Anesthesiology may put some people to sleep, but the specialty is about to get a wakeup call.
Sonya Pease, MD, CMO for anesthesia services at Knoxville-based TeamHealth, says anesthesiologists' role in care delivery is poised to expand beyond the operating room.
Perioperative leadership. The biggest change in anesthesiology today is that anesthesiologists are being groomed to become perioperative directors, says Dr. Pease, an anesthesiologist herself. From their vantage point working with physicians and nurses of multiple specialties at all stages of surgery and recovery, she says anesthesiologists can coordinate episodes of care for patients in the pre-, post- and intraoperative phases, helping to lessen patients' risk factors and improve their outcomes.
"What we're really good at is recognizing risk factors," she says. "If you want your kidney taken out, you want to make sure you're optimized prior to surgery. There are things we can do in the preoperative setting that will help, and it's a known fact that medical care becomes more expensive if a patient has a complication during surgery. If you're diabetic and your blood sugar is running high, then we know your chances of having a complication after surgery are higher." Predicting and preventing or lessening those complications can also help to keep ORs running on schedule and prevent last-minute cancelations and delays.
Half of many hospitals' revenue comes from surgery, she says, and surgery makes up 60 to 70 percent of most hospital budgets. With such a large chunk of the hospitals' budget at stake, excellent perioperative leadership is a must. If anesthesiologists can help reduce risks of readmittance, longer hospital stays or less satisfied patients, then they can protect millions in hospitals' already threatened revenue streams and even boost income through raising value-based purchasing multipliers thanks to satisfied patients.
"In the near-future world, the value-based purchasing modifier will apply to all providers of all specialties by 2017, and 30 percent of the value-based purchasing modifier will be based on patient satisfaction. In anesthesiology, we know pain and how to treat it, and the number one factor for patients' dissatisfaction in hospitals is uncontrolled pain," Dr. Pease says.
Outside the OR. "We as anesthesiologists are not just involved in surgery anymore. If a patient is admitted to the hospital with a sickle cell disease attack or Crohn's disease exacerbation, an anesthesiologist can manage hard-to-treat inpatient pain to improve the patient's hospital experience," Dr. Pease says.
When surgery is necessary, anesthesiologists are able to consult with patients to help them prepare for surgery and reduce risk factors. Simple recommendations such as quitting smoking just eight weeks before surgery can drop the risk of post-operative pneumonia by sometimes up to 50 percent, she says, making for shorter hospital stays and better quality care. Meeting with a perioperative anesthesiologist before undergoing a procedure allows for better management and treatment for conditions like sleep apnea, pulmonary disease and chronic pain management syndromes. Blood management protocols can also be implemented prior to the day of surgery and can benefit patients tremendously by decreasing the risk of blood transfusions and potential complications associated with blood transfusions.
Benefits of scale. Just like any other medical specialty, leaders in anesthesiology rely on evidence-based best practices to determine the best drugs and techniques to use for different clinical circumstances. Not only does that drive patient outcomes, but quality-based care can bolster financial outcomes as well. TeamHealth has an advantage here over hospital-employed anesthesiologists and smaller anesthesiology practices, Dr. Pease says, because it manages more than 250 anesthesiologists and 1,100 certified nurse anesthetists and anesthesiologist assistants at about 50 facilities across the country. That enables TeamHealth to draw upon five years of data from over a million patient encounters performed in a wide geographic span, eclipsing the mere 1,000 to 5,000 analyzed in most anesthesia studies, she says.
TeamHealth's enormous bank of quality outcome data helps change physician behavior and allows TeamHealth to create benchmarks on hundreds of quality measures. Having a quality outcome database that is compliant, 100 percent validated and able to be risk-stratified is critical in developing predictive modeling programs for future anesthesia practice models. "We track every anesthetic that we administer nationwide. We're currently collecting over 250,000 anesthetics annually into our database," Dr. Pease says. "The whole purpose is to track quality and evaluate outcomes. If you can't measure outcomes and give individual feedback to providers, then you can't change behavior, fix system issues and improve patient care."
Scope of care. Dr. Pease began her career as an anesthesiologist assistant and practiced for eight years as she went back to medical school and became an anesthesiologist. After receiving her MD, she went into private practice for 10 years, becoming the owner and operator of her own practice.
Like many anesthesiologists in small hospital practices, she found she spent far more of her time centered on running the business and struggling to report quality measures than seeing and caring for her patients. TeamHealth is able to relieve most of these administrative burdens for providers so they can focus on patient care, she says.
Dr. Pease believes buying into economies of scale will play a much larger role for hospitals contracting anesthesiology services, as will relying more heavily on mid-level clinicians like AAs and CRNAs. There are critics in the industry who argue such practices risk breaching the appropriate scope of care for these professionals, but she says anesthesiologists like herself should view advanced practitioners as professional colleagues who are able to expand our anesthesia resources to meet the demands of healthcare today. This allows physicians to allot their time on the most complex cases that require their expertise and focus more on medical diagnosis, disease treatment and management and prevention of complications that may occur during the perioperative course of a patient's hospital stay.
"I think advanced practice clinicians are going to be critical to our future," she says. "I went back [to school for my MD] because I loved what I was doing [as an anesthesiologist assistant] and I wanted to have a deeper, broader knowledge to handle more complex cases. All of [TeamHealth's] anesthesia practices incorporate the anesthesia care team model that utilizes anesthesiologists working with AAs and CRNAs. It's a model we very much believe in."
