The US healthcare sector is undergoing significant payment reforms, leading to the emergence of Alternative Payment Models (APMs) aimed at improving clinical outcomes and patient experiences while reducing costs. This scoping review provides an overview of the involvement of anesthesiologists in APMs as found in published literature. It specifically aims to categorize and understand the breadth and depth of their participation, revolving around 3 main axes or “Aims”: (1) shaping APMs through design and implementation, (2) gauging the value and quality of care provided by anesthesiologists within these mods, and (3) enhancing nonclinical abilities of anesthesiologists for promoting more value in care. To map out the existing literature, a comprehensive search of relevant electronic databases was conducted, yielding a total of 2173 articles, of which 24 met the inclusion criteria, comprising 21 prospective or retrospective cohort studies, 2 surveys, and 1 case–control cohort study. Eleven publications (45%) discussed value-based, bundled, or episode-based payments, whereas the rest discussed non–payment-based models, such as Enhanced Recovery After Surgery (7 articles, 29%), Perioperative Surgical Home (4 articles, 17%), or other models (3 articles, 13%).The review identified key themes related to each aim. The most prominent themes for aim 1 included protocol standardization (16 articles, 67%), design and implementation leadership (8 articles, 33%), multidisciplinary collaboration (7 articles, 29%), and role expansion (5 articles, 21%). For aim 2, the common themes were Process-Based & Patient-Centric Metrics (1 article, 4%), Shared Accountability (3 articles, 13%), and Time-Driven Activity-Based Costing (TDABC) (3 articles, 13%). Furthermore, we identified a wide range of quality metrics, spanning 8 domains that were used in these studies to evaluate anesthesiologists’ performance. For aim 3, the main extracted themes included Education on Healthcare Transformation and Policies (3 articles, 13%), Exploring Collaborative Leadership Skills (5 articles, 21%), and Embracing Advanced Analytics and Data Transparency (4 articles, 17%).Findings revealed the pivotal role of anesthesiologists in the design, implementation, and refinement of these emerging delivery and payment models. Our results highlight that while payment models are shifting toward value, patient-centered metrics have yet to be widely accepted for use in measuring quality and affecting payment for anesthesiologists. Gaps remain in understanding how anesthesiologists assess their direct impact and strategies for enhancing the sustainability of anesthesia practices. This review underscores the need for future research contributing to the successful adaptation of clinical practices in this new era of healthcare delivery.
See Article, page 24
As the healthcare sector in the United States undergoes significant payment reforms, there is an escalating focus on value—or healthcare outcomes achieved per dollar spent. Many Alternative Payment Models (APMs) have emerged, aiming to improve clinical outcomes, enhance patient experiences, and reduce costs.1 These changes, led by the Centers for Medicare and Medicaid Services (CMS), are influencing the entire landscape of healthcare delivery. With the introduction of the Quality Payment Program, along with the Merit-Based Incentive Payment System (MIPS), Advanced APMs, bundled payment models, and population-based Accountable Care Organization (ACO) models, both governmental and nongovernmental commercial payers are exploring and adopting these value-based initiatives.
This shift is gradually altering the roles of healthcare providers, with anesthesiologists in particular finding themselves at the forefront of many APMs due to their expanding role in perioperative patient management.2–4 Their involvement in these innovative payment and delivery models (also referred to as value-based care [VBC]) varies greatly, but for this review they can be characterized into 3 broad subject matter objectives or “aims”: (1) delivering impact through designing and implementing APMs, (2) accurately measuring their value and quality of care within these models, and (3) developing nonclinical skills to drive further value. This review was designed to generate summarizing results and insights for each of the 3 subject matter objectives.
