As surgical cases and patient flows continue their migration from hospitals to ambulatory surgery centers, many ASC operators are seeking insight into how they can optimize care pathways that lend themselves to an outpatient setting.
During Becker's 28th Annual Meeting: The Business & Operation of ASCs, in an executive roundtable sponsored by North American Partners in Anesthesia (NAPA), Francis Abdou, MD, Clinical Regional Vice President for NAPA's Mid-South Region, along with Chief Development Officer & EVP, Peter Doerner, and other NAPA leaders, facilitated a discussion about how reinforcing the role of anesthesia at ASCs can facilitate increased patient volumes.
Three key takeaways were:
- One possible future of ASCs envisions a model driven by anesthesia. This model draws on the concept of the perioperative surgical home (PSH), where the anesthesia care team performs the role of a "hospitalist" for ASC patients, coordinating the entire system of perioperative care. This includes coordinating all perioperative stages (i.e., pre-, intra- and post-operative, along with recovery care) and microsystems (e.g., nursing, pharmacy, radiology, post-ASC discharge planning, physical therapy).
Not obviating the importance of other care team members, Dr. Abdou highlighted that for a successful anesthesia-driven ASC model, it is necessary for centers to be staffed by "clinicians with the appropriate skill sets, including interpersonal skill sets, clinical skill sets and understanding of the big picture to make all of this work together." That includes nurse navigators, who can organizationally sit either in the surgeon's office or with the anesthesia team, and whose role is to interface between anesthesia nurses, other care teams and the patient. Another important element is maintaining a warehouse of quality-related data to help ASCs make decisions and develop evidence-based practices based in actual metrics and analysis, locally and nationally.
- Anesthesia is key to winning hospital surgeons' trust in shifting patients and procedures to ASCs. One NAPA leader recounted a case in a Maryland market where NAPA serves a variety of hospitals and ASCs. An ASC that had available capacity—but had not previously performed breast surgeries—opened itself up to this type of procedure and gained 600 new patients within one year. This success was thanks to the established trust and efforts of a hospital anesthesia team who specialized in breast surgeries. Their expertise laid the foundation for a standardized protocol to perform these surgeries in the ASC. This process ultimately achieved better patient outcomes.
"It was an opportunity to serve a handful of breast patients in the ASC and prove the success of this approach. Our model reduced opioids, controlled costs for the facility and the patients, and increased satisfaction scores for both surgeons and patients," this NAPA leader said, adding that within seven months, the hospital began referring most of its breast patients to that ASC. "In this model, anesthesia became the air traffic controller, while the surgeons gained the trust of the patients. In the end, the surgeons were advising patients: 'You can have your procedure [at the hospital] or [the ASC]; I recommend that you have it [at the ASC].'"
- Implementing an anesthesia-driven ASC model is not without challenges. Roundtable participants noted some of the challenges they have faced when trying to implement elements of an anesthesia-driven ASC model. The most prominent challenge is achieving alignment with surgeons' policies and receiving buy-in from health plans regarding sharing savings with ASCs that accrue due to patients obtaining lower-cost care at ASCs.