pain management.
"What we are doing is we are actually freezing some of the nerves that supply the knee joint, and those nerves are numb for about three months," he said. "And these patients can actually participate in physical therapy, movement, [have] less pain, less opioids. We have seen that these patients who have received cryoanalgesia take less opioids."
His practice is currently conducting a study to see whether the use of cryoanalgesia will allow patients to return to full daily living earlier than those who do receive other pain-management treatments.
Recruiting is key
Having the right team is essential in creating a more expansive anesthesia practice capable of responding to market demands, Dr. Sudheendra said.
"We are also investing in leaders in anesthesia who actually can work, not only in the operating room, but also in the C-suite, with the administrators, surgeons and cardiologists, to build this perioperative surgical home," he said.
Anesthesia practices must also adapt to changes in what younger generations of anesthesia providers are looking for in an employer, such as better work-life balance and more flexible scheduling.
"The group is investing in leaders of the future," he said. "When I say investing, that means we are compensating them above the market value of these anesthesiologists, so that they then add value to the group."