The emergence of these APMs and the transition toward value-based healthcare is not only changing the healthcare landscape in the United States but also presenting new challenges and opportunities for anesthesiologists.5 Despite the abundant discussions on the theoretical aspects of applying VBC to anesthesiology, there has been a lack of comprehensive exploration of how these concepts are applied in practice.6,7 In light of this, the goal of this scoping review is to map out the existing literature on anesthesiologists’ involvement in APMs and VBC, identify the contributions made by anesthesiologists in the transition toward VBC, and highlight the areas requiring further research. By providing an overview of the current state of research in this field, we aim to identify gaps in knowledge, and ultimately, aid in the successful adaptation of clinical practices in this new era of healthcare delivery.
METHODS
Literature Search
A comprehensive search of 3 electronic databases (MEDLINE, Embase, Cochrane Control Register of Controlled Trials) was performed in January 2022. The methodology for this scoping review was guided by the outlines set forth by the Preferred Reporting Items for Systemic Reviews and Meta-Analysis Scoping Review extension (PRISMA-ScR) and Levac et al.8,9 The search was designed to identify publications from January 1, 2010, to December 31, 2021. The search strategy used a combination of keywords and their synonyms. Key search terms included “Anesthesiologist,” “Value,” “Alternative Payment Model,” “Accountable Care Organization,” “Bundled Payment,” “Bundle,” “Episode,” “MIPS,” “Savings,” “Shared Savings,” “Gainsharing,” and “Quality Metric.” For a detailed search strategy, refer to Supplemental Digital Content 1, Supplemental Table 1, https://links.lww.com/AA/E590. The results from all database searches were combined and duplicates were manually removed.
Selection of Sources of Evidence
The process of study selection began with an initial screening of the de-duplicated search results based on title and abstract, and full text if necessary. Two reviewers independently considered each potential source of evidence for inclusion, according to the following criteria: (1) the full-text version of the article was accessible in English, (2) the publication described health systems and/or payment structures based in the United States (noninternational), (3) the subject matter concerned human subjects (nonveterinary), (4) the study design was conducted via scientific methodology with moderate to high levels of evidence as based on the Oxford Centre for Evidence-Based Medicine (OCEBM), (5) the subject matter was relevant to at least 1 of the 3 categories of subject matter or “aims” that define the scope for this review. Relevance was determined based on specific criteria for each category. Relevancy to aim 1 was determined based on whether or not the publication demonstrated anesthesiologist participation or association with the process of establishing an APM. Relevancy to aim 2 was determined based on whether or not the publication discussed any metrics used for the explicit purpose of assessing anesthesiologist performance within an APM. Relevancy to aim 3 was determined based on whether the publication identified any characteristics, competencies, aptitudes, or experiences unrelated to clinical skills associated with desired outcomes in an APM setting. Publications may align with 1, 2, or all 3 of these aims. Discrepancies were resolved through discussion between the reviewers until consensus was reached.
Charting the Data
Two reviewers separately charted the data from each source that fulfilled the inclusion criteria, including author, year, journal, type of publication, type of institution, number of institutions involved, sample size of patient population, data collection method, clinical focus, APM or VBC model discussed, and relevance to each objective. A side-by-side comparison of these characteristics was performed across sources.
To assess methodological quality, we used the 7-component domain-based evaluation from the Cochrane Handbook for Systematic Reviews of Interventions for randomized controlled trials (RCTs), the Newcastle-Ottawa Scale (NOS; 8-component point-based evaluation) for case-control cohort studies, and a modified NOS (6-component scale) for observational studies without control.10,11 We also used the OCEBM (5-step grid system) to rank studies based off levels of evidence.12 In the event of RCTs being present, those with uncertain risk of bias in 2 or fewer domains would be deemed to be of high quality; and those with 4 or more domains with uncertain risk of bias or 1 domain with high risk of bias would be considered low quality. For case–control cohort studies that were evaluated based on NOS, those missing fewer than 2 components were considered high quality (ie, low risk of bias); those missing 2 to 3 components were considered fair quality (ie, moderate risk of bias); those missing more than 3 components were considered low quality (ie, high risk of bias).10 For observational studies without controls, those missing any of the 6 modified NOS components were considered low quality. In the case of opinion editorials and systematic reviews of the literature, no risk of bias assessment was conducted and these sources were approached with the presumption of the highest potential risk of bias.
