The Expansion of Anesthesiology Leadership in ASCs: 4 Key Areas

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With the rise of regulatory burdens and the fall in reimbursements, ambulatory surgery centers face a challenging landscape. Surgery centers navigating this landscape can look to the anesthesia leadership at their facilities to help them survive and thrive. Anesthesiologists' roles at ASCs are expanding and they play an invaluable part in helping surgery centers do what they do best — provide cost-effective and high-quality care.
Dr. Bauss
"Looking to the future, ASCs seem ideally situated to be leaders in the provision of coordinated, patient-centered, high-value surgical care, says Lawrence A Bauss, MD, medical director at Surgery Center of Kalamazoo in Portage, Mich. "As we strive to provide a less fragmented healthcare experience for our patients, anesthesiologists must continue to provide leadership for the perioperative experience. Anesthesiologists are uniquely positioned to coordinate the care of the surgical patient from preoperative preparation, through discharge and beyond."

Here are four areas in which the anesthesiologist's role at ASCs is expanding:

1. Perioperative care. Anesthesiologists are becoming perioperative specialists rather than simply providing intraoperative anesthesia and immediate postoperative care, according to Dr. Bauss. It is possible for anesthesiologists to play an active role in the total medical care of the patient, which even surgeons may not be in a position to do.

"The basic fact is that anesthesiologists do more to determine the quality of a patient's total surgical experience than the surgeon, since they are focused on the whole patient while the surgeon is only focused on a specific anatomical site," says Tony Mira, president and CEO of Anesthesia Business Consultants. "It is this reality that is driving the concept of the Perioperative Surgical Home model."

According to the American Society of Anesthesiologists, the Perioperative Surgical Home model is a patient-centered, physician-led system of coordinated care. The model will broaden the anesthesiologist's scope of practice to promote standardization and improve clinical outcomes, notes the ASA.

The expansion of an anesthesiologist's role to include a greater emphasis on perioperative care will help improve patient comfort and safety, says Mr. Mira.

2. ASC productivity and cost savings. "The focus on patient comfort and safety is only part of the picture, though," says Mr. Mira. By assessing and preparing patients for their outpatient surgical experience and caring for them throughout, anesthesiologists can also enhance ASC productivity and throughput. "This can be a significant opportunity to distinguish one ASC over another," he says.

Anesthesiologists can provide highly individualized preoperative testing that can result in reduced costs while still providing necessary information. With more focused pre-surgical testing, patients previously not considered ASC candidates could be treated safely and discharged promptly, thereby increasing patient volume at an ASC.

Also, anesthesiologists have experience in reducing recovery times through the proactive management of anesthetic and surgical complications, which can lead to high patient satisfaction, says Dr. Bauss.    

3. Postoperative pain relief. Anesthesiologists play a vital role in intraoperative and postoperative pain relief as they can tailor anesthetics to quicken recovery and discharge and minimize the side effects that most concern patients. "Patient satisfaction surveys tell us that pain and postoperative nausea and vomiting are the primary concerns of our patient customers," Dr. Bauss says.

There is data suggesting regional anesthesia's superiority to opioids for postoperative pain management and morbidity reduction, and at the Surgery Center of Kalamazoo, anesthesiologists often use continuous nerve block catheters and the ON-Q Pain Relief System to reduce the need for opioids in patients.

"As we move into a new era of medical practice, it is essential that we strive to provide value-based, outcome-oriented and satisfaction-driven care," says Dr. Bauss.

4. "Big picture" approach. "There are many aspects of patient safety and comfort that have yet to be fully explored and developed," says Mr. Mira. "Data is key. The judicious application of some of today's powerful data capture and database tools allows anesthesia groups to understand enormous amounts of data about patient conditions and their responses to both surgery and anesthesia." By mining this data, anesthesiologists can help guide perioperative care at ASCs to improve clinical protocols and further minimize complications.

Anesthesiologists can also provide a "big picture" approach by assessing the relative cost of ASC processes, says Dr. Bauss. For example, the cost of equipment and supplies for providing regional anesthesia techniques may be lower than the often-overlooked costs of prolonged post-anesthesia care unit stays for pain or nausea.

"As we move forward in a 'pay for value' system, these types of assessments will be critical to the financial stability of our ASCs," says Dr. Bauss.

According to Mr. Mira, each year a higher percentage of cases are performed in ambulatory or outpatient facilities, and to a large extent, more effective anesthesia care is facilitating and encouraging this change.

"These are exciting times to be involved in medicine if we recognize the potential for new paradigms that improve the overall care of our patients," says Dr. Bauss. "It is a perfect time as an anesthesiologist to more fully apply the expertise we have gained over the years."   

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