What Does the Future Hold for Ambulatory Anesthesia? Q&A With SAMBA's Dr. Michael WalshMichael Walsh, MD, is an anesthesiologist and a member of the board of directors for the Society of Ambulatory Anesthesia. He is an assistant professor of anesthesiology at the Mayo Clinic in Rochester, Minn.
Dr. Walsh and SAMBA have worked to develop and promote a clinical outcomes registry for anesthesia called SCOR. His organization also works continuously to promote ambulatory anesthesia.
Here are a few key points about SCOR, what SAMBA hopes to accomplish through the registry, and future trends for ambulatory anesthesia.
Question: How does SCOR relate to the future of ambulatory anesthesia?
Dr. Michael Walsh: I think the emphasis on outcomes and measuring outcomes is going to continue to be the next wave in healthcare [reform]. Everyone thinks they are doing a great job, but we are not sure we are measuring or benchmarking well. At the same time, the government is also putting pressure on inpatient settings to prove the value for outcomes for payments.
A couple of national registries are being put together now. Some have been looking at outcomes for surgery but not as much about anesthesia. [SAMBA] has developed an outcomes registry called SCOR. The thing that makes it different is that is has a single form for each patient. You get a very discreet collection of "this patient, with this outcome." It allows for risk-adjustment and comparisons with like procedures to like procedures, based on knowing which kind of cases and patients you are actually doing in your practice.
An abstract presented at the ASA annual meeting last fall described 50,000 cases in that registry. I may be a little biased, but it's exciting stuff. We are going to generate data and establish that value equation that is so important in payment schemes. The national registry is free for SAMBA members. We are trying to make sure that we are getting positive outcomes and a good value for our value equation. It's in its early stage of development, but growing by leaps and bounds.
Q: How is the ambulatory anesthesia industry reacting to other pressing challenges?
MW: We continue to battle our two biggest nemeses of pain and nausea and vomiting. There continues to be research in those areas. Most anesthesiologists will use a multimodal approach, utilizing medications with different mechanisms in order to minimize side effects, so it continues to be a hot topic. We are doing a lot more work in regional anesthesia and sending people home with catheters for post-op pain. They recently came out with a long-lasting bupivacaine for injection. We'll see if that allows us to send people home who last year we wouldn't have been able to discharge.
Q: What new procedures will move to the outpatient setting because of pain advances?
MW: It's hard to predict what new procedures will be done in outpatient settings, but think of procedures that are staying in the hospital over night because of the pain. With orthopedic procedures, if you can utilize a catheter, you could send them home. This is not new. With liposomal bupivacaine you might be able to send some of the plastic surgery patients home. You are also starting to see more gynecology cases go home too, but it's hard to predict what will be next.
Q: What is the biggest trend in your field for the upcoming year?
MW: We are at such a point in medicine of dramatic changes with the Patient Protection and Affordable Care Act that it's almost impossible to predict. There are going to be lots of changes and things are happening fast, but the general trend is consolidation in the ASC industry. We'll have to wait and see how it shakes out and what effects there will be on anesthesia coverage. Will ASCs be bought out by hospitals? Will they no longer be independent? Anesthesiologists are along for the ride on some of those trends.
Q: How will anesthesiologists deal with drug shortages?
MW: I think drug shortages will continue in the near term, until they can address the root causes for the problem. As anesthesiologists, we are trying to make due with what we have. Some try to make sure they have a stockpile of the most popular drugs. Propofol is such a versatile and effective medication in the outpatient world, and there are not a lot of great substitutions for that medicine. I think Propofol shortages are what we are worried about the most. It's frustrating when you are forced out of what you think would be the best anesthetic because the drugs aren’t available. And there are real differences in terms of recovery times and incidence of nausea and vomiting. The American Society is working hard to help solve this problem.
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