Anesthesia Management: ASA lecture: The Economics of the PSH: What Do Payers Want?

For physician anesthesiologists, much of the discussion of the Perioperative Surgical Home (PSH) model of care has focused on clinical processes, with its economic impact taking a back seat..

“We are tending to look at this from our own internal anesthesiology-driven perspective. But the reality is that payers are not always going to see things that way. That is why we wanted to have these speakers to convey to us what commercial and government payers want,” said Peter Dunbar, M.B., Ch.B., M.B.A., Vice Chair of the ASA Committee on Future Models of Anesthesia Care and a member of the PSH Steering Committee, who will lead the session. Two of the speakers are Jeff Thompson, M.D., of Mercer Healthcare, Seattle, and former director of the Washington State Health Care Authority, and Marc L. Leib, M.D., Chair of the ASA Committee on Economics and Chief Medical Officer, Arizona Health Care Cost Containment System, Phoenix. Mercer Healthcare works with major employers in Washington State on meeting the health care needs of employees.

“The third speaker is unparalleled in understanding anesthesia economics. He is the ASA Vice President for Professional Affairs. In addition to being an expert on Medicare, he has an encyclopedic knowledge of the economics of the practice of anesthesiology,” Dr. Dunbar said of speaker Stanley W. Stead, M.D., M.B.A., President of Stead Health Group, Inc., Encino, California.

“Dr. Leib will talk about the Medicaid system, Dr Stead will cover Medicare and Dr. Thompson will help us understand what major employers look for when they purchase health care,” Dr. Dunbar said. “I am hoping for an engaging panel where speakers can tell us what employers want and what government payers want, and we have someone who has a real understanding of the economics of anesthesia services as they presently work.”

One of the challenges for the acceptance of the PSH model is that under current reimbursement strategies, physician anesthesiologists are paid to be in the O.R. or to manage complicated patients, he said.

“We are not being paid to prepare the patient and we are not getting paid to coordinate care across the arc of their hospital admission,” Dr. Dunbar said. “Today’s economic incentives in anesthesiology are not aligned to produce the best outcomes. For instance, there is no real financial incentive to improve quality or reduce waste. The PSH is designed to improve quality and efficiency, but the model will only be truly sustainable when the monetary incentives are in the right places. I believe that the patients, their employers and government programs all want the same things ASA is aiming for in the PSH, but we need to understand the purchasers if we are going to get them to understand us.

“Most of the talks on the Perioperative Surgical Home are relating to the nitty-gritty work — how do we organize our pre-op or post-op clinics, how do we get a local bundle of care or how do we get people working together in teams? The talks in this session are reaching out to payers to find out what they want.”