From the perspective of Chicago’s Mobile Anesthesiologists, the accelerating tailwinds of payers, patients, value-based care, and COVID-19 have had a positive impact on the physician office space over the past two years. In this post-COVID world, we will continue to see patients look for alternatives to hospitals and ASCs to receive care. Despite some bumps along the way through their creative leveraging of the No Surprises Act, long term, payers will increase incentives to encourage physicians, especially proceduralists, to shift care to the office setting. Similarly, physicians will continue to pursue opportunities to increase their productivity and efficiency by leveraging technology and their physical office space to care for their growing patient base.
The office setting is and will continue to be the answer for patients and physicians, emphasizing safety, experience, and cost savings. And fortunately for all involved, all healthcare stakeholders are aligned and will benefit from this continued shift.
Over its 25+ year history, Mobile Anesthesiologists helped pioneer and perfect office-based anesthesia. Today, its mission remains to assist our office-based clients in providing an unparalleled office-based surgical experience. The office is their niche and they hire anesthesiologists, nurses, and other clinical support staff that understand why the office is unique and that our customers include not only our patients, but the proceduralists and their office staff.
Mobile’s turnkey solution is purpose-built to alleviate the headaches associated with procedure days by:
• Managing the overall perioperative flow,
• Staffing the physician anesthesiologists and pre/post-op recovery room nurses,
• And providing, managing, and maintaining all anesthesia-related medications, supplies and equipment, all at our cost.
That model has proven to increase efficiency, patient experience, and physician satisfaction while also driving additional top-line revenue to each of the office-based clients they serve. Today, we’re going to dive into how and why it works so well.
An experienced physician that has historically performed surgical procedures at both hospitals and ASCs has grown accustomed to depending on the facility and administration to make sure the setting is safe and meets all requirements and regulations. That allows the physician to simply go in and only worry about doing their job as the surgeon or proceduralist. But when someone brings those procedures to their office setting, they are now responsible for all facility and safety related items, which includes but is not limited to anesthesia, emergency medication/equipment, ACLS trained staff, and liability/risk management. Since this is outside their scope of training and expertise, they must trust others to make sure all of that is being taken care of and provided to match the standards and safety of a hospital or licensed surgery center.
They’ll also need to verify that the information your vendors, personnel, service providers, anesthesia partner, and consultants is accurate. It is their liability, as a provider, including the passed-on risk to the patient if they are not doing the proper due diligence and work to make sure they and their patients are in the best possible position for a successful experience. It only takes one bad outcome to ruin everything you have built so it is worthwhile to spend the time researching and finding the optimal setup, support, and teammates.
Mobile has also built up an extensive understanding of regulatory best practices:
For example, Illinois has a law that requires a physician to have a certain amount of CME hours on anesthesia to supervise a CRNA in their office. CRNAs also have different professional liability coverage than a physician anesthesiologist does, and if something goes wrong on the anesthesia side the surgeon can still be exposed as the primary liability holder. There’s also a whole host of emergency equipment, medications, crash carts, airway management supplies, ACLS training, proper nursing support, safety training, and proper policies and procedures can be offered up by your perioperative, anesthesia, and/or equipment vendor, all of which Mobile covers for its clients at no additional cost.
From a regulatory perspective, doing procedures in the physician office setting is unlike a hospital or ASC and the only person holding the bag if something goes wrong is the physician. Mobile Anesthesiologists is more than a staffing company, and the services they provide aren’t just “warm bodies.” They cover all of the above and more, including revenue cycle for their own services.
In office settings, given the opportunity to maximize patient flow in the office and minimize the disruption of other hospital factors, the pace of the procedures themselves are generally quicker, benefitting both the patient and your practice where time is of the essence. However, it’s critical to still provide an excellent patient experience for their own comfort and safety, but also to support a proceduralist’s reputation. As a result, the role of the anesthesia team is elevated to not only optimize the efficiency but more importantly provide a safe and comfortable patient experience which is the foundation of Mobile’s model.
In office-based settings, with the perioperative nurses Mobile Anesthesiologists includes in its model, the anesthesia teams have the time to comfort patients who may be anxious prior to and following the administration of anesthesia. This improved patient-anesthesia interaction allows physicians to focus on what they do best—perform exceptional surgical procedures to achieve the best possible outcomes.
Here are four ways Mobile’s exceptional nurses keep patients from feeling lost in the mix.
1. Educate patients in advance of a procedure. When patients are well informed about what to expect, they are less nervous. In having dedicated nurses there, Mobile can take steps to let patients know how they will feel as the anesthesia is being administered, how quickly it will take effect, and what to expect when they wake up. In addition, asking them about their previous experiences with anesthesia and surgery could help in determining care.
2. Put ourselves in the patient’s shoes. Patients are in a vulnerable place, so treating them with respect will make a world of difference. Each interaction with Mobile nurses and doctors starts with: “If it were you or your loved one, what would you want or need to know?” With that approach, they the time to make sure they are comfortable. That communication should extend to the patient’s loved ones who are waiting as well. While this may sound basic, too often the little things are forgotten over time.
