Somnia Anesthesia Services recently presented a free webinar entitled, "What New Trends in Anesthesia Quality Will Mean to Your Bottom Line."
The speaker was Hugh Morgan, quality assurance officer, Somnia Anesthesia Services.
Mr. Morgan began the presentation by discussing key factors that affect anesthesia quality, which included:
• Continued scrutiny of regulatory and accreditation compliance, as well as financial visibility for anesthesia
• Recent CMS payment updates that now link payments to anesthesia quality, making alignment between anesthesia and the hospital or ASC even more crucial
• Projected reduction of physician payments by 25 percent in 2011, according to the 2011 Physician Fee Schedule Final Ruling
• Ongoing emphasis on tying quality to payments through accountable care organizations and healthcare reform
Rethinking traditional views of anesthesia provision
Mr. Morgan stated that a discussion on the financial impact of anesthesia quality must begin with a clear definition of anesthesia quality. "The traditional perspective has been [that quality exists] on a clinical level … and much of this has been anecdotal," he said. "We might talk about a good anesthetic or a bad anesthetic, and there has always been a dearth of anesthesia benchmark data available to us."
He said data on anesthesia quality has generally been exclusionary rather than over-arching, and it rarely looks at an entire patient population for their anesthetic experience. In addition, anesthesia provision has become commoditized to the extent that facilities think one anesthesia provider is just as valuable as any other.
He emphasized that new trends or new perspectives in anesthesia have to be valued and understood as they have significant effect on a number of different stakeholders, including patients, surgeons, OBs, proceduralists, nurses and other allied health staff; all who all work closely with and rely on anesthesia staff on a daily basis. Each group of stakeholders must be considered by facility administrators and senior level management to effectively improve anesthesia value.
Determining quality and value
As facilities consider a quality assessment for anesthesia services, Mr. Morgan said that they must first ask, "What is our anesthesia value proposition beyond the delivery of baseline anesthetic care on a daily basis?" In other words, is the facility getting what it expects and what it pays for? He claimed that measuring different aspects of anesthesia provision is essential for improvement, as well as understanding how each component ties together.
Determining the value of your anesthesia service begins with staffing, which Mr. Morgan claimed includes:
• How are staff developed, recruited and trained?
• Are administrators, nurses and surgeon leaders involved in the process of developing and training staff?
• Are coverage expectations and utilization aligned and clear?
• Which of the multiple staffing models — all MD, combined MD-CRNA, anesthesia assistants — is the facility going to use?
He stressed that facilities should formalize the process of determining anesthesia quality by using an ongoing evaluation tool, such as The Joint Commission's FPPE/OPEE, a bi-annual evaluation of clinical staff competencies and skills. "This is a good working document to improve a clinician's accountability to clinical and administrative responsibilities," he added.
Incentives for anesthesia excellence
Recent CMS payment updates include requirements for anesthesia concerning documentation and the ability of CRNAs to deliver analgesia for labor epidurals. According to Mr. Morgan, it is critical that anesthesia practices understand their requirements under the new conditions for participation. "You also need to keep forms updated so that if a surveyor were to come to the facility, they would see the group is up-to-date and current with the latest requirements," he stressed. He mentioned that PQRI now also includes three critical measures reported by anesthesia on an annual basis.
Anesthesia plays a big role in accreditation, as anesthesia provision is clearly tied to 7 of 17 current national patient safety goals. Mr. Morgan emphasized the importance of s anesthesia risk management, including keeping records on appropriate equipment and machine checks, medication safety and security, storage and labeling requirements and medical legal documentation, is essential to maintain high survey "readiness."
CMS now requires that anesthesia practices have a formalized QAPI program in place to participate and bill Medicare/Medicaid patients, stated Mr. Morgan. He outlined the following ways to prevent risks with anesthesia provision:
• Anesthesia provider education and training
• Mock surveys to ensure compliance
• Updated forms (EMR) to prompt and ensure provider compliance
• PI initiatives to address deficiencies
Download the Somnia Anesthesia Services webinar here.
Learn more about Somnia Anesthesia Services.
