Shaina Drummond, MD, of UT Southwestern in Dallas shares her top three concerns in the healthcare field today:
1. Healthcare consolidation: Over the last several years we are seeing a trend towards large anesthesia managed care companies and/or hospitals purchasing private practice anesthesia groups in order to gain market share, resulting in the employment of physicians. Usually consolidation results in an adjustment of the workforce to maximize collections and reduce expenses. Proponents of consolidation feel that large entities have better bargaining power for network reimbursement, the ability to expand the number of in-network anesthesia providers, provide more opportunities to collect data for quality improvement projects, and offer more subspecialized anesthesia care (i.e. preoperative clinic, critical care, acute and chronic pain services). Critics argue that consolidation typically results in increased workload for employed physicians, decreased physician job satisfaction, decreased salaries, the elimination of partnership tracks, the need for fewer anesthesiologists, increased medical direction/supervision of CRNA’s, decreased opportunities for solo MD provider anesthesia, less input into practice management changes and removal of group stipends to help cover falling anesthesia reimbursements.
2. Scope of Practice Expansion: It is a well-known fact that many states are allowing certified registered nurse anesthetists to practice anesthesia independently without the presence of a physician anesthesiologist. The Department of Veterans Affairs has recently set forth a proposal called the VHA Nursing Handbook, which seeks to expand the scope of practice of advanced practice nurses at the VA. The policy was designed to address the shortage of primary care physicians in the VA system in hopes of decreasing patient wait times. However, while there are shortages of other healthcare providers in the VA, the agency’s own data indicate that there is no shortage of physician anesthesiologists. The most controversial elements of the document are proposed changes to VA’s current surgical anesthesia care delivery policies. Specifically, the changes would abandon the current physician-nurse team-based model of anesthesia care in VA and allow independent practice of all certified registered nurse anesthetists at the VA. This proposal is not in line with the current team based approach to healthcare being utilized by most medical institutions and hospitals around the country. In addition, The Centers for Medicare and Medicaid Services have ruled in favor of allowing payment for nurse anesthetists to practice chronic pain medicine, despite the fact that they have little to no requirements for any chronic pain medicine education during their training; whereas, physician anesthesiologists who practice chronic pain management have completed four years of residency training (usually with two to three months of chronic pain exposure), an extra year of training called a fellowship in chronic pain management, as well as subspecialty board certification in chronic pain management.
3. Proving our Value to Hospital Administrators and the Public: The era of showing up to work, doing your own cases in the operating room, and going home has come to an end. Physician anesthesiologists need to show surgeons, administrators, and patients that they are valuable members of the healthcare team. With constant changing healthcare reimbursement laws and the shift towards quality based care, the specialty of anesthesiology must find ways to show its value while at the same time provide care at a lower cost without compromising patient safety. Physician anesthesiologists must become more involved in the entire spectrum of patient care and not just the operating room. This will likely require innovative infrastructure changes for many anesthesia groups. Physician anesthesiologists will likely need to step out of their comfort zone by broadening their skill sets to include the preoperative, operative, and postoperative (ICU) phases of care in addition to assistance with discharge planning and home care (i.e. pain management). As these changes take place, it will also require anesthesia training programs to revamp curriculums to encompass a wider range of educational and leadership experiences outside of the operating room.
Learn more from Dr. Shaina Drummond at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.