Involving Anesthesia in Transparency and ACOs: Q&A with Somnia Chief Medical Officer Dr. Rob Goldstein

Rob Goldstein, MD, chief medical officer for Somnia, discusses the role of anesthesia in an ACO and the benefit of involving anesthesia providers in transparency initiatives.

Q: What is the role of transparency in an accountable care organization?

RG: An ACO is comprised of clinicians who transparently share in the decision-making process and are thereby willing to be accountable for true patient-centered care. The concept of an ACO centers on the idea that everyone wants to understand the care that is provided, what it costs and what quality outcomes it produces. Organizational relationships and all relevant clinical, legal, and administrative processes within the ACO should be clearly defined and transparent to physicians, other healthcare professionals, and the public. One way to improve transparency is by collecting and providing data to those it impacts. Transparency also requires that expectations are clear to all stakeholders. This is an element of the process that often gets lost in translation.

Q: What is the value and importance that anesthesia will play in an accountable care organization?

RG: Anesthesia is extremely important to accountable care organizations because as a specialty, we impact so many different care areas throughout the facility. Whether it's in ambulatory care, inpatient care, the OR, ICU, obstetrics or the radiology or GI suite, almost every element of the hospital is impacted or touched by anesthesia.
If an accountable care organization wants to understand how a facility is performing, anesthesia will play a critical role in that assessment. In order for the hospital to be comfortable and confident in reporting on what and how they're doing, they need an extraordinarily sophisticated and professionally managed anesthesia group. The group should be transparent on how they're performing and understand the hospital's expectations.

Anesthesia can provide the ACO with essential operational support and fiscally-sound decision-making through what we are calling an Accountable Anesthesia Organization or AAO. An Accountable Anesthesia Organization serves as a transparent, collaborative partner in the delivery of high-quality and cost-effective anesthesia care. 

Q: What is the value of an Accountable Anesthesia OrganizationTM (AAO) to its patients? What is its value to the facility or facilities it serves?

RG: An AAO's primary focus is improved quality of care and cost-efficiencies. AAOs need to quantify the quality of care and lower cost; they need to be patient-centric and measure the success of that approach; and they need to make evidence-based decisions about care.

Quantifying quality of care means going beyond regulatory and accreditation compliance. The facility should measure performance and outcomes and feed that information back to clinicians so they can strive for higher outcomes and better performance. There also needs to be alignment as it relates to cost of care. Anesthesia departments are often misaligned because someone else is managing the department's budget. As a result, Anesthesiologists may forego less expensive options for the delivery of safe and effective care simply because they are not aware of the cost. They're not matching evidence-based protocols and cost to improve overall utilization of resources. 

Anesthesia departments need to get feedback from hospitals in the form of satisfaction surveys. HCAHPS surveys now require performance evaluations of departments of surgery and anesthesia, and that evaluation has a big impact on the hospital bottom line. There needs to be processes to evaluate and capture that data to then improve the patient experience. In the ideal continuum of care, the anesthesiologist takes care of the patient before they arrive in the hospital through a pre-op clinic, then continues care through surgery and manages care post-operatively. We need to know how well we're doing and how our actions impact the bottom line throughout that continuum. Evidence-based protocols are very important to overall cost and quality.

Q: What is the potential impact on the clinicians employed by an AAO?

RG: There is an element of uncertainty in the community because a lot of anesthesia groups are being asked to be accountable, but they don't know what that means. The clinicians don't fully understand the standard or how to meet it, so they get defensive and meet the minimum standard thrust upon them rather than being proactive. The benefit of an AAO is that it provides an "aha!" moment where the clinicians realize they don't have to be defensive. Instead, there's a framework they can use to improve patient care and patient outcomes while containing cost. The clinicians can collaborate with the department and the hospital because everybody’s goals are aligned.

For physicians, AAOs will increase coordinated care and offer a complete view of the patient.  As a result, clinicians are more professionally satisfied and more productive. The work environment improves. Anesthesia departments are strained and stressed about the idea of being "accountable," so AAOs are very comforting to clinicians because they dispel the myth that accountability will disrupt clinical practice. Having Somnia involved also gives clinicians greater job security, which is really important. If your department of anesthesia is underperforming, your job is at risk. When you have a partner to improve clinical outcomes and save money, you can enjoy greater job security.

Learn more about Somnia.

Read more advice from Somnia and its clients:

-8 Steps to Building a Truly Transparent Hospital

-Rules for Beyond-Use Dating of Medications Drawn Into Syringes: Q&A With Anesthesiologist Dr. Clifford Gevirtz of Somni

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