Follow Somnia Anesthesia on Twitter.
The speaker was Hugh Morgan, quality assurance officer, Somnia Anesthesia Services.
Mr. Morgan began the presentation by discussing key factors that affect anesthesia quality, which included:
• Continued scrutiny of regulatory and accreditation compliance, as well as financial visibility for anesthesia
• Recent CMS payment updates that now link payments to anesthesia quality, making alignment between anesthesia and the hospital or ASC even more crucial
• Projected reduction of physician payments by 25 percent in 2011, according to the 2011 Physician Fee Schedule Final Ruling
• Ongoing emphasis on tying quality to payments through accountable care organizations and healthcare reform
Rethinking traditional views of anesthesia provision
Mr. Morgan stated that a discussion on the financial impact of anesthesia quality must begin with a clear definition of anesthesia quality. "The traditional perspective has been [that quality exists] on a clinical level … and much of this has been anecdotal," he said. "We might talk about a good anesthetic or a bad anesthetic, and there has always been a dearth of anesthesia benchmark data available to us."
He said data on anesthesia quality has generally been exclusionary rather than over-arching, and it rarely looks at an entire patient population for their anesthetic experience. In addition, anesthesia provision has become commoditized to the extent that facilities think one anesthesia provider is just as valuable as any other.
He emphasized that new trends or new perspectives in anesthesia have to be valued and understood as they have significant effect on a number of different stakeholders, including patients, surgeons, OBs, proceduralists, nurses and other allied health staff; all who all work closely with and rely on anesthesia staff on a daily basis. Each group of stakeholders must be considered by facility administrators and senior level management to effectively improve anesthesia value.
Determining quality and value
As facilities consider a quality assessment for anesthesia services, Mr. Morgan said that they must first ask, "What is our anesthesia value proposition beyond the delivery of baseline anesthetic care on a daily basis?" In other words, is the facility getting what it expects and what it pays for? He claimed that measuring different aspects of anesthesia provision is essential for improvement, as well as understanding how each component ties together.
Determining the value of your anesthesia service begins with staffing, which Mr. Morgan claimed includes:
• How are staff developed, recruited and trained?
• Are administrators, nurses and surgeon leaders involved in the process of developing and training staff?
• Are coverage expectations and utilization aligned and clear?
• Which of the multiple staffing models — all MD, combined MD-CRNA, anesthesia assistants — is the facility going to use?
He stressed that facilities should formalize the process of determining anesthesia quality by using an ongoing evaluation tool, such as The Joint Commission's FPPE/OPEE, a bi-annual evaluation of clinical staff competencies and skills. "This is a good working document to improve a clinician's accountability to clinical and administrative responsibilities," he added.
Incentives for anesthesia excellence
Recent CMS payment updates include requirements for anesthesia concerning documentation and the ability of CRNAs to deliver analgesia for labor epidurals. According to Mr. Morgan, it is critical that anesthesia practices understand their requirements under the new conditions for participation. "You also need to keep forms updated so that if a surveyor were to come to the facility, they would see the group is up-to-date and current with the latest requirements," he stressed. He mentioned that PQRI now also includes three critical measures reported by anesthesia on an annual basis.
Anesthesia plays a big role in accreditation, as anesthesia provision is clearly tied to 7 of 17 current national patient safety goals. Mr. Morgan emphasized the importance of s anesthesia risk management, including keeping records on appropriate equipment and machine checks, medication safety and security, storage and labeling requirements and medical legal documentation, is essential to maintain high survey "readiness."
CMS now requires that anesthesia practices have a formalized QAPI program in place to participate and bill Medicare/Medicaid patients, stated Mr. Morgan. He outlined the following ways to prevent risks with anesthesia provision:
• Anesthesia provider education and training
• Mock surveys to ensure compliance
• Updated forms (EMR) to prompt and ensure provider compliance
• PI initiatives to address deficiencies
Download the Somnia Anesthesia Services webinar here.
Learn more about Somnia Anesthesia Services.
Follow Somnia Anesthesia on Twitter.