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Maximizing reimbursement through anesthesia: 3 takeaways

As healthcare continues down the path of value-based care, ASCs take on more financial risk and must find ways to maximize reimbursements by improving performance regarding CMS' ASCQR measures.

High quality anesthesia services are becoming increasingly important for the fiscal health of ASCs. It's critical for ASC directors to properly assess anesthesia services. Areas of focus should be the service's use of metrics crafted in accordance with CMS conditions for coverage and compliance standards to internally measure quality, the placement of leadership management strategies to ensure staffing consistency and the service's investment in infrastructure to improve compliance.

During Becker's ASC Review's 23rd Annual Meeting in Chicago, Hugh Morgan, vice president of quality assurance with Somnia Anesthesia, discussed the importance of maximizing quality in anesthesia, citing anesthesia's involvement in every operational aspect of care and its potential influence on 50 percent of ASCQR measures. Optimizing anesthesia quality will continue to grow in importance as CMS adds anesthesia quality measures and commercial payers begin adopting value-based payment models.

"You really have to start thinking, 'what is my anesthesia service doing, how [is it] performing and quantifiably demonstrating value?'" said Mr. Morgan.

Here are three aspects of anesthesia to assess for quality.

1. Leadership and staffing: The ASC is a team sport and requires daily team leadership. An ASC's anesthesia leaders should be connectors across disciplines, working well with surgeons and nurses. Anesthesia services can often be spread thin across multiple locations. It's important to determine whether or not the anesthesia team is dedicated to the success of ASC or more focused on services for other facilities. According to Mr. Morgan, ASC administrators should also know who is accountable for the anesthesia team.

"This group, which often comes in and comes out, can leave you wondering who to call when there is a breakdown in compliance," said Mr. Morgan. "You have to know who you can call if there is a breakdown or if there is something not going in the direction you need it to go in."

Additionally, the ASC should push to maintain consistent anesthesiologist staffing to avoid a "revolving door of providers." Regular staffing changes can result in inconsistent standards, which will ultimately lead to unpredictable quality and safety.

2. Compliance and quality: An ASC's anesthesia group should work to meet CMS' compliance conditions for coverage, and quality assurance and performance improvement standards by measuring clinical outcomes and reviewing this data with ASC administrators, quantifiably demonstrating the value of the anesthesia services being provided. Patient satisfaction pertaining to anesthesia should be measured with anesthesia specific preoperative and postoperative satisfaction surveys. ASC directors should also be involved with evaluating anesthesia staff.

3. Investment: Pressure to comply with new and growing reporting measures instituted by CMS is intensifying for anesthesia services, and the cost of keeping up with these requirements is significant. According to Mr. Morgan, a key question ASC should about their anesthesia services is, does my anesthesia team have the invested infrastructure and resources to keep up with healthcare reform challenges, and if not, how can I help?

"A lot of these groups just don't have the resources and infrastructure to keep up with the new demands of quality reporting," said Mr. Morgan. "It's time to sit down and have a candid conversation with your anesthesia provider."

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