Taking back anesthesia

The small department that can make a huge difference ... and how you can improve it.

Just as the OR can make a life-and-death difference to a patient, it can also have as grave of an impact on the hospital organization itself. Sound melodramatic? Consider this: Seventy-two percent of a hospital’s revenue comes from the OR. In other words, the OR can support up to three-quarters of the hospital’s other departments or strategic initiatives – or conversely, its lack of success can contribute to a hospital’s demise.

To that end, when the OR faces internal conflict, staffing issues, operational roadblocks, or anything else that inhibits its success, it can have serious ramifications that reach far beyond a single patient, physician, procedure or even department. And because the anesthesia department is a major factor in every OR’s success, having a strong, stable and supportive practice is critical.

Hear from Ron McDaniel, Vice President of Premier Anesthesia, a leading national anesthesia management company, about the methods and tactics that can make an impact – and the proof that validates their success.

EHM. Why are there so many problems in the anesthesia department?
There is no one simple answer to this question, but any complex environment can become ripe for problems – and few medical practices are forced to cope with the number of changing variables than anesthesia.

First, anesthesia must accommodate surgeons’ schedules, including varying and even unpredictable lengths of time for procedures. Second, payors have historically set a low price for anesthesia coverage, creating a fractious situation for hospital executives – they know they must competitively compensate anesthesiologists, yet their reimbursements are not adequate.

Third, anesthesia practices are experiencing the downstream affects of a reduction in medical school graduate openings in anesthesia: fewer anesthesiologists have been trained, and there’s now a supply-and-demand crisis.

Clearly, hospitals must have anesthesia to maintain and grow their surgery volume – and they are forced to pick up the shortfall between high-priced providers and low payment for anesthesia procedures. These factors, combined with the high-pressure OR environment, can contribute to a tensions and conflict within the anesthesia department.

EHM. What solutions exist to help hospitals “win” with their anesthesia department and OR?
Many hospitals have found success by looking outside their current anesthesia department structure and engaging with an objective third party – namely, an anesthesia management company.

The anesthesia management company consults with hospital leadership, sets goals for the department, and engages in several initiatives to help achieve these goals:

1. Leadership that is sustainable and dedicated to business and operational goals over the long term, rather than a rotating medical director that changes on an annual basis
2. Dedicated recruiting expertise to ensure the most highly qualified providers who are the best cultural fit are part of the anesthesia team
3. Protocols and processes that meet the department’s and hospital’s goals for efficiency and care

EHM. What major changes does the anesthesia management company typically make?
It’s first important to address what the anesthesia management company does not change. For instance, the anesthesia company does not “clean house” and get rid of the current providers unless a special situation warrants such drastic action. As a matter of fact, most or all providers remain with the department and simply become independent contractors of the management company – and are often thrilled to have a parent entity taking care of administrative and management hassles.

The major change enabled by the anesthesia management company is leadership, leadership, leadership. Because an anesthesia management company is uniquely focused on the business of anesthesia – the processes, operations, management and teamwork – it puts a structure in place that enables providers to focus on what they do best, and care about most – patient care.

EHM. What are the key advantages to utilizing an anesthesia management company?
First of all, experienced and consistent leadership can enable drastic improvements. Why? Mainly because a sustainable entity – not an already-busy medical director appointed on an annual basis – is monitoring both near-term and long-term strategic objectives and making sure they’re achieved.

Another major advantage is national recruitment power. Local practices and hospitals often do not have the time or resources to recruit the best providers. However, particularly in highly collaborative, highly productive departments such as the OR, teamwork and cultural fit is critical. A national anesthesia management company can draw upon national resources to ensure the anesthesia practice is truly staffed by the best clinicians who are the best fit.

EHM. It sounds good, but doesn’t the anesthesia team usually resist this type of change?
Perhaps initially; after all, aren’t most people resistant to change? Pretty quickly, however, providers see the advantages and improvements. They see their lives becoming simpler; their practice environment more peaceful and productive. A good anesthesia management company facilitates an environment of trust and teamwork – and they foster communication and an “open door” policy between leadership and providers. As a result, providers feel better about the practice and often remain with the anesthesia management company for many years.

EHM. You mention “partnership” – but that term is so often overused. What does partnership really mean in the context of an anesthesia management company and its providers?
It’s important to note that strong partnership models are set up to facilitate both a tactical partnership as well as a philosophical one. First, the tactical: Premier Anesthesia enables a tactical partnership by making providers independent contractors, not employees of the management group. This subtle difference gives providers autonomy while also allowing them to be part of a bigger, stable group – in other words, it’s the best of both worlds for them. They are more likely to feel a sense of collaboration and kinship with the management team, as they are not relegated to “employee status” where they can theoretically be told what to do.

Second, and even more important, is a philosophical partnership. This sense of camaraderie, and this ability to work toward common important goals, is fostered by the anesthesia management company’s attention to communication and desire to lead. It’s a proactive strategy that ensures providers have a voice, thus making them comfortable with the management company’s leadership.

EHM. Enough with the talk – what proof is out there that this model works?
Premier Anesthesia has enabled many hospitals across the nation to realize significant benefits:

• A leading Southeast health system increased surgery cases by 100 per month within 60 days of engaging with Premier Anesthesia
• A conflict-filled anesthesia practice dealt with continuous turnover, including five Chiefs of Anesthesia within 10 years. Premier Anesthesia recruited 8 permanent anesthesiologists and 29 permanent CRNAs within five months, including a new medical director. Six years later, the anesthesia practice remains stable and strong.
• A “Top 100” hospital as ranked by Solucient Institute was satisfied with their anesthesia group’s clinical expertise, but identified the need to improve leadership, business structure and teamwork. Premier Anesthesia’s service-oriented model, which re-directs anesthesia’s focus to its two customers, surgeons and patients, enabled changes such as decreased OR turnaround times, improved on-time case starts and expanded anesthesia services.

In summary, it’s important to note that restructuring the anesthesia practice by engaging an anesthesia management company is not a “fast fix.” It is, however, a smart, long-term solution that can, in many situations, yield quick results. The OR is truly a critical component of any hospital, and if you’re not getting the most out of it, improving the anesthesia practice may be a solution. Do your research and find an anesthesia company that has delivered real, sustained improvements. Ask for references from both hospital executives as well as anesthesia providers themselves. Their frank opinions speak louder than any brochure or marketing piece.

For more information about Premier Anesthesia, including complete case study information, please contact Ron McDaniel at McDaniel@PremierAnesthesia.com or (865) 408-9966, or visit www.PremierAnesthesia.com.

ABOUT PREMIER ANESTHESIA:
Premier Anesthesia is a national anesthesia practice management company solely focused on building and managing the best anesthesia teams in the industry. Anesthesia is our only business, and we know it well. We believe that the anesthesia team is one the hospital’s most critical assets, and it should be managed for excellence, profitability and growth. Our business acumen, recruiting power and team approach have been a catalyst for success in ORs across the nation, and we manage the tasks essential to your success and profitability:

• Recruit and retain highly-qualified anesthesiologists and CRNAs
• Identify and implement protocols to increase hospital revenue
• Maintain a departmental attitude of teamwork and career satisfaction
• Manage anesthesia services, including billing and collections
• Continually monitor operations and improve efficiencies in the OR

To learn more, visit www.PremierAnesthesia.com today!