Anesthesiologists have long talked about the transition to perioperative medicine and how this shift will affect the specialty. Leading institutions have already made the move. And the lessons they have learned along the way can help smooth the shift for others.
“Perioperative medicine is no longer in the talking phase, it is in the action phase,” said Annemarie Thompson, M.D., Professor of Anesthesiology and Medicine at the Duke University Medical Center. “Some institutions have led the way in perioperative medicine, and many others are interested in establishing a perioperative medicine service. We all want to do the right thing for patients, and there are some powerful financial incentives moving us in the same direction”
Dr. Thompson will moderate Tuesday’s session “Perioperative Medicine: Practicing on the Edge,” a panel discussion on the practical aspects of anesthesiologist-led initiatives. Panelists from U.S. and U.K. institutions will discuss the successes, the challenges and the pathways leading to anesthesiologist involvement from preoperative through postoperative care, including ICU settings.
“I trained as an internist and remember doing perioperative medicine consults,” Dr. Thompson said. “When I got into my anesthesiology residency, I started wondering why anesthesiologists aren’t also active in a perioperative consult service. Years later, we are.”
It is not that anesthesiologists are trying to supplant internists, surgeons, critical care physicians and other providers, she said. In modern practice, anesthesiology is the one specialty that spans the entire range of patient care from intake through surgery to discharge.
Anesthesia-led perioperative medicine is not a controversial approach, Dr. Thompson said. But anesthesiologists must respect the vested interests that other specialties have in the perioperative episode.
“That means the inclusion of surgeons, internists and critical care physicians who have an interest in the excellent care of patients,” she said. “We all want the best outcome for patients. And we all recognize that there are important financial incentives moving us toward the creation of perioperative medicine pathways.”
The move toward bundled payments and outcomes-based reimbursement reinforces the need to provide coordinated care that is focused on providing the best outcomes in the most cost-effective manner.
“If our services are not as efficient and our outcomes are not as good, or if our patients do not appear to value our services, we will lose out to other hospitals or systems that are better coordinated and do a better job of getting more providers on the same page in thinking about and providing patient services,” she said. “It is what payers want and, most importantly, it is what patients want.”
At this point, perioperative models are still in the formative stages, the pathways still being explored and refined. Not every anesthesiologist is interested in moving out of the O.R. and into what is still an informal subspecialty within anesthesiology, Dr. Thompson said.
“For those who are interested in high-visibility, multidisciplinary collaboration, there is no more fertile space than perioperative medicine to forge these new connections with hospital administration, surgical colleagues, internal medicine and critical care,” she said. “This session is about a new space for people who want to see and build the broad role that anesthesiologists can play in the hospital system.”