5 strategies to transform anesthesia for your ASC

ASC owners and administrators frequently utilize simple heuristics when selecting anesthesia providers, often limiting selection criteria to coverage availability, cost and surgeon relationships.

This approach implies that many surgery center leaders and owners view anesthesia as a commodity, defined by Investopedia as:

“A basic good . . . that is interchangeable with other commodities of the same type. Commodities are most often used as inputs in the production of other goods or services. The quality of a given commodity may differ slightly, but is essentially uniform across producers.”

That anesthesia serves as an input in producing surgery is unquestionable. However, by viewing anesthesia providers as interchangeable or delivering uniform quality, ASC leaders and owners leave value on the table.

Anesthesia can differentiate surgery centers. Below details five strategies for enabling ASC differentiation via anesthesia.

1. Make Anesthesia a Growth Engine
Anesthesia can help surgery centers drive growth by:
• Enabling new service lines and
• Directly contributing cases.

New Service Lines
Total joints represent a salient example of an anesthesia-supported service-line addition. Vizient projects the proportion of primary hip and knee replacement surgeries performed in outpatient settings will double by 2026, and due to the lofty margin potential associated with these cases, virtually all multi-specialty and orthopedic-focused ASCs want to develop joint programs. In doing so, ASC owners and administrators are well-served to acknowledge that not all anesthesia groups are created equal.

Efficaciously caring for outpatient joint-patients requires anesthesia that minimizes post-surgical nausea and vomiting and maximizes ambulation. Furthermore, patient-selection comprises another determinant of outpatient joint programs’ success, and anesthesia providers should heavily contribute to, if not lead, pre-surgical testing (PST) and resultant decisions on patients’ readiness for ambulatory joint procedures.

Partnering with anesthesia groups that have direct experience with outpatient joints and have codified that experience into PST and care protocols not only drives better patient outcomes, but also gives orthopedic surgeons confidence in transitioning appropriate cases to surgery centers.

Case Contributions
Interventional pain management (IPM) represents the archetypal example of an opportunity for anesthesia to contribute cases to ASCs. Again, in this regard, not all anesthesia groups are created equal.

Many surgery centers have experienced the frustration of purchasing equipment and dedicating space for an anesthesia-led pain management program, only to see volume projections fail to materialize. Anesthesia groups that have demonstrated clinical and business capabilities to stand-up de novo pain management programs and integrate those programs into centers’ overall care continuums mitigate the risk that ASCs’ IPM investments fail to generate ROI. Equally important is working with an anesthesia group that understands and complies with regulatory guidelines when adding IPM services to its clients’ sites to avoid risking Anti-Kickback violations.

2. Use Anesthesia to Enable Disruption
Anesthesia-supported ASC volume growth opportunities are not limited to total joints and pain. For the first time in the industry’s history, healthcare underwriters (employers, health insurers and consumers) care about the lower cost and superior quality offered in outpatient settings. In 2016, health plans responding to a Change Healthcare survey projected an almost 33% reduction in fee-for-service business through 2021, offset by growth in value-based payment models. Exploiting this newfound interest in value requires that ASCs enter into innovative reimbursement arrangements, designed to steer volume to the optimal site of service.

ASCs’ success inside bundled, pay-for-performance, shared savings and similar reimbursement models can be easily derailed by an ill-prepared or abstaining anesthesia group. Moreover, most private anesthesia groups are ill-prepared to take risk, as private groups tend to distribute earnings, versus retain and invest earnings to fund transformation.

Therefore, the ASCs that are most successful in value-based strategies will have anesthesia groups that enable (instead of encumber) their strategies. This means securing an anesthesia group that offers: direct experience inside alternative reimbursement arrangements, a sophisticated managed care contracting team, data assets and analytical resources required to undertake risk and intellectual capital (e.g., care protocols, technology) that reduces waste and standardizes care to best-practice.

3. Operationally Integrate Anesthesia into the Team
Beyond adding cases, anesthesia can drive increased ASC distributions by identifying and leading efforts to:

• Improve on-time starts, enabling reduced labor spend or increased volume (through capturing latent demand),
• Reduce turnover time, enabling reduced labor spend or increased volume,
• Compress schedules, enabling reduced labor spend and
• Optimize the supply chain, enabling reduced drug costs.

Of course, most anesthesia groups (1) do not view the above performance improvement (PI) initiatives as their responsibility and (2) are not positioned to meaningfully contribute to PI initiatives. ASCs that partner with anesthesia groups that have readily accessible data-assets and analytical resources to support PI initiatives, as well as cultural and financial incentives for anesthesia team members to contribute to their clients’ operational success, create the ability to generate outsized profits and distributions.

4. Leverage Anesthesia to Improve Service
Just as anesthesia can help surgery centers improve operations, it can help surgery centers improve service. The past decade has seen an unprecedented level of healthcare cost-shifting from employers to consumers. According to the CDC, almost 45% of Americans, aged 18-64 with employment-based health insurance coverage, are enrolled in high-deductible health plans, up from about 15% in 2007.

As a result of this cost-shifting, consumers actively “shop” for healthcare with ever-increasing frequency. Like for any good or service, however, cost is not consumers’ only consideration when healthcare shopping. Service, often manifesting itself in the form of online reviews, can function as a deciding factor when patients chose between one ASC and another.

Thus, the old joke, “Anesthesiologists and CRNAs don’t have to be nice. They just put patients to sleep,” no longer applies. Conversely, the anesthesia team should be a key-contributor to delivering on ASCs’ ideal patient experiences/brand promises. Centers that want to stand-out and use exceptional service to drive awareness and volume should seek-out an anesthesia partner that has:

• Drafted, tested, defined and implemented service standards for patients and patients’ families,
• Built and implemented tools (i.e., surveys) to measure service performance and
• Invested in technology to enhance the patient experience.

5. Create a Strategic Partner
Finally, ASCs that leverage anesthesia to differentiate will expect their groups to provide clinical leadership for their centers, in lieu of simply purveying staffing models. This requires that anesthesia:

• Actively engages in or leads PI initiatives,
• Actively engages in efforts to add or strengthen clinical services,
• Enhances the patient experience, through technology and standardization of service to best-practice,
• Shares performance metrics (quality, cost and service), regularly, and collaboratively develops corrective action plans when warranted,
• Proactively shares and implements cost, quality and service improvement opportunities and
• Dedicates local and regional (if applicable) leadership to the surgery center.

In part, because of the low standard to which most centers have held their anesthesia providers, the above seems utopian, mythical and unrealistic to many ASC partners and administrators. Nevertheless, anesthesia groups that can deliver on the above exist. Typically, such groups have intentionally invested in creating anesthesia leaders through leadership training; at-risk compensation packages, tied to client (ASC) objectives; and overt, cultural expectations for Chiefs to provide perioperative leadership, instead of solely overseeing staffing.

A Call to Action
Modern healthcare is too complicated for ASC owners and administrators to limit expectations of their anesthesia providers to coverage, cost and likable clinicians. The time has come for ASC principals and leaders to evaluate anesthesia options in-terms of each group’s ability to differentiate their center. In the future, the most successful surgery centers are likely to expect more and, therefore, get more from anesthesia.

Thomas Dixon (tdixon@napaanesthesia.com) is a Business Development Officer at North American Partners in Anesthesia (NAPA), 2018’s top-ranked anesthesia vendor, according to Black Book Research. Dr. Michael Loiacono (mloiacono@napaanesthesia.com) is an anesthesiologist now serving as Senior Vice President of Clinical Operations for NAPA.

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