Collating, Summarizing, and Reporting the Results
For each aim, we performed an inductive thematic analysis to recognize the primary themes in each of the selected sources.13 This approach involved meticulous reading and systematic coding, appropriate given our goal of generating summarizing results for our review objectives. For each source that met the inclusion criteria, the main findings related to our objectives were extracted and coded through line-by-line reading. The codes for each source were grouped based on similarities to inform the development of descriptive themes associated with each source. Each reviewer generated codes and higher-level descriptive themes independently. The reviewers then discussed each source’s descriptive themes to develop broader analytical themes that would link different sources and construct larger interpretive structures. The reviewers also utilized these discussion sessions to produce names and explanations for each analytical theme.
OVERALL RESULTS
Search Strategy Overview
Our initial search strategy yielded a total of 2687 articles. After excluding 498 international and 16 veterinary publications, we were left with 2173 articles. On further review for relevance to our objectives, we excluded another 2149 articles, resulting in 24 full-text articles for inclusion. The PRISMA flow diagram depicting the article selection process can be found in Figure 1.
These articles consisted of a diverse range of study designs, including 21 prospective or retrospective cohort studies, 2 surveys, and 1 case–control cohort study. We found that 75% of the studies were conducted in academic settings, while 79% were single-institution studies. The scope of the reviewed literature spanned several payment and nonpayment models. Specifically, 11 articles (45%) discussed value-based, bundled, or episode-based payments. The remaining articles discussed non–payment-based models, such as Enhanced Recovery After Surgery (ERAS; 7 articles, 29%), Perioperative Surgical Homes (PSH; 4 articles, 17%), or other models (3 articles, 13%). In terms of clinical focus, the articles covered various specialties including anesthesiology, orthopedics, obstetrics, cardiology, gastroenterology, oncology, and pediatrics (Table 1 and Supplemental Digital Content 2, Supplemental Table 2, https://links.lww.com/AA/E591).
| Relevance to study aim | Value |
|---|---|
| Aim 1 | 17 (71%) |
| Aim 2 | 7 (29%) |
| Aim 3 | 11 (45%) |
| Study type | |
| Prospective or retrospective cohort | 21 (88%) |
| Survey study | 2 (8%) |
| Case–control cohort study | 1 (4%) |
| Type of institution | |
| Academic | 18 (75%) |
| Private | 3 (13%) |
| Other | 3 (13%) |
| Institutions involved | |
| 1 | 19 (79%) |
| 2–3 | 4 (17%) |
| >3 | 1 (4%) |
| No. of patients in sample size (mean)a | 5865 |
| No. of patients in sample size (median)a | 623 |
| Data gathering method | |
| Electronic medical record | 16 (67%) |
| Hospital financial/accounting data | 1 (4%) |
| Survey/other | 7 (29%) |
| Clinical focus | |
| Anesthesiology | 5 (21%) |
| Orthopedics | 11 (45%) |
| Gastrointestinal, obstetrics, oncology, pediatrics | 4 (17%) |
| Other | 4 (17%) |
| Care model | |
| Value-based care | 2 (8%) |
| Bundled or Episode-Based Payment | 9 (38%) |
| Enhanced Recovery After Surgery | 7 (29%) |
| Perioperative Surgical Home | 4 (17%) |
| Other | 3 (13%) |
| Risk of bias | |
| Low | 12 (50%) |
| Moderate | 5 (21%) |
| N/A | 7 (29%) |
| Levels of evidence | |
| Moderate | 23 (96%) |
| High | 1 (4%) |
