5 Ways to Increase Anesthesia Cost-Effectiveness in ASCs
1. Prevent anesthesia side effects. Patients experiencing side effects from anesthesia can be a major driving force behind anesthesia costs in ASCs, Neil Kirschen, MD, said. Dr. Kirschen is the chief of pain management in the department of anesthesiology at South Nassau Communities Hospital in Oceanside, N.Y., and the medical director for the Pain Management Center of Long Island in New York.
When patients experience side effects, such as nausea and vomiting, they require additional care and cannot be discharged as quickly.
"You need to treat them and visit them more frequently in the post-anesthesia recovery room," he said. "You also need to use different medications that can be rather expensive to counteract the nausea."
Anesthesiologists in ASCs should work to prevent side effects in order to reduce time in the PACU and move cases along more quickly. Dr. Kirschen recommends using minimal amounts of opioid narcotics for pain relief and opting instead for sedative hypnotics and prophylactic antiemetics.
"Preempting is the best way to hand those situations," he said. "Certain surgeries are notorious for causing nausea, such as gynecology and cosmetic procedures. Treat those patients properly and avoid side effects later on."
2. Collect upfront from patients. Collecting from patients is the area where most anesthesia providers need to improve, said Jody Hinton, director of billing operations for the central division at abeo in Fort Worth, Texas. Failing to collect from patients can become a strain to profits.
The process for collecting from patients has drastically changed for anesthesia in the last few years. In the past, anesthesia billers would charge the payor and then send an invoice to the patient. If the patient didn't respond, it wasn't a major problem. Patients were more able to pay, she said, because they had fewer out-of-pocket expenses, their deductibles weren't as high and their incomes were better. Now, companies have to more aggressively go after patient payments.
Some practices have pre-payments where patients have to pay their bills before services are rendered. She recommends educating patients about the services they will receive and the cost of those services so the patients are informed as to what they will be responsible for paying. Work out an aggressive payment plan with patients who cannot pay in full up front so they can pay the bill off quickly.
3. Evaluate equipment costs. Anesthesia equipment prices are rising, which can be a challenge for cost-conscious ASCs. Two of the most common tools — an ultrasound for regional anesthesia and a glide scope — are practically standard, Thomas Wherry, MD, said, making it difficult for anesthesiologists to perform jobs without them. Dr. Wherry is the principal for Total Anesthesia Solutions in Ellicott City, Md., and a consulting medical director for Health Inventures.
To combat this issue, surgery centers should be mindful of the anesthesia market and accommodate their provider as much as possible. "If you want to secure your service, provide your group with superior technology," he said.
However, anesthesia providers used to working with hospitals may have unrealistic expectations for what the center can afford to provide. The anesthesia machines themselves can range from $20,000 to $100,000. While a hospital with a larger capital budget may be able to afford the more expensive machine, it is not crucial for proper patient care.
"What they have at the hospital may be overkill," he said. "You don't necessarily need to replicate it at the surgery level." Anesthesia groups should make sure to consider the ASC's budget before requesting unnecessary high-end machines.
4. Unclog post-operative rooms. Your ASC will be able to perform more cases — and therefore make more money — if the pre- and post-op processes are efficient. According to Rajiv Chopra, principal and CFO for The C/N Group, anesthesiologists are a major factor in how fast a patient recovers from anesthesia, and a skilled anesthesiologist can mean patients feel better faster and can free up the post-op recovery room for the next case.
"Your anesthesia can make a difference," Mr. Chopra said. "Once the surgery is done, how quickly are patients recovering so they can leave the facility? A lot of this ties back into anesthesia, and if you don't have an anesthesiologist with that skilled component, it can create challenges for you just from a recovery time perspective." He said safety and quality can be maintained without clogging up the post-op recovery room and delaying the process for other patients.
5. Create an environment of cost awareness. Anesthesiologists are typically trained to be cognizant of costs, Dr. Kirschen said, but not all physicians are inclined to think in this vein.
"We [anesthesiologists] have been brought up to try to be conservative in our use of equipment," he said. "Surgeons are not always as cognizant of how much things cost."
Working to create a cost-conscious environment can encourage other surgeons and staff members to look more closely at what is being spent. Anesthesiologists can set a good fiscal example in their ASCs by getting the most use out of equipment and stretching dollars.
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