Anesthesia and Value-Based Care: From surviving to thriving.

illustrated depiction of anesthesia's role in value-based care

Portions of this piece on anesthesia and value-based care were originally published by Scope partner practice Mobile Anesthesiologists in Becker’s ASC review. It has been updated to reflect policy changes by CMS and changing landscape of non-hospital surgical care.

While the backbone of value-based care is primary care and preventative medicine, inevitably surgical intervention is required to address ongoing chronic conditions, even outside of acute events. While ongoing debates around the “necessity” of anesthesia for procedures like colonoscopies continues to take place among payers, safe, effective anesthesia is an undeniable part of the patient experience for millions of Americans each year.

With the growth of ACOs and the launch of ACO Reach, more providers are working within a value-based care reimbursement models, giving facilities the opportunity to separate themselves from their competition. Those that demonstrably deliver consistent, safe, high-quality care can expect to prosper. This is especially true if there are poor outcomes that can result in negative reviews and the potential loss of Medicare certification or surgery center licensure. Even the zero-sum payment pools of ACA and Medicaid populations, and their management, are becoming differentiators: if Community Clinic A is able to meet the standards of their contracts better than Community Clinic B in the same geographic area, Clinic A essentially pick Clinic B’s pockets.

Most of the financial incentives under value-based care are shared savings, also known as the “low and slow” payment models. As a result, specialists tend to get underpaid or shut out completely, no matter how necessary they are to providing care. With tightening reimbursements, stricter regulations, and growing competition for patients, a less-than-optimal anesthesia and surgical partner will derail success for specialists navigating these already stringent models. With anesthesia as a “secondary specialty” providing services to other specialists that are facing similar headwinds in shared savings, staying afloat can feel virtually impossible. At the same time, well trained anesthesia staff that are equipped to handle any and all situations is vital to ensuring patient safety. The ability to stack (and track!) these successes is necessary to reap the financial benefits of the value-based initiative.

ASC Commodification of Anesthesia in Value Based Care

In ambulatory surgical centers especially, diminishing payments for necessary specialist care is creating a race to the bottom that is already impacting quality and safety, which in turn is adding fuel to the fire of hospital lobbyists trying to claim there are safety issues with non-hospital procedures, despite decades of data to the contrary. However, much like surgery itself, safe and effective anesthesia can’t be compromised, even in the face of ever tightening reimbursements that disregard specialists.

Fundamentally, a one-size-fits-all anesthesia style doesn’t work in the value-based model where patient satisfaction and safety are a priority. To meet growing demand, anesthesia requires an individualized approach to patient care that involves meeting with patients pre- and postoperatively to ensure that the delivery of anesthesia meets each patient’s unique needs. Easily-recognizable benefits of a positive anesthesia and perioperative experience include reduced anxiety, expedited recovery, taking time to educate the patient on the anesthesia plan, and the elimination of post-op pain and nausea while minimizing cost.

How Anesthesia Groups can Thrive under Value-Based Care

There are positive next steps already taking place, though. The financial constraints placed on anesthesia practices by lopsided VBC reimbursement models and a commodification of their work in an otherwise explosive ASC market are forcing anesthesia groups to find new value-add for partners. This means finding new support to save where they can without compromising a safe, pleasant patient experience and a quality of life for their clinical teams. Under organizations like AMS, anesthesia groups can evolve into full-service business platforms that can take up every non-clinical task an anesthesia group is faced with, turning those groups into problem solvers for their clients in an undeniable partnership that’s critical to an ASC’s success. This allows anesthesia groups to be able to track and share key performance indicators in which they played a role including reasons for case cancelations, recovery time, room turnover times, patient satisfaction, unusual occurrences, hospital transfers, patient callbacks, patient balances, and postoperative pain and nausea/vomiting. This data will support benchmarking efforts and help to identify opportunities for improvement across the entire clinical workflow, setting an ASC apart from the competition.

Whether an ASC is outsourcing anesthesia services or keeping it in-house, it’s important not to overlook anesthesia’s ever-evolving value in VBC and FFS payment models.

The Right Team is the Recipe for Success.

With the right anesthesia group in place you will be one step closer to achieving and exceeding your quest to attain excellence in patient safety and satisfaction (key components of value-based care) in the new year. And if you aren’t asking your anesthesia provider to prove their track record and quality outcomes, you should.

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