Electronic capture of patient information before and after surgery is an essential component of an effective anesthesia quality management program.Postoperative data are the outcomes of our work. These include rare safety issues related to intraoperative care, but not always apparent in the OR or PACU: events like neurologic injury, myocardial infarction, aspiration pneumonia or complications of pain management. More common, and increasing in importance, are the “patient-centered” outcomes which will be used by external regulators to judge us: the occurrence of nausea and vomiting, the adequacy of pain management, and overall patient satisfaction.Preoperative information, on the other hand, is the substrate for understanding anesthesia risks. Comparison of outcomes across institutions will require careful risk adjustment, and electronic capture of pre-existing conditions, chronic medications and pertinent diagnostic studies will enable this process. Even information as simple as the ASA physical status can be a powerful tool for understanding anesthesia outcomes across broad...

Anesthesia practices looking to optimize their value proposition at their respective facilities have sought a greater role in the preoperative preparation of their patients. The emphasis on efficiency and the continuity of care in recently suggested models of healthcare reimbursement, including Accountable Care Organizations, have drawn renewed attention to opportunities within the preoperative clinic. The economic reality is that providers and facilities are not getting paid to provide those services under current reimbursement rules. Preoperative clinics can provide benefits in quality of care and cost reduction, in addition to the significance of improving patient and surgeon satisfaction. Anesthesia practices are in a unique position to develop the preoperative clinic into a valuable resource.The expenses of a poorly performed preoperative assessment are borne by both the surgical department and anesthesia provider (as well as by the patient) in the form of poor utilization. Patient satisfaction and outcomes are affected by delays and...

Written by: Shawn Michael DeRemer, MD and Gregg M. White, CRNA, MSAnesthesia Associates Northwest, LLC (AANW), Portland, ORHealth care delivery has gradually shifted from in-hospital to outpatient settings, most recently to physicians’ offices. In fact, in 2009 the number of office-based procedures in the United States numbered 12 million. Nevertheless, though outpatient surgery may be more convenient and financially beneficial for both doctors and patients, many physicians are not taking advantage of the full realm of possible procedures that could be offered in an office setting.In 2010, we decided to expand our own anesthesia management and staffing services business by helping physicians expand their practices. Our idea was to bring the surgical suite to physicians’ offices via a fully equipped van that would deliver all necessary resources — and also foster a “culture of safety.”WHAT WE NEEDEDWe went to task outfitting a slick- looking van with everything a physician might need...

Have you and your group been thinking about how to grow your practice? The trend toward anesthesia practice consolidation continues its momentum. Not only do groups seek more and more opportunities to merge, to acquire other groups and to join larger organizations; they are an increasingly attractive acquisition target.Mark Weiss, Esq.’s article “The Company Model of Anesthesia Services: Will Less Money Lead to Jail Time?” is an excellent review of the development of the troublesome “company model” as well an explanation of the associated compliance issues that you don’t have to be a lawyer to understand.For a different perspective, consider AAA Executive Committee member Franc Galinanes’s article “Anesthesia: The Increasing Consolidation of Our Industry.” As a Senior Director for North American Partners in Anesthesia, Mr. Galinanes is in a good position to discuss the advantages of the three major types of consolidation: practice mergers, joining a larger organization and sale to...

Some of us are old enough to remember the days when anesthesia prtoviders got paid more or less based on what they decided to charge. It used to be that a favorable mix of patient insurance coverage (payor mix) and reasonably busy operating rooms was sufficient to ensure the financial viability of an anesthesia practice. There was a time when anesthesiologists talked about things like group formation, hospital contracts and managed care negotiations in the abstract as interesting options. Conventional wisdom held that a few persistent and disciplined secretaries would be sufficient to provide for the business requirements of the typical practice. Sadly those days of entrepreneurial opportunity have given way to a whole new set of practice management challenges. Survival and success now have much less to do with the favorability of the payor mix or even with the clinical qualifications of the providers; today’s practices must constantly monitor  and...

While the business of health care continues to evolve, there is perhaps no part of it changing faster than anesthesia. Numerous factors are quickly shifting the market towards an even more competitive and demanding landscape. The days of anesthesia groups simply providing clinical coverage in a hospital’s operating rooms are, for better or for worse, drawing to a close.As the expectations of hospitals for the types and levels of services to be provided by anesthesia are increasing, anesthesiologists now find themselves performing cases in non-traditional anesthetizing locations such as GI Suites, ECT and Electrophysiology. In addition, many anesthesiologists are expected to serve in roles not always seen as traditional for anesthesia, such as holding the broad responsibility for Peri-Operative Services, Pre-Surgical Testing processes, serving as leaders of hospital committees, etc.A continued shift in payor mix, to government payors that have long undervalued anesthesia services, has forced an increasing number of anesthesia...