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Sonya Pease, MD, CMO for anesthesia services at Knoxville-based TeamHealth, says anesthesiologists' role in care delivery is poised to expand beyond the operating room. Perioperative leadership. The biggest change in anesthesiology today is that anesthesiologists are being groomed to become perioperative directors, says Dr. Pease, an anesthesiologist herself. From their vantage point working with physicians and nurses of multiple specialties at all stages of surgery and recovery, she says anesthesiologists can coordinate episodes of care for patients in the pre-, post- and intraoperative phases, helping to lessen patients' risk factors and improve their outcomes.
"What we're really good at is recognizing risk factors," she says. "If you want your kidney taken out, you want to make sure you're optimized prior to surgery. There are things we can do in the preoperative setting that will help, and it's a known fact that medical care becomes more expensive if a patient has a complication during surgery. If you're diabetic and your blood sugar is running high, then we know your chances of having a complication after surgery are higher." Predicting and preventing or lessening those complications can also help to keep ORs running on schedule and prevent last-minute cancelations and delays.
Half of many hospitals' revenue comes from surgery, she says, and surgery makes up 60 to 70 percent of most hospital budgets. With such a large chunk of the hospitals' budget at stake, excellent perioperative leadership is a must. If anesthesiologists can help reduce risks of readmittance, longer hospital stays or less satisfied patients, then they can protect millions in hospitals' already threatened revenue streams and even boost income through raising value-based purchasing multipliers thanks to satisfied patients.
"In the near-future world, the value-based purchasing modifier will apply to all providers of all specialties by 2017, and 30 percent of the value-based purchasing modifier will be based on patient satisfaction. In anesthesiology, we know pain and how to treat it, and the number one factor for patients' dissatisfaction in hospitals is uncontrolled pain," Dr. Pease says.
Outside the OR. "We as anesthesiologists are not just involved in surgery anymore. If a patient is admitted to the hospital with a sickle cell disease attack or Crohn's disease exacerbation, an anesthesiologist can manage hard-to-treat inpatient pain to improve the patient's hospital experience," Dr. Pease says.
When surgery is necessary, anesthesiologists are able to consult with patients to help them prepare for surgery and reduce risk factors. Simple recommendations such as quitting smoking just eight weeks before surgery can drop the risk of post-operative pneumonia by sometimes up to 50 percent, she says, making for shorter hospital stays and better quality care. Meeting with a perioperative anesthesiologist before undergoing a procedure allows for better management and treatment for conditions like sleep apnea, pulmonary disease and chronic pain management syndromes. Blood management protocols can also be implemented prior to the day of surgery and can benefit patients tremendously by decreasing the risk of blood transfusions and potential complications associated with blood transfusions.
Benefits of scale. Just like any other medical specialty, leaders in anesthesiology rely on evidence-based best practices to determine the best drugs and techniques to use for different clinical circumstances. Not only does that drive patient outcomes, but quality-based care can bolster financial outcomes as well. TeamHealth has an advantage here over hospital-employed anesthesiologists and smaller anesthesiology practices, Dr. Pease says, because it manages more than 250 anesthesiologists and 1,100 certified nurse anesthetists and anesthesiologist assistants at about 50 facilities across the country. That enables TeamHealth to draw upon five years of data from over a million patient encounters performed in a wide geographic span, eclipsing the mere 1,000 to 5,000 analyzed in most anesthesia studies, she says.
TeamHealth's enormous bank of quality outcome data helps change physician behavior and allows TeamHealth to create benchmarks on hundreds of quality measures. Having a quality outcome database that is compliant, 100 percent validated and able to be risk-stratified is critical in developing predictive modeling programs for future anesthesia practice models. "We track every anesthetic that we administer nationwide. We're currently collecting over 250,000 anesthetics annually into our database," Dr. Pease says. "The whole purpose is to track quality and evaluate outcomes. If you can't measure outcomes and give individual feedback to providers, then you can't change behavior, fix system issues and improve patient care."
Scope of care. Dr. Pease began her career as an anesthesiologist assistant and practiced for eight years as she went back to medical school and became an anesthesiologist. After receiving her MD, she went into private practice for 10 years, becoming the owner and operator of her own practice.
Like many anesthesiologists in small hospital practices, she found she spent far more of her time centered on running the business and struggling to report quality measures than seeing and caring for her patients. TeamHealth is able to relieve most of these administrative burdens for providers so they can focus on patient care, she says.
Dr. Pease believes buying into economies of scale will play a much larger role for hospitals contracting anesthesiology services, as will relying more heavily on mid-level clinicians like AAs and CRNAs. There are critics in the industry who argue such practices risk breaching the appropriate scope of care for these professionals, but she says anesthesiologists like herself should view advanced practitioners as professional colleagues who are able to expand our anesthesia resources to meet the demands of healthcare today. This allows physicians to allot their time on the most complex cases that require their expertise and focus more on medical diagnosis, disease treatment and management and prevention of complications that may occur during the perioperative course of a patient's hospital stay.
"I think advanced practice clinicians are going to be critical to our future," she says. "I went back [to school for my MD] because I loved what I was doing [as an anesthesiologist assistant] and I wanted to have a deeper, broader knowledge to handle more complex cases. All of [TeamHealth's] anesthesia practices incorporate the anesthesia care team model that utilizes anesthesiologists working with AAs and CRNAs. It's a model we very much believe in."
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