3. Mobile takes ownership and communicates if something goes wrong. While Mobile Anesthesiologists has had zero med-mal payouts in its 25 year history in treating over half a million patients, this is still a foundational element to our work. Patient safety always includes ownership and communication. Anesthesia teams must always make sure they let the patient know what occurred after the procedure and inform them of any signs they need to watch out for. For example, if an aspiration happens and a patient gets fluid in their lungs a fever doesn’t always develop right away. In some patients it can take as long as 48 hours for a fever to occur. The same holds true in the case of a fall. While the patient may appear fine initially, they are considered a fall risk from anesthesia and should not be ignored.
4. Mobile Anesthesiologists is an integrated part of the care team. Surgeons and anesthesia have different skills, training, and focus during a procedure. The nursing staff connects all of that, so it is a true team effort to provide the safest patient care possible. Mobile’s pre-op and recovery nurses are the perioperative and patient experience leaders who can make sure a client’s patients see a seamless flow where their best interest is the top priority. Being in a silo and only focusing on the task at hand for a nurse is not an option. They must contribute in all phases of the continuum of care and be the patients’ guide from start to finish, which makes them the make or break for excellent patient care.
People remember the things that are the most impactful to them. In healthcare, too often the experience is not positive due to the anxiety, fear of the unknowns, and severe health complications. Office-based surgical practices have the opportunity to change that perception given the intimate setting in which procedures are performed and the preventative care focus, which contributes to healthier and longer lives. Who a physician partners with on the anesthesia side can make a world of difference in the care and compassion patients receive, which can lead to positive patient experiences and more people choosing you over another provider.
The reality for a lot of anesthesia providers out there is risk management programs are more about their crisis management program after an adverse event has occurred. Certainly there are situations beyond our control, so having a crisis management program is vital, but investing in systems and processes to avoid as many adverse events as possible is a cornerstone of a high-quality anesthesia practice.
Mobile Anesthesiologists takes the following steps and at the very least, recommends proceduralists ask any anesthesia provider about the following:
What is your patient screening process?
It can be costly for an anesthesia practice to spend time pre-oping patients, but it’s an investment that pays off. Ensuring that any necessary work-ups or additional lab work are done in advance of the procedure helps to avoid last-minute cancellations. And pre-oping patients in advance ensures that procedures will be performed in the appropriate setting; not everyone is a good candidate for office-based surgery, so the sooner we can get them scheduled at the hospital or ASC if necessary, the better.
Do you follow any accreditation standards? Which one(s)?
Three main accrediting bodies provide varying levels of requirements for office-based surgery: AAAHC (the Accreditation Association for Ambulatory Health Care), QUADA (formerly the American Association for Accreditation of Ambulatory Surgery Facilities), and JCAHO (the Joint Commission for Accreditation of Healthcare Organizations). These accreditation ensures that an anesthesia provider complies with a base level of guidelines that demonstrate an organization’s commitment to patient safety and quality. They also ensure that an anesthesia provider keeps up with new and changing requirements, as the guidelines are constantly being updated to reflect best practices.
Do you have a peer review process?
Not only does a structured peer review process ensure that an organization’s clinical leadership is committed to high-quality care, it can also prevent repeated issues, facilitate communication among the clinical staff, and ensure complete and accurate documentation. A good peer review process is randomized and anonymized to minimize bias, should never be treated as a “blame game”, and has its general findings shared throughout the organization.
Mobile also works with risk management experts from leading medical malpractice carriers about red flags that are often indicative of poor risk management programs. They identified the following:
• Lack of communication among the staff. When staff members refuse to share information—good or bad—that is a sign that issues will repeat themselves.
• One-and-done training. Ongoing training is essential to ensure staff stay current on their skills and compliant with the latest policies.
• No corrective action plan for clinicians. When problems arise, do they ignore them and hope they go away (spoiler: they won’t!)? Or do they professionally address issues for everyone’s long-term benefit?
• Policies collecting dust. Things change, including state laws, accreditation requirements, and best practices. When was the last time policies were reviewed? (Hint: Policies should be reviewed at least annually.)
The Mobile way is always putting clients and patients first. That’s why they invest so heavily in preventative risk management strategies. Doctors have reduced liability, the business staff see financial gains, and most importantly, patients are safer and happier. Don’t be afraid to ask your anesthesia providers about their risk management strategy.
Mobile Anesthesiologists has been proudly serving Chicago’s office-based, ambulatory surgery center, and pediatric dental anesthesia needs for 25 years. The key to their long-term growth and high client satisfaction has always been about taking ownership of everything they can to prioritize patient safety and remove all abrasion on the path to success for its clients. While today has been an extensive spotlight of the work they do, it’s still ultimately the tip of the iceberg. Mobile also works diligently to provide competitive pay and benefits, alongside an exceptional quality of life for its clinicians, with reliable schedules and, because of the ambulatory focus, no weekends, holidays, or call. This is, in and of itself, an investment in its clients’ patients: happier, more well-rested doctors are able to provide a better level of care, supporting safety and outcomes.
There may be other ways to tackle office-based anesthesia, but the team at Mobile Anesthesiologists will continue to focus on going that extra mile until the rest of healthcare catches up. To get in touch or learn more, visit their website.
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