| Authors | Year | PMID | Aim 1 (n = 17) | Protocol standardization (n = 16) | Design and implementation leadership (n = 8) | Multidisciplinary collaboration (n = 7) | Role expansion (n = 5) | Aim 2 (n = 7) | Process-based and patient-centric metrics (n = 1) | Shared accountability (n = 3) | Time-driven activity-based costing (n = 3) | Aim 3 (n = 11) | Education on healthcare transformation and policy (n = 3) | Exploring collaborative leadership skills (n = 5) | Embracing advanced analytics and data transparency (n = 4) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tsang et al20 | 2021 | 34765887 | 1 | 1 | |||||||||||
| Klemt et al49,50 | 2022 | 34716766 | 1 | 1 | |||||||||||
| Taylor et al24 | 2021 | 34669504 | 1 | 1 | 1 | 1 | |||||||||
| Ferrara et al19 | 2022 | 34339616 | 1 | 1 | 1 | 1 | 1 | 1 | |||||||
| Beal et al22 | 2021 | 34128845 | 1 | 1 | 1 | 1 | 1 | ||||||||
| Kugelman et al51 | 2021 | 33937457 | 1 | 1 | |||||||||||
| Ellis et al17 | 2021 | 33546602 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||
| Chawla et al54 | 2021 | 33271324 | 1 | 1 | 1 | 1 | |||||||||
| Wyles et al16 | 2021 | 32978023 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||||||
| Allen et al55 | 2020 | 31866015 | 1 | 1 | 1 | 1 | 1 | ||||||||
| Martin et al7 | 2019 | 29511420 | 1 | 1 | |||||||||||
| Grant et al18 | 2018 | 29274837 | 1 | 1 | 1 | ||||||||||
| Kim et al56 | 2017 | 28632535 | 1 | 1 | 1 | 1 | |||||||||
| Ehrenfeld et al57 | 2017 | 28106608 | 1 | 1 | 1 | 1 | |||||||||
| Yanamadala et al25 | 2017 | 28067696 | 1 | 1 | 1 | 1 | 1 | ||||||||
| Miller et al44 | 2016 | 27871537 | 1 | 1 | |||||||||||
| Brooks et al58 | 2016 | 27785096 | 1 | 1 | 1 | ||||||||||
| French et al40 | 2016 | 27637823 | 1 | 1 | |||||||||||
| Brolin et al21 | 2017 | 27592373 | 1 | 1 | 1 | ||||||||||
| Sibia et al31 | 2016 | 27067175 | 1 | 1 | |||||||||||
| Oh et al59 | 2015 | 26412993 | 1 | 1 | |||||||||||
| Raphael et al45 | 2015 | 26222981 | 1 | 1 | 1 | 1 | 1 | ||||||||
| Gotlib et al46 | 2015 | 26183086 | 1 | 1 | 1 | 1 | 1 | ||||||||
| Foglia et al52 | 2013 | 23331799 | 1 | 1 |
With respect to our aims, 17 articles (71%) addressed the subject matter of aim 1, 7 articles (29%) addressed aim 2, and 11 articles (45%) addressed aim 3. We also found 10 articles (42%) related to multiple aims. The themes with the highest frequency for each aim were tabulated and evaluated based on relevance to the various aspects of APM development (Table 2). A visual summary of the extracted themes for each aim and their relevance to the various stages of APM development is provided in Figure 2.
Discussion: Themes and Implications
Within the perioperative environment, anesthesiologists are situated at the heart of recent APM demonstrations such as ACOs, bundled payments, quality-based reimbursement policies like MIPS, and innovative delivery pathways like the PSH and ERAS.14 The review found a rising trend of anesthesiologists not just as part of these processes but as leaders and drivers of health care transformation. The publications covered a range of topics, increasingly moving from theoretical principles to practical examples of anesthesiologist-led and anesthesiologist-supported multidisciplinary initiatives. We generated summarizing insights and identified key themes related to the ways in which anesthesiologists have made impactful contributions (aim 1), how these contributions are measured (aim 2), and the nonclinical capabilities that have been utilized for successful outcomes (aim 3) in APMs.
AIM 1: DELIVERING IMPACT THROUGH THE DESIGN AND IMPLEMENTATION OF APMs
Results
Our scoping review identified a wide array of themes associated with articles related to aim 1. The most prominent themes included: protocol standardization (16 articles, 67%), design and implementation leadership (8 articles, 33%), multidisciplinary collaboration (7 articles, 29%), and role expansion (5 articles, 21%) (Table 2).
