10 Ways to Improve Anesthesia in Your ASC

Here are 10 tips on using your ASC's anesthesiologists to help save money, promote efficiency and build a great relationship among your staff.

Saving money and promoting efficiency

1. Invest in the right equipment. Certain pieces of equipment make it easier for anesthesiologists to do their job and thus improve ASC efficiency, while other equipment is not as essential, says Doug Yunker, MD, an anesthesiologist and medical director at Upper Arlington Surgery Center in Columbus, Ohio. Here are some examples:
  • Ultrasound. Use an ultrasound for regional blocks. The ultrasound system costs $40,000 but it provides a more accurate reading.
  • Intubating device. The Gliderscope, which costs about $9,000-$10,000, helps the anesthesiologist intubate patients. Without this device, intubation can take a while for some patients, frequent attempts can make them hypoxic, and in some cases intubation is not possible and surgery must be called off.
  • BIS monitor. On the other hand, a BIS monitor for brain waves may not be needed. "We've used it at the hospital and not found it to be helpful on a routine basis," Dr. Yunker says.
From: 4 Ways to Improve ASC Profitability From an Anesthesiologist's Perspective

2. Partner with exceptional anesthesiologists for your ASC. One of the keys to efficiency in an ASC is the pre-op and post-op process, says Raviv Chopra, principal and CFO for The C/N Group. When you look at some of the more acute surgical specialties — orthopedics is one where this is critical, Mr. Chopra says — you need to maintain an efficiency mindset without compromising patient safety and comfort.

"Your anesthesia can make a difference," he says. "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. Again, you want to maintain safety and quality without having patients clogging up your post-op recovery room.

From: 3 Ways to Improve Your ASC's Processes and Overall Efficiency: Anesthesiologists, Room Turnover and Cash Cycle

3. Implement standardized pre-op assessment criteria across all anesthesia providers in the anesthesia group. To maximize ease and convenience of patient preoperative evaluation, with a goal of eliminating same-day cancellations and the elimination or reduction of redundant preoperative laboratory requirements, specific pre-op guidelines are set and disseminated to surgeons and facility staff, says Susan Kizirian, COO for ASCOA. "When all anesthesia providers follow these same protocols, everyone is on the same page, eliminating confusion and case cancellations," Ms. Kizirian says. "Any variance to the protocol allows immediate evaluation for patient appropriateness and subsequent testing and evaluation as necessary."

From: 3 Steps to Involve Anesthesia in ASC Cost Reduction Efforts

4. Don't hire; contract out. Rather than hire anesthesiologists, Roanoke's physician-investors preferred to contract with a large independent anesthesiology group because it provided more flexibility. "An employee is on a fixed schedule," T.K. Miller, MD, president and medical director of Roanoke (Va.) Orthopaedic Center, says. "When there is no more work, you still have to pay him for the rest of the day." In contrast, when an anesthesiologist from the group is done at the ASC, he or she can go back to the hospital and do add-on cases there.

From: 4 Best Practices for ASC Anesthesia: Roanoke Orthopaedic Center.

5. Discuss expectations about equipment purchase when you are selecting an anesthesia group. Sometimes an anesthesia group will request an expensive piece of equipment your surgery center can't afford. "If you have an anesthesia group that comes in and wants a certain kind of scope for difficult intubations, then the next group comes in and wants something different," that gets expensive, says Vicki Edelman, administrator of Blue Bell (Pa.) Surgery Center. "Discuss equipment before you sign anything."

She says equipment purchasing is one reason to invest in a great anesthesia group and make the effort to keep them in your center. If you keep the same group over a number of years, you will probably have to change your equipment less often, and your center will suffer less transitional stress. "Maintaining the stability of a group within your center is optimal," she says. "It's not good for the ASC to have two, three or four different groups within four years, because then the community and [other providers] see that you're not easy to work for and with."

From: 4 Critical Steps for Selection of a Quality ASC Anesthesia Group

Building good relationships with anesthesiologists

1. Align anesthesiologists with your ASC's interests by giving them a financial investment in the center.
Sandy Berreth, administrator of Brainerd Lakes Surgery Center in Baxter, Minn., says the challenge of aligning anesthesiologists with the financial interests of an ASC can be overcome by giving the anesthesiologists a financial investment in the center.

Her advice: Get your anesthesiologists financially involved by making them a part of the governing body of the center. This could mean making an anesthesiologist a medical director or a board member and letting them vote on process changes. "The ability to vote on the decisions that matter to them can make your anesthesiologists more engaged in the processes at your center," she says.

For Ms. Berreth, whose physicians and staff are financially motivated by part-ownership and bonuses, respectively, the anesthesia group often seems oddly distant from the center's goals and interests. "Your surgery center is only as good as the people and processes you have in the surgery center," she says. "You want your anesthesiologists financially invested [by purchasing shares or sitting on the board] instead of feeling like outsiders."

From: Follow This Best Practice to Better Align Anesthesiologists With Your ASC

2. Appoint a strong medical director. If your medical director is a respected presence, you can guarantee a strong ally. Theresa Palicki, administrator of Eastside Surgery Center in Columbus, Ohio, says ASCs can make the mistake of appointing a "low man on the totem pole" who is brand new to the group as director. Instead, you want a medical director who has been an integral part of the group for a few years and has clinical experience that other anesthesiologists respect. "If things need to be changed in the anesthesia group and you have to send someone inexperienced to talk to the anesthesiologists, they won't listen," she says. Eastside Surgery Center's current medical director is president of the entire anesthesia group. Because he has a lot of sway and connections to the community, he fights for the ASC by reaching out to surgeons and convincing them to joint the center.

From: 5 Ways to Improve Your Relationship With Anesthesiologists

3. Be truthful about scheduling. When a surgeon says a case should last two hours, it shouldn't then take four hours. "There needs to be truth in scheduling," says Thomas Wherry, MD, medical director of Health Inventures and principal of total Anesthesia Solutions. The chronically late or under-posted surgeon will have a significant impact on morale. Anesthesia groups tend to run tight schedules and will often travel to several locations. Running past the posted time for preventable reasons will certainly minimize their ability to cover other locations.

From: 4 Ways ASCs Can Improve Relationships Between Surgeons and Anesthesiologists

4. Recruit a nursing staff that will keep your anesthesiologists happy.
Ms. Palicki says anesthesiologist satisfaction often depends on the working relationship between the anesthesiologists and the nursing staff. "You don't want nurses that are too pedantic," she says. "You want nurses that follow the rules, but you also want them to look more at what's best for the patient than at the minute details of the policy."

From: 5 Ways to Improve Your Relationship With Anesthesiologists

5. Involve anesthesiologists in ASC operations.
Anesthesiologists have the primary responsibility of providing appropriate, excellent anesthesia that allows for a quick turnover, but a good group will not shy away from assisting with other aspects of the ASC's operations.

"They have to be team players," says Ms. Edelman. "They have to realize that if we need them to push a stretcher, give us a hand at moving a patient — we're all in this together. If they function like a team with us, it just makes everybody feel like we're all here for the same reasons and the right reasons."

From: 5 Elements of a Great ASC Relationship With Anesthesia Groups

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