Value-based reimbursement models have made it more important than ever for physicians in all specialties to track their quality and cost data using analytics. Although anesthesiologists' responsibilities have traditionally focused on the operating room, they too should prioritize developing robust systems for data analytics, according to a panel of three anesthesiologists at Becker's ASC Review 23rd Annual Meeting: The Business and Operations of ASCs in Chicago.
V.K. Puppala, MD, an anesthesiologist and interventional pain physician at Atlanta-based Alliance Spine and Pain Centers; Tony Mira, president and CEO of Anesthesia Business Consultants; and Darrel Saldanha, MD, an anesthesiologist and pain management physician and physician owner of Hyde Park (Ill.) Surgical Center, discussed the importance of data analytics for anesthesia practices in a pay-for-performance healthcare system.
Heather Punke, a managing editor with Becker's Healthcare, moderated the discussion.
There are three main reasons for this, according to the panelists.
1. Anesthesiologists' role in quality improvement efforts is expanding. Anesthesiologists' responsibilities are no longer contained within the walls of the OR. As the industry continues its collective push to provide higher quality care at a lower cost, anesthesiologists must become more involved in patients' care outside of the OR and even outside of the hospital because bundled payments make healthcare providers financially responsible for the entire episode of care, including the period immediately following discharge. To ensure the best possible outcomes, anesthesiologists are realizing they need to get involved in preparing the patient for surgery and making the proper arrangements for recovery to reduce infections and readmissions. Data analytics is indispensable to this endeavor.
"It's all about quality metrics and care," said Dr. Saldanha. "If the ASC or hospital tracks data correctly, they can monitor complication rates and quality outcomes, which anesthesia can use to help prevent some of the negative thing we are trying to avoid. It's a matter of knowing how to collect the data and what to do with it."
2. Better data can make or break negotiations with payers. Various metrics are taken into account when it comes to setting payment rates, including patient outcomes, length of stay, rate of complications and readmissions. With accurate data that proves an anesthesia practice is high-performing, it will be much easier to make the case for higher reimbursement from payers, according to Dr. Mira.
During negotiations, "if you don't lead with [data] you will lose," said Dr. Mira. "I need to be able to show exactly why my anesthesiologists should get paid more than others. That's my goal. In this day and age the only thing that will support you in negotiations is data."
Dr. Puppala noted that reimbursement for procedures from Medicare is substantially lower than reimbursement from commercial payers, so negotiating successfully with commercial insurers is integral. This is especially pertinent for the future, as "the commercial payers always follow Medicare's lead," and could reduce rates further in the future, said Dr. Puppala.
3. Physician-level data offers insight on areas ripe for improvement. By tracking anesthesiologists' performance on a variety of metrics, physician leaders and administrators can identify where each physician stands in terms of cost and patient outcomes compared to their peers, which can ultimately help them when it comes to negotiating with payers for more favorable rates, Dr. Mira pointed out. Additionally, by comparing individual physicians' performance data to that of their peers and industry benchmarks, it is easier to get physicians — who typically crave data and evidence — to change their behavior to better align with value-based models of care.