Implications
Standardization of Protocols
A multitude of the articles we encountered stress the advantages of standardized anesthesia protocols within the framework of APMs, reflecting a recent shift in anesthesia practice. The perceived benefits of standardization included improved adherence to best practices, reduced chances of overlooking essential care pathway components, and enhanced capacity for quality improvement, among others.15 It appears that ERAS and PSH models regularly feature protocol standardization, with reported improvements in adherence to newly agreed-on protocols following standardization rollout.16,17 The broader impact of such standardization on patient outcomes and health care costs was also evident in a few studies.18–20
Our review also emphasized the integral role of anesthesiologists in the creation and implementation of these standardized protocols, highlighting the potential to leverage their expertise to refine APMs.21–23 Examples of such involvement were observed in various settings, including a large academic medical center’s surgical home.16 Further exploration in this area is necessary, especially considering the increasing prevalence of APMs.
Leadership Opportunities
Our scoping review highlighted the increasing leadership roles of anesthesiologists across the care continuum under APMs as a notable theme. Their clinical acumen and operational capabilities have been instrumental in driving the redesign of APMs, especially in ERAS and PSH transformations. Anesthesiologists are not just contributors to clinical pathway design but also implementation leaders across various APMs. The evidence affirms their influential role in administrative decision-making, shaping payment and care models to optimize perioperative care.16,17
Wyles et al16 showcased an anesthesiologist acting as Executive Committee co-chair in bundled payments implementation for total hip arthroplasty (THA) and total knee arthroplasty (TKA) with other anesthesiologists serving on committees and subcommittees. Ellis et al17 attributed their ERAS implementation success to a dedicated structure and the appointment of a physician anesthesiologist champion to drive culture change within perioperative services. Change management was aided by anesthesiology grand rounds, daily reminders to anesthesia providers, and individualized compliance and performance reports.17 These findings underscore the expanding and influential leadership roles anesthesiologists are undertaking in APMs.
Multidisciplinary Collaboration
A significant portion of our included articles pointed to the value of multidisciplinary collaboration for successful APMs. We noticed a recurring theme around breaking down traditional silos and fostering cooperative relationships among various perioperative stakeholders. This is particularly relevant to anesthesiologists, whose work often intersects with surgeons and nursing staff throughout all phases of acute care.23–25 Leahy et al23 emphasized the value of input from a diverse team, including perioperative nurses, quality improvement specialists, and administrative executives in building a pediatric PSH for laryngeal cleft repair.
Role Expansion
The evolution of anesthesiologists’ scope from operating room to perioperative management has offered novel opportunities under APMs. This review identified anesthesiologists’ significant role in perioperative patient-centered care, palliative care, and chronic conditions management. Emphasis is placed on proactive patient engagement, risk stratification, and postoperative goal discussions for optimal preoperative care adjustment.
The preoperative realm benefits significantly from anesthesiologists’ involvement in patient education, counseling, prehabilitation, and thorough preoperative testing.21 Anesthesiologists’ preoperative consults foster shared decision-making, which can enhance psychosocial optimization and patient-reported outcomes. The potential reduction in mortality rates and hospital length of stay (LOS) has been associated with anesthesiologists’ preoperative consults in various studies.26–28 These consultations also contribute to significant cost savings by minimizing unnecessary preoperative testing, increasing operating room throughput, and saving time.29
The anesthesiologists’ role is also expanding into postoperative care. Collaborations with physical therapy professionals are emerging to improve care transitions.16,24 These expansions offer an opportunity to develop and optimize analgesic plans, reducing postoperative complications.30 Sibia et al31 also identified anesthesiologists’ role in promoting same-day ambulation as part of an ERAS protocol, thereby reducing LOS and associated costs.
