Most specialty groups are wondering how the advent of accountable care organizations will impact their practice, but anesthesia, which is often a relatively separate entity from the hospital, is in a unique position. Jonathan Friedman, COO of Somnia Anesthesia Services, discusses how ACOs will impact the provision of anesthesia.
Q: The details of how ACOs will work are still somewhat uncertain, but how do you think anesthesia groups will contribute to cutting costs while improving quality care?
Jonathan Friedman: When we discuss our role with the hospital, we focus on anesthesia’s part in facilitating the operations of the OR. It is not just about sedation of the patient. Our involvement runs very deep, ensuring that ORs are operating in an efficient and effective manner. We also have the responsibility of providing care in areas outside of the OR, including but not limited to the cath lab, radiology, endoscopy, and the emergency room. We also visit patients on the floors of the hospital to follow-up on their care and perform rounds for pain management.
We partner with the hospital, providing transparency in the form of data, indicating where we believe there may be inefficiencies. Our database is rich with information, including procedures performed, diagnoses, and other factors, assisting the institution in their assessment of issues that impact the quality of care, which serves as the foundation for accountable care organizations. We have a deep repository of information available for institutions to make use of to suit their own particular needs.
Q: How do you predict anesthesiologist compensation will be affected by payment structures in ACOs?
JF: The payments are going to be bundled, placing the hospital in the unenviable position of deciding which portion of the reimbursement will be disseminated to the institution, surgeon, radiologist, anesthesiologist and any other parties involved in the care of the patient. What happens to anesthesia reimbursement will be very interesting. I don't know if hospitals will look to employ the anesthesiologists, but I know that anesthesiologists will have to demonstrate their worth.
The basic concept of an ACO is clearly in alignment with what Somnia, an "Anesthesia Accountable Organization," currently offers its clients in the way of quality assurance, cost-containment, and overall care improvements. Well-managed healthcare organizations with measurable, compliant, and cost-effective results will likely be the ACO success stories.
Q: How will involvement in an ACO affect the day-to-day clinical practice of an anesthesiologist?
JF: I think it's going to put more pressure on anesthesia. It's going to put a lot more pressure on anesthesia groups to ensure a high standard of care is maintained and documented. We have many discussions and meetings with our staff, informing them of the importance of complete documentation as it will serve as major factor in reimbursement for the ACO. We will need to develop best practices and there will only be more pressure on the anesthesiologist in the future to provide that quality of care and the documentation supporting the care given.
It's a team approach. Partnering with the hospital and understanding the surgeons and acting as that facilitator, communicator and diplomat is going to be vitally important to the smooth operation of the OR in accordance with the standards dictated by the ACO, which can easily fall into a state of chaos.
Q: What drives that chaos and what can be done to curb it?
JF: ACOs are pilot programs. It's going to be very challenging to [start an ACO]. Organizations may be jumping into these pilot programs without having a full understanding of the risks involved.
[Facilities] need to take measures to understand where improvements need to be made first and leadership needs to accommodate the operation of an ACO. They need to understand the risks involved financially, ascertaining potential losses pertaining to readmission rates, treatment of patients with chronic conditions, and other pressures in providing for the treatment of a patient population. You cannot jump into a pilot project without first sitting down with all parties; including the surgeon, anesthesiologist, nursing staff and other involved parties to understand the resources, risks and rewards of this type of program.
Q: How can anesthesiologists and anesthesia groups prepare themselves for these anticipated changes now?
JF: First and foremost, the clinical staff still must focus on the delivery of care to their patients, regardless of yet another acronym — in this case, ACO.
Anesthesia groups need to immerse themselves in the literature available. We need to know as much about the healthcare industry as any party out there, we need to become the experts. Pick up publications from such organizations as the HFMA and the ACHE, and learn what is important to the CEO. Organizations may be running to be first in line, rather than figuring out whether an ACO is the best fit for their institution. The best thing to do is to read about the various models of ACO activity and research value-based purchasing. For example, two models come to mind at Baylor and Dartmouth.
Author's note: According to Deloitte's "Accountable Care Organizations: A new model for sustainable innovation," Dartmouth/Brookings Institute has signed on three sites — the Carillion Clinic (Va.), Norton Healthcare System (Ky.) and Tucson (Ariz.) Medical Center — for an ACO pilot program with private payors and, eventually, Medicaid. Both Baylor hospital system and the Robert Wood Johnson Foundation are piloting test ACOs, and Baylor is planning to incorporate 4,500 physicians and 13 hospitals into an ACO and implement a bundled payment system to control costs.
