Author: Tony Mira
The training of anesthesia providers focuses on the clinical skills necessary to manage patients safely and comfortably through the trauma of surgery. The irony is that, ultimately, the quality of care provided has little to do with the ongoing viability and success of the practice. The time has come to refocus practice management goals.
We all know that anesthesia is an essential element in the running of an operating room. It is the anesthesia provider who makes it possible for the surgeon to successfully perform the procedure. Patients must remain motionless, be pain free and not have any unexpected reactions to the trauma of the surgery. Many would even say that anesthesia providers do more to determine the quality of a patient’s overall surgical experience than the surgeon. Then, again, this is what anesthesiologists and CRNAs have been trained to do; so, this is what is expected of them. The fact is that most patients are at greater risk driving to the hospital than undergoing anesthesia for surgery. So, what is the big deal?
Anesthesia providers have become the unsung heroes of the operating room. In the seventies and eighties, many large groups chose providers with high clinical skill and would accommodate those with less-than-optimal communication skills. How things have changed! As it became known that anesthesiologists were among the top physician income earners, it started to attract the best and the brightest residents. Ironically, the arcane world of the anesthesia provider became a clinical niche in which his/her realm was defined by the four walls of the operating room. Little was expected of these providers who showed up for their cases and then disappeared out the door. Although anesthesia providers prided themselves on delivering a quality clinical experience, market realities have come to make what happened outside the operating room more important to their future success than the actual skills they provided. Too often, anesthesia practices have found themselves captive to the hospital and its staff for their income and lifestyle. The practice management challenge has become one of influence and control. How can an anesthesia practice effectively influence the factors that determine the profitability of the practice?
The specialty has been undergoing some refocusing. It was particularly significant that the ASA decided to hold its first practice management seminar in 1994. Since then, practice management has become a critical aspect of the management of all practices. This has become evident in payer contracting and the negotiation of facility contracts. Most practices have come to understand the need for professional management. The ASA has played a significant role in promoting a concept that focuses on a role anesthesia providers can play in managing patients through the entire perioperative continuum. While many anesthesiologists have actively promoted the concept of the perioperative surgical home, not all are such active supporters.
Solutions to Current Concerns
What then, are practical strategies that the typical anesthesia practice can pursue to enhance the relationship with the facility and allow them to exert more influence and control? We often say that, when you have seen one anesthesia practice, you have seen one anesthesia practice. While each practice has its own set of challenges and opportunities, there are at least three aspects of the management of the practice that can greatly enhance the degree of partnership with the facility.
The first of these management strategies is customer service. This has become one of the most important factors to hospital administrators. As managing a hospital becomes increasingly complex and challenging, it is increasingly important that each specialty supports and enhances the quality of the patient’s overall clinical experience. As has been said many times, administrators want three things from anesthesia: ability, affability and availability. Because customer satisfaction is determined by the customer and not the provider, it has become essential that practices constantly test their ability to meet and exceed the expectations of the administration and the surgeons. There are various tools that can be used to accomplish this but the most important tool of all is communication. Today’s practices need to have an ongoing and meaningful dialogue with administration. It does no good to only meet with administration when it is time to renew the contract.
The second management tool is data sharing. Anesthesia has more and better data about what actually happens in the operating rooms and delivery suites. The question is how it is used. While billing data can be quite useful in the management of the practice’s cash flow, this does not necessarily help the facility. The time has come for practices to open their databases to administration. There are a number of dimensions of the anesthesia database that are of great interest and value to administration. It turns out most administrators don’t fully appreciate the economic challenges of anesthesia. Utilization statistics and profitability calculations by venue can be used quite effectively to enhance the dialogue with administration. We often say that the greatest challenge facing most anesthesia practices is generating enough revenue to recruit and retain a sufficient number of qualified providers to meet the coverage expectations of the facility. The only way to reset those expectations is by sharing data.
A third arrow in the group’s management quiver involves working with administration to define and defend their mission parameters. Historically, anesthesia practices have been somewhat passive in their response to hospital expectations and requirements. The administration would tell the group to jump, and the response would be, “how high?” This has resulted in what consultants refer to as scope creep—a phenomenon where the service expectations keep expanding. The time has come to become more pro-active in identifying opportunities for process improvement and cost management, and that means having a frank and fruitful discussion with your facility administrator. The idea is to be seen as part of the solution, not the problem. Establishing scope limits and pointing out opportunities for more efficient usage of space and personnel, for example, may bring about a win-win for both group and hospital.
Too many practices will lose their contracts or become absorbed by larger entities. To some extent, this is an inevitable consequence of an increasingly competitive medical marketplace. However, it is not always necessary or the best option. Strategic advisors often remind us that the beliefs and strategies that got us to where we are today will not get us to where we need to be tomorrow. This is both the challenge and the opportunity of the current environment.