AIM 2: ACCURATELY MEASURING ANESTHESIOLOGIST VALUE AND QUALITY OF CARE WITHIN APMs
Results
For aim 2, the common themes were Process-Based & Patient-Centric Metrics (1 article, 4%), Shared Accountability (3 articles, 13%), and Time-Driven Activity-Based Costing (TDABC) (3 articles, 13%) (Table 2). Further, we identified a wide range of quality metrics that were used in these studies to evaluate anesthesiologists’ performance. These metrics encompassed 8 domains based on the Quality Payment Program: clinical outcomes, patient engagement experience, quality, efficiency, cost/resource utilization, and structural measures (Supplemental Digital Content 3, Supplemental Table 3, https://links.lww.com/AA/E592).
Implications
Process-Based Metrics and Patient-Centered Measures
In broadening the scope of anesthesiologist practice, it is essential to accurately measure the additional value they provide. The literature search conducted in this scoping review indicates a focus on process-based metrics which are centered on physician behaviors over patient experiences of care and outcomes.32 Our mapping of the literature highlights efficiency, cost/resource utilization, quality, and structural domains of measurement as recurring themes in anesthesia-specific quality and performance measures. Interestingly, patient-reported outcomes were underrepresented in the literature suggesting that while payment models are shifting toward value, patient-centered metrics have yet to be widely accepted for use in measuring quality and affecting value-based payment for anesthesiologists.
The scoping review also unveiled an increasing interest in patient-reported outcome measures (PROMs) and patient-reported experience measures, owing to their ability to encapsulate the immediate impact of care and long-term patient quality of life.33 Several perioperative PROMs, such as the EuroQol-5 Dimension (EQ-5D), the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS Global-10), and the WHO Disability Assessment Schedule (WHODAS 2.0) are recognized as robust measures for overall preoperative health status and surgical care outcomes.34 Despite the findings of this review, PROMs are accepted as a tool to measure overall preoperative health status and to assess the outcome of surgical care.33,35 They also appear to play a role in multidisciplinary decision-making and in assessing the impact of chronic pain on patient well-being.36,37 This provides a promising direction for further investigation into the integration of such measures into anesthesia-specific value assessment and reimbursement models.
Shared Accountability in APMs
The concept of shared accountability emerges as a key theme from the literature, particularly episode-based bundled payments. Certain cost and outcome measures beyond the initial 24-hour postsurgery (eg, LOS, unplanned readmission) are, by convention, mainly attributed to surgeons.32,38 Despite the challenges in determining jointly-attributable measures, anesthesiologists are well positioned to play a crucial role in influencing many metrics in APMs, including patient experience (pain control, postoperative nausea, vomiting, etc), operational efficiency, and cost/resource utilization.29 Strategies like shadow bundles used by some ACOs that allow anesthesiologists to manage subsets of services under their control are also noteworthy.39
Time-Driven Activity-Based Costing
From the studies scoped in this review, a clear pattern emerges underlining the importance of accurate cost accounting for value measurement and success in APMs.40 TDABC is recognized as an invaluable methodology, capable of providing a granular view of individual cost components, as opposed to traditional cost-analysis models. It captures the intricacies of healthcare workflows, quantifying costs at each step of a patient’s care journey.20,41 TDABC’s utility is illustrated by its application in studies, such as the comparison of 3 periarticular infiltration analgesic pathways for TKA patients20 and the evaluation of anesthesiology-related costs for 11 common oncologic outpatient surgical procedures.40 Another application of TDABC allowed for substantial workflow changes and anesthesiologist reassignment in acute pain management services for 610 thoracic procedures, resulting in 18% total cost savings.42 These instances underline TDABC’s pivotal role for anesthesiologists in understanding cost of care and enhancing value across various perioperative services.41
AIM 3: CULTIVATING THE NONCLINICAL CAPABILITIES ANESTHESIOLOGISTS NEED TO FURTHER DRIVE VALUE
Results
For aim 3, the main extracted themes included Education on Healthcare Transformation and Policies (3 articles, 13%), Exploring Collaborative Leadership Skills (5 articles, 21%), and Embracing Advanced Analytics and Data Transparency (4 articles, 17%) (Table 2).
