While the eventual fate of the Patient Protection Affordable Care Act (PPACA) will be decided in the near future, by either the Supreme Court or the next Congress and Administration, what is not open for debate is that healthcare has changed. As the business of medicine evolves to accommodate the changes called for in the healthcare reform laws, so should anesthesiologists anticipate their place in the new environment. The physician group that is able to make informed decisions will be best positioned to evolve and thrive in this era of change. Just like the old Saturday morning cartoon said, “Knowledge Is Power”; by gathering, understanding and responding to information, anesthesiologists can be certain to meet the needs of their clients and proactively position themselves as a catalyst for change.
One way of taking that proactive step is to use data to help shine a light on the inner workings of your anesthesia practice. It’s been said that the only things that get improved are the things that get measured. Using data, benchmarking and deriving best standards are proven tools that can help you improve performance and accomplish the goals of your organization. This article will discuss the types of information you can look at, some methods of collecting the data and how you can use that information to assess trends and meet the needs of your practice and its customers.
Where to Start
As you begin the process of gathering data, the first step you should take is to define exactly what you want to measure. It can be easy to get lost in a sea of numbers, figures and trends; deciding which have the greatest impact on your practice is key. You should decide on what the most important clinical and business goals of your practice are and then focus on what factors can help you achieve those goals and begin to measure them. There are many ways you can collect your data, much of which will become easier with an Anesthesia Information Management Systems (AIMS). However, until your hospital installs an AIMS, and you have effectively built a bridge to your practice management company or billing system, you will need to dedicate significant manual resources to gather and compile the data. There are a number of tablets and PC based products on the market that can help to automate part of the process and all options should be considered.
Data gathered over a long period of time, for a large numbers of providers and patient encounters will lead to a significant database which can be queried. Once you have that database, you can use a computer program as simple as Microsoft Excel or as complex as a robust Business Intelligence system to slice, dice and understand your data. Having a strong core team of analytical minds looking at your information is the best way to make heads or tails of what trends and information your data is telling you. Comparing your clinical data against one of the national anesthesia-specific Patient Safety Organizations (from either the Anesthesia Business Group or the AQI) can provide insight for your clinical outcomes data, while measuring against MGMA norms for your business results has long been the industry standard-bearer.
How Data Helps
As I said in my article published in the Summer 2011 issue of the Communique, Anesthesia: The Increasing Consolidation of our Industry, the days of anesthesiologists as passive participants in a hospital are over. In order to thrive, anesthesiologists must take a leadership position within their hospital, anticipate patient and surgeon needs and continue to demonstrate additional value outside of the operating room.
Anesthesiologists must align their goals with their hospitals and surgeons, while concurrently keeping their practice’sbottom line in mind. There are a limitless number of areas that physicians can use data to meet these goals; here are some which are key in 2012:
Accountable Care, Shared Savings & the Surgical Home—As the first rounds of Pioneer ACOs begin their efforts to more closely integrate health care and reduce costs, the need for anesthesia to take a lead role in the new innovations made possible under PPACA is clear. The need for anesthesia to become the “Perioperative Leader” in the hospital to quarterback surgical care is greater now more than ever.
Utilizing information you’ve gathered on the patient care experience before, during, and after surgery will help anesthesiologists seize the leadership mantle and provide the insight that’s needed to work closely in ACOs and other programs. Measuring clinical outcomes, helping to reduce re-admissions, and finding ways to increase efficiency will enable you to succeed.
Responding to New Service Requests—As procedures and cases move further outside the “four walls” of the hospital, anesthesiologists are being asked to provide services in areas historically not covered by anesthesia departments. Services such as interventional radiology, electrophysiology, gastroenterology labs, and cardiac catheterization labs are increasingly becoming regularly staffed anesthetizing locations.
If you’re able to analyze the data from past experience in these areas (such as average case length, room turnover, average units per case, cases per day, and typical start/end times for the service), you will be able to respond to service requests in an informed manner which will meet the needs of the surgeon and the hospital. If you’ve done your analysis correctly and respond in the most appropriate manner, this should also lead to additional, profitable cases for your anesthesia group.
Practitioner Reviews—The increasing regulations of hospital accreditation are having a cascading effect on physicians at the hospital. The Joint Commission’s requirements for practitioner review are a specific area where data will help today’s anesthesiologist. Focused Professional Practice Evaluations and Ongoing Professional Practice Evaluations (FPPE/OPPE) standards require that each clinician be reviewed regularly to ensure the ability to meet their medical staff privileges.
As you build your database of clinical outcomes, the ability to review the clinicians on your team becomes much more focused, intuitive and easier. You will be able to compare the outcomes one clinician has against peers within your group, monitor how often they have performed certain procedures (fiber-optic intubations, lines) and to make sure they are maintaining their skill set so that the FPPE/OPPE standard is met. You can then build a dashboard to review the performance of each member of your group on regular basis, establish best practices and improve the overall performance of your department.
Last, certainly not least….Providing Better Patient Care—Sometimes the most obvious things can be overlooked when you consider the broader picture; the forest for the trees. The first thing that can, and should, be improved when using data is making sure that the information leads to better patient care, either directly or indirectly. Regularly reviewing outcomes to look for trends, tracking critical events and putting in place process improvement protocols will help you make improvements in patient care.
If you’re able to successfully track and improve all the above, it’s the patient who will benefit most of all. Through clinicians who are more skilled because they keep their skills up to date, clinical protocols which address patient needs, anesthesia care for services that never had it before and an anesthesia group that is working with its hospitals and surgeons to reduce the cost of healthcare.
What Comes Next
Building a database, analyzing and using your data should not be a one off project. After you’ve decided what to look for, figured out how to measure it and analyzed the data, you need to improve your processes to make sure the change you want actually occurs. Once improvements have been demonstrated you need to establish a control mechanism to keep your improved standards from drifting back to their historical norms. A revision to the mean is a natural tendency, working to retain improvements and establishing a healthy dissatisfaction with “good enough” will help your group stay ahead of the curve.
The topics that you’ve decided to measure and improve this year will not be the same issues you need to manage next year—always be on the lookout for areas of improvement. If you’re cognizant of changes within and outside of your hospital, your anesthesia practice will be able to meet the continuing needs of your hospital, its surgeons and, most importantly, your patients and will be able to thrive in whatever changes healthcare will experience in the future.