Anesthesiologists should also speak to people around the hospital. Talk to the surgeons and ask them what their thoughts are on [the direction] of healthcare. They should attend seminars, track Websites and read publications with the most recent information available.
The anticipated change can also be seen as an opportunity to consider an anesthesia management service such as Somnia. Through partnering with an anesthesia management service, clinicians can expect sound, reliable management services and the provision of valuable information on industry best practices and innovative thought leadership.
Q: Are there steps anesthesiologists can take to make sure they're involved in ACOs in a way that's financially beneficial?
JF: They should start opening up a dialogue, demonstrating the value they provide. You could say that about anesthesia — you need to show your value and articulate that value to the surgeon and the hospital. Show them, don’t just tell them. Provide the numbers, proactively implement a robust quality management program. Demonstrate that you are knowledgeable about what's happening in healthcare. It will prove that you are more than an anesthesiologist, you are a perioperative specialist — you're a well-educated, informed and valuable partner.
Q: How will acting as that "perioperative specialist" improve the continuum of care?
JF: I think the number one way is through the quality of the anesthesiologist. The anesthesiologist needs to be involved in the full continuum of care, from pre-operative review of the patient to post-operative care of the patient. . It's important to know and speak to the patient and try to develop a relationship with the patient in advance. We call our patients beforehand and encourage them to come to pre-admission testing. During recovery, the anesthesiologist remains involved with the patient, helping to manage any discomfort/ pain, monitoring all vital signs, even speaking with family members.
These steps can prevent patients from having to stay in the hospital for an elongated period of time or from complications. Anesthesiologists can also provide quicker, more efficient turnover and keep the surgeon more at ease.
Q: In your experience, what kind of specialized processes do anesthesia groups already use that might help an ACO?
JF: Anesthesia groups accumulate a lot of data. We have the ability to say, "Here's where you're more vulnerable, here's where you may need to provide for additional care."
At Somnia, we put anesthesiologists through an extensive credentialing process. The anesthesiologists may complain about our own exhaustive credentialing process, but we want to make sure we are putting the best quality clinicians in the O.R. Our orientation also incorporates an all inclusive education of quality care, developing relationships with the surgeon and the hospital, and continues throughout the anesthetist's association with our company.
Learn more about Somnia Anesthesia Services.
Q: The details of how ACOs will work are still somewhat uncertain, but how do you think anesthesia groups will contribute to cutting costs while improving quality care?
Jonathan Friedman: When we discuss our role with the hospital, we focus on anesthesia’s part in facilitating the operations of the OR. It is not just about sedation of the patient. Our involvement runs very deep, ensuring that ORs are operating in an efficient and effective manner. We also have the responsibility of providing care in areas outside of the OR, including but not limited to the cath lab, radiology, endoscopy, and the emergency room. We also visit patients on the floors of the hospital to follow-up on their care and perform rounds for pain management.
We partner with the hospital, providing transparency in the form of data, indicating where we believe there may be inefficiencies. Our database is rich with information, including procedures performed, diagnoses, and other factors, assisting the institution in their assessment of issues that impact the quality of care, which serves as the foundation for accountable care organizations. We have a deep repository of information available for institutions to make use of to suit their own particular needs.
Q: How do you predict anesthesiologist compensation will be affected by payment structures in ACOs?
JF: The payments are going to be bundled, placing the hospital in the unenviable position of deciding which portion of the reimbursement will be disseminated to the institution, surgeon, radiologist, anesthesiologist and any other parties involved in the care of the patient. What happens to anesthesia reimbursement will be very interesting. I don't know if hospitals will look to employ the anesthesiologists, but I know that anesthesiologists will have to demonstrate their worth.
The basic concept of an ACO is clearly in alignment with what Somnia, an "Anesthesia Accountable Organization," currently offers its clients in the way of quality assurance, cost-containment, and overall care improvements. Well-managed healthcare organizations with measurable, compliant, and cost-effective results will likely be the ACO success stories.
Q: How will involvement in an ACO affect the day-to-day clinical practice of an anesthesiologist?
JF: I think it's going to put more pressure on anesthesia. It's going to put a lot more pressure on anesthesia groups to ensure a high standard of care is maintained and documented. We have many discussions and meetings with our staff, informing them of the importance of complete documentation as it will serve as major factor in reimbursement for the ACO. We will need to develop best practices and there will only be more pressure on the anesthesiologist in the future to provide that quality of care and the documentation supporting the care given.
