By Michael Simon, M.D.
Michael Simon, M.D. is a practicing anesthesiologist and Regional Director for North American Partners in Anesthesia (napaanesthesia.com) where he builds and leads perioperative super structures for hospitals throughout the country.
When I first became involved in drafting the six-part NAPABriefs series on accountable care, it brought to mind when we first began evolving the old-school fee-for-service model to a true perioperative team able to deliver increased and measurable quality outcomes at reduced costs that contributed to better reimbursements for hospitals.
That’s the focal point of the first NAPABrief – how to build the perioperative super structure to support the best possible surgical experience. Under the old-school model, an anesthesiologist came to work, focused on providing good, safe patient care, and went home. But then, hospitals began asking how they could do things more efficiently and effectively to positively impact their number one expense – the OR. The more questions they asked, the more they saw that the path often led to anesthesiology because we touch so much of the perioperative process. And of course, healthcare reform added fuel and intense urgency to those efforts.
There are so many touch points in the loosely connected system we call the perioperative process, that it begs for one person with the responsibility, accountability and authority to coordinate and personalize it for the patient, the surgeons and everyone else on the perioperative team. We’ve learned that the secret is viewing surgery as one continuum of care, with one physician leader overseeing the process and accountable for the entire patient experience and results.
The question we get most often from hospital executives is why have anesthesia as the central coordinator? The simple answer is that a hospital-based anesthesia group touches every main area involved in surgery
For instance, anesthesiologists work with: primary care doctors in obtaining patient’s long-standing histories; hospitalists, as they may help with complicated post-op care on the floor; cardiologists because some patients need various cardiac work-ups pre-operatively; even hematologists when it comes to best transfusion practices. We constantly interact with hospital administration. We work with purchasing to ensure we’re using the most cost effective products, and we have a place on all related committees. When you put that together, anesthesiologists work with more specialists and operating functions across the perioperative spectrum than anyone else.
Once this perioperative super structure is locked into place, hospitals will be ready to take the five steps outlined in the remaining five NAPABriefs to truly transform the OR by connecting quality, outcomes, the patient experience and cost-saving measures as a new way of thinking about OR management.
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