FTI CONSULTING, INC. Despite Anesthesia Services' importance in managing patients (safety, outcomes) and the operating room, a suboptimal and non-collaborative relationship often exists between anesthesia group and hospital administration. Collaborative problem solving, decision-making and communications do not occur on a regular basis. A shortage of anesthesia providers further magnifies the complex operational challenges.
In this article, anesthesia staff-shortages are quantified, operational challenges identified and solutions provided. The latter includes an evaluation of contracts, service and clinical quality, resource utilization and operational efficiency. Despite the changing landscape, opportunities exist to improve quality of care while reducing cost.
Aging Population and Increased Demand for Surgery and Alteration of Payer Mix
The
Between 2020 and 2030, the government share of insured lives, Medicare and Medicaid increases from 40.7% to 43.4% (270 basis points).4 Although the enrollment change is incremental, its significance on operating margins is more pronounced, given the disparity in reimbursement.
Consolidation of Practices and Staff Shortages
Independent physician practices are disappearing as hospitals and health systems, payers and private equity firms purchase them. As of
More specifically, 42,267 anesthesiologists operate in
Staff shortages have also been reported for certified registered nurse anesthetists ("CRNAs"). According to the National
Lagging Value-Based Care
Value-based care ("VBC") models are designed to offer incentives to providers for controlling medical spend while improving outcomes and health equity. These models target significant variation among hospitals and providers in the rate of complications and mortality.14 VBC implementation is lagging, though leading academic medical centers have established
The Anesthesiology Performance Improvement and Reporting Exchange ("ASPIRE") consists of 23 process and outcome measures.17 Implementation can reduce variation and results in measurably improved outcomes.18 Other quality-oriented interventions by anesthesiologists include preoperative optimization, procedural standardization, segmentation by risk and complexity, the adoption of best practices and perioperative pain management.19
Evident Operational Challenges
As a key clinical function led by and comprising highly skilled clinicians, Anesthesia Service often presents challenges to senior hospital executives for a variety of reasons:
- The anesthesia team provides services to multiple specialty-procedure areas within a hospital, including Operating Rooms, Labor and Delivery ("L&D"),
Gastrointestinal Laboratory ("GI-Lab"),Cardiac Catheterization Laboratory ("Cath-lab"),Electrophysiology Laboratory ("EP-Lab"), Interventional Radiology ("IR") and certain Diagnostic Radiology procedures as needed, as well as Ambulatory Surgical Centers. Each area has its unique workflow, care-demand pattern and coverage requirement. The corresponding managerial complexity can be overwhelming. - The lack of data transparency impedes the thorough understanding of the anesthesia group's performance. Systematic evaluation of the quality and efficiency of anesthesia services compels the hospital administration to compile and be able to construe multiple sets of clinical, operational, and financial data. The collection of data itself is sometimes a daunting task, not to mention the analysis and accurate interpretation. Quite often, the rationale of a request-to-expand subsidy can be very difficult to evaluate and justify.
- The management of Anesthesia Services tends to be heavily political and involves years, if not decades, of evolving partnership between the hospital and the service providers. The ever-changing regulatory, reimbursement and market environments further intensify the difficulty in exploring improvement opportunities.
Proposed Solutions
FTI Consulting Health Solutions has developed a unique approach to thorough assessment of service, value and quality to assist hospital executives in addressing improvement opportunities in Anesthesia Service's operational efficiency, managerial effectiveness and financial performance. The
- Contract evaluation and negotiation support | Subsidy review, compensation, coverage, performance targeting
- Service quality to perioperative service | Pre-admission testing, operating rooms, post-anesthesia care unit
- Service quality to non-operating-room areas | L&D, GI-Lab, Cath-Lab, EP-Lab, IR
- Resource utilization | Staffing models, staffing ratios, non-primetime coverage
- Operational efficiency | Patient throughput, response time
- Leadership and collaboration | Partnership with hospital administration and clinical operation management team
- Clinical quality | Reintubation, prolonged stay in the recovery room
Case Studies
Footnotes
1:
2:
3: "Anesthesiology: Supply, Demand and Recruiting Trends."
4: National Healthcare Expenditures, Health Insurance Enrollment and Enrollment Growth Rates, Table 17.
5: "PAI-Avalere Health Report on Trends in Physician Employment and Acquisitions of Medical Practices: 2019-2021,"
6: "Physician Specialty Data Report: Active Physicians in the Largest Specialties, 2019,"
7: "PAI-Avalere Health Report on Trends in Physician Employment and Acquisitions of Medical Practices: 2019-2021,"
8: "Physician Specialty Data Report: Active Physicians in the Largest Specialties, 2019,"
9: Ibid.
10: "Physician Specialty Data Report: Active Physicians by Age and Specialty, 2019,"
11: "The Future of Anesthesiology: How Anesthesiologist and CRNA Shortages Are Making an Impact," Medical Business Management (
12: "History. About the NBCRNA." National
13: "What Healthcare CFOs Should Know About the CRNA Shortage,"
14:
15:
16:
17:
18: Ibid.
19:
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
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