It's a team approach. Partnering with the hospital and understanding the surgeons and acting as that facilitator, communicator and diplomat is going to be vitally important to the smooth operation of the OR in accordance with the standards dictated by the ACO, which can easily fall into a state of chaos.
Q: What drives that chaos and what can be done to curb it?
JF: ACOs are pilot programs. It's going to be very challenging to [start an ACO]. Organizations may be jumping into these pilot programs without having a full understanding of the risks involved.
[Facilities] need to take measures to understand where improvements need to be made first and leadership needs to accommodate the operation of an ACO. They need to understand the risks involved financially, ascertaining potential losses pertaining to readmission rates, treatment of patients with chronic conditions, and other pressures in providing for the treatment of a patient population. You cannot jump into a pilot project without first sitting down with all parties; including the surgeon, anesthesiologist, nursing staff and other involved parties to understand the resources, risks and rewards of this type of program.
Q: How can anesthesiologists and anesthesia groups prepare themselves for these anticipated changes now?
JF: First and foremost, the clinical staff still must focus on the delivery of care to their patients, regardless of yet another acronym — in this case, ACO.
Anesthesia groups need to immerse themselves in the literature available. We need to know as much about the healthcare industry as any party out there, we need to become the experts. Pick up publications from such organizations as the HFMA and the ACHE, and learn what is important to the CEO. Organizations may be running to be first in line, rather than figuring out whether an ACO is the best fit for their institution. The best thing to do is to read about the various models of ACO activity and research value-based purchasing. For example, two models come to mind at Baylor and Dartmouth.
Author's note: According to Deloitte's "Accountable Care Organizations: A new model for sustainable innovation," Dartmouth/Brookings Institute has signed on three sites — the Carillion Clinic (Va.), Norton Healthcare System (Ky.) and Tucson (Ariz.) Medical Center — for an ACO pilot program with private payors and, eventually, Medicaid. Both Baylor hospital system and the Robert Wood Johnson Foundation are piloting test ACOs, and Baylor is planning to incorporate 4,500 physicians and 13 hospitals into an ACO and implement a bundled payment system to control costs.
Anesthesiologists should also speak to people around the hospital. Talk to the surgeons and ask them what their thoughts are on [the direction] of healthcare. They should attend seminars, track Websites and read publications with the most recent information available.
The anticipated change can also be seen as an opportunity to consider an anesthesia management service such as Somnia. Through partnering with an anesthesia management service, clinicians can expect sound, reliable management services and the provision of valuable information on industry best practices and innovative thought leadership.
Q: Are there steps anesthesiologists can take to make sure they're involved in ACOs in a way that's financially beneficial?
JF: They should start opening up a dialogue, demonstrating the value they provide. You could say that about anesthesia — you need to show your value and articulate that value to the surgeon and the hospital. Show them, don’t just tell them. Provide the numbers, proactively implement a robust quality management program. Demonstrate that you are knowledgeable about what's happening in healthcare. It will prove that you are more than an anesthesiologist, you are a perioperative specialist — you're a well-educated, informed and valuable partner.
Q: How will acting as that "perioperative specialist" improve the continuum of care?
JF: I think the number one way is through the quality of the anesthesiologist. The anesthesiologist needs to be involved in the full continuum of care, from pre-operative review of the patient to post-operative care of the patient. . It's important to know and speak to the patient and try to develop a relationship with the patient in advance. We call our patients beforehand and encourage them to come to pre-admission testing. During recovery, the anesthesiologist remains involved with the patient, helping to manage any discomfort/ pain, monitoring all vital signs, even speaking with family members.
These steps can prevent patients from having to stay in the hospital for an elongated period of time or from complications. Anesthesiologists can also provide quicker, more efficient turnover and keep the surgeon more at ease.
Q: In your experience, what kind of specialized processes do anesthesia groups already use that might help an ACO?
JF: Anesthesia groups accumulate a lot of data. We have the ability to say, "Here's where you're more vulnerable, here's where you may need to provide for additional care."
At Somnia, we put anesthesiologists through an extensive credentialing process. The anesthesiologists may complain about our own exhaustive credentialing process, but we want to make sure we are putting the best quality clinicians in the O.R. Our orientation also incorporates an all inclusive education of quality care, developing relationships with the surgeon and the hospital, and continues throughout the anesthetist's association with our company.
Learn more about Somnia Anesthesia Services.