Implications
Education on Health Care Transformation and Policy
The broader landscape of health care policies, including APMs, greatly influence the role and responsibilities of anesthesiologists. Clinicians must comprehend the variances between various APMs systems and fee-for-service payment, and the financial theories promoting shared savings between payers and providers.43 This understanding can be enhanced through more comprehensive education about quality metrics, billing and coding practices, CMS healthcare policy, and the various stages of patient care.17,22
The current literature underscores the urgency for anesthesiologists to comprehend the larger implications of governmental decisions and organizational dynamics on APM implementation. Suggesting a gap in the existing curriculum, it is indicated that further emphasis on this knowledge through continuous updates and spaced repetition throughout residency and fellowship, and within continuing medical education, is necessary.44
Exploring Collaborative Leadership Skills
The literature points to an evolution in the role of anesthesiologists, expanding from a solely intraoperative consultant to a more central figure in perioperative care teams.44 This expanded role necessitates anesthesiologists to develop leadership skills that promote interdepartmental cooperation and guide longitudinal patient care.16,17,19,35,45,46 The literature also highlights the importance of certain traits, such as empathy, emotional intelligence, and communication skills, in contributing to high-quality, team-based patient care in the operating room.28,47,48 Trustworthiness, credibility, reliability, and other leadership qualities are proposed to be key factors in this evolution, providing an area for further exploration and study.
Embracing Advanced Analytics and Data Transparency
As anesthesiologists assume more responsibility in perioperative care, the need for access and analysis of quality, operational, and cost data becomes essential. Advances in technology, such as machine learning and Artificial Intelligence (AI) predictive algorithms, facilitate the identification of patients at high risk for poor surgical outcomes and increased care costs.49 Studies by Klemt et al50 and Kugelman et al51 highlighted the potential of AI in accurately predicting discharge planning and outpatient versus inpatient status, respectively. For optimizing these data-driven tools, it is necessary to establish standardized, shareable metrics, the choice of which would depend on use case, scope, and clinical scenario.15,38,47,52 Dashboard utility is enhanced by fostering a culture of transparency and shared commitment to use data for positive clinical improvements.38 Increasingly, these dashboards are seen in APM/bundled payment models and MIPs, providing detailed scorecards on clinical outcomes, quality, and cost performance to providers and hospitals alike.53 As such, more research and evidence are needed to establish best practices for integrating these tools into clinical practice.
Limitations
Although our scoping review provided valuable insights into the role of anesthesiologists in APMs, there are inherent limitations. In our effort to provide a broad overview of a field, this review may lack the depth of analysis. Therefore, although we have identified key themes and trends, the detailed appraisal and synthesis of the evidence are not within the scope of this study. Despite our comprehensive search strategy, some relevant literature may not have been included due to indexing issues or because it was published in nonacademic outlets. Similarly, gray literature, which may provide additional perspectives, was not included in our search. Despite these limitations, this scoping review underscores the evolving role of anesthesiologists in APMs and invites further in-depth studies to understand the mechanisms, facilitators, and barriers to their effective participation in this transformative movement in healthcare delivery.
CONCLUSIONS
The overview of existing literature illustrates a growing trend toward improving health care value through the deployment of APMs that engage various stakeholders—patients, providers, and payers. Throughout this scoping review, we observed a recurring theme pointing to anesthesiologists as pivotal in the design, implementation, and refinement of these emergent delivery and payment models. Their unique position as perioperative experts not only allows them to navigate the shifting landscapes of healthcare delivery but also suggests their potential role in reframing the system’s perception of “value.” This review mapped the existing literature and identified the rich opportunities available for anesthesiologists to innovate and contribute to perioperative change, particularly through their engagement with APMs. It also revealed gaps in our understanding of how anesthesiologists assess their direct impact and strategies for enhancing the sustainability of anesthesia practices. Future research should focus on exploring these gaps, advancing our knowledge on anesthesiologists’ roles and contributions in this rapidly evolving area of healthcare.
REFERENCES