Improved Patient Outcomes: Anesthesia Leading The Way
Summary: Leadership is indispensable. As hospitals search for better ways to cut costs and improve quality, many have discovered a new model of care delivery that is being led by anesthesiologists.
The trail boss in the series Rawhide was in charge of the whole shebang, but he needed a Rowdy Yates to drive them doggies home. We're talking about the ramrod—the one who would keep the cattle moving as a single unit and in the same direction. He would do this by putting together a team of wranglers, each of whom had a specific task to take on; and, so, it was the ramrod who exercised an indispensable position of leadership.
Hospitals are increasingly seeing the benefits of implementing the ramrod approach when it comes to their surgical cases. They are looking for someone to take on the overall leadership role with regard to the patient's experience from the time of scheduling the surgery to post-recovery and beyond, and many of these health facility trail bosses are looking to the anesthesia department for their ramrods.
The Perioperative Concept
Several years ago, the healthcare community began a bold transition to a pay-for-performance (PFP) model, meaning that payment would be increasingly tied to quality of care, as well as cost-effective care. Years of incentive programs initiated by the Centers for Medicare and Medicaid Services (CMS) attempted to steer this PFP process by rewarding those who made efforts toward quality and efficiency and reducing reimbursement to those who didn't. CMS also backed other concepts that it believed would foster greater efficiencies in patient care, such as the accountable care organizations (ACOs) and alternative payment models (APMs), where coordination of care within a team of healthcare workers is emphasized.
Recently, the American Society of Anesthesiologists (ASA) proposed another concept that builds on these attempts at increasing efficiencies and quality of care. It is known as the perioperative surgical home (PSH) model. The PSH is a team-based approach that is led by an anesthesiologist and includes nurse practitioners and other PSH team doctors. All preoperative, intraoperative and postoperative patient care functions are performed by a single PSH team—rather than several different departments—who are assigned to that particular patient. The PSH team's selection begins from the decision to operate, and their involvement in the patient's care continues until 30 days after discharge.
Benefits of the PSH Model
"The problem with the current surgical model is that it is totally disjointed, disconnected, and there is no communication." This is the assessment of Dr. Mike Schweitzer, chairman of the ASA's Committee of Future Models of Anesthesia Practice, and a proponent of the PSH model. It is his contention that the traditional department approach to patient care is ineffective and needs to be scrapped in favor of an integrated team approach, as best represented by PSH.
According to the ASA, patients experience better outcomes and are more satisfied when their care runs through the PSH model. This includes a reduction in postoperative complications and the shortening of their hospital stay. What this means is a cost-effective health delivery system that translates into a better patient experience, which is then reflected by higher marks in publicly available patient surveys.
In addition to happier patients and the holding down of costs, the benefits of the PSH model include a greater appreciation for the anesthesiologist in the eyes of the hospital. As the leader of the PSH team, the anesthesiologist is the one who is directly responsible for this cost-reduction and quality increase that brings smiles to the faces of hospital CEOs and CFOs. This, in turn, should lead to better bargaining power on the part of the anesthesia group when it comes time for stipend negotiations. According to the ASA, "the PSH has the potential to invigorate the specialty."
PSH Case Study
It's one thing to talk about the merits of PSH in the abstract. It's another to see it in operation. The following is an excerpt from a true case study that was submitted to the ASA:
Dr. Barnes is a physician anesthesiologist who works for a private practice group that serves a large metropolitan hospital. He takes the PSH idea to the administration. They agree to let him put together a pilot program, specifically related to bladder cancer patients. Dr. Barnes approaches the broader care team to gain buy-in. Implementing new standardized care pathways for surgical urology will require the shared effort of a multidisciplinary team. The team focuses on reducing length of stay by creating an integrated pre-operative clinic, standardizing care and tracking outcomes. They even conduct multidisciplinary clinical team rounds to facilitate information sharing and address issues in real-time, and they deliver staff education to ensure standardized care protocols are understood and followed.
It isn't long before Dr. Barnes and his team see signs of improvement. Patient satisfaction improves; there are fewer canceled cases; and the hospital admits more patients as efficiencies take effect. Even physician satisfaction improves as the care team works together better than ever. Ultimately, length of stay is lowered, which means lower costs and better outcomes.
It's clear that we are entering a new phase for the practice of anesthesiology in the hospital setting. We may be nearing the time when PSH becomes the standard of care, and anesthesia groups have an opportunity to take the lead in this new care paradigm. Increasing anesthesia's leadership role in the hospital is not without its problems. The PSH means more responsibility and more time invested. However, the anesthesia group can further cement its relationship with the administration by embracing this leadership role and would be in a stronger position to receive financial support from the hospital in light of the cost-reduction achieved. If you have further questions about this topic, visit the ASA's PSH site at An Overview | American Society of Anesthesiologists (ASA) (asahq.org). You can also speak to your account executive about this topic or, alternatively, you can submit your question to info@anesthesiallc.com.