With patient satisfaction and quality metrics driving big changes in how physicians get paid, anesthesiologists — perhaps more than any other specialty group — find themselves on shifting ground.
During a panel at Becker's 14th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in Chicago on June 9, anesthesiologists Steven Sheinman, MD, of Sunrise, Fla.-based Sheridan Healthcare, and Kenneth Candido, MD, of Downers Grove, Ill.-based Advocate Healthcare discussed — with vim and vigor — some of the major issues facing modern anesthesiologists.
On MACRA
With the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 steadily approaching, there is genuine concern among physicians as to the makeup of the quality metrics that will determine payment for services given to Medicare patients. Many see the methods behind the quality measures as perplexing; some go so far as to suggest they are intrinsically flawed.
"We don't know where their particular quality metrics come from. I don't believe that there is any evidence-based medicine that supports the metrics that they're looking for," said Dr. Sheinman.
The physician quality reporting set to come in 2017 provides ample challenges for anesthesiologists because of their limited face time with patients. Unlike surgeons and primary care physicians, a patient only comes into contact with their anesthesiologist for brief moments.
"As anesthesiologists, we're handicapped by virtue of the fact that our relationship with patients is so minimal," Dr. Candido says. "They don't recognize us, they don't really recognize the kind of tasks we perform. Studies show pain control doesn't translate into higher [patient] satisfaction ... All the metrics they have to rate physicians in our specialty are only going to be used against us."
Dr. Candido went on to assert that anesthesiologists will have to come up with novel ways to interact with patients and develop relationships, though he's not sure how successful these tactics will be. Dr. Sheinman agreed that new tactics will be needed, stating that anesthesiologists need to get out in front of the patient more, especially in post-operative settings.
On the American opioid epidemic
According to the CDC, prescription opioids were associated with 19,000 deaths in 2014 — more than any year on record. As physicians who regularly administer pain medication, anesthesiologists are among those at the frontlines of this epidemic and will likely play a major role in potential solutions moving forward.
"We live in a world of drug addiction and dependence. This is a huge challenge in anesthesiology. How do we manage [opioid users] in the operating room and how to we find pathways and methodology to limit the pain they have during surgery as well as post-operatively," said Dr. Candido.
Dr. Sheinman added, "It's time for all anesthesiologists to start utilizing best practices to limit the amount of narcotics patients receive and use other forms of analgesics."