MNASCA ANNUAL EDUCATION CONFERENCE APRIL 14-15, 2011 Presented by: Mary Sturm, Sr. VP Clinical...
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Transcript of MNASCA ANNUAL EDUCATION CONFERENCE APRIL 14-15, 2011 Presented by: Mary Sturm, Sr. VP Clinical...
MNASCA ANNUAL EDUCATION CONFERENCE
APRIL 14-15, 2011
Presented by: Mary Sturm, Sr. VP Clinical OperationsSurgical Management Professionals
Strong Anesthesia Relationships for a Strong Center
Presented by: Mary Sturm, Sr. VP Clinical OperationsSurgical Management Professionals
Goals of Anesthesia in an ASC
Must Drive Value and
Improve Quality
Anesthesia Business Models
Traditional model
Employment model
Owner Provider Model
Traditional Model Independent group practice model is most common
Pros Typically do not receive compensation from ASCIn a large metro area- may be able to “ shop” providers Can attempt to cover service levels in contract language
ConsASC may have less control
(even with a contract in place)Smaller markets may only have one game in town Can bring hospital mentality to the ASCCan be more complicated if anesthesiologists and CRNAs have separate contracts with center
Employment Model
ProsMore control Can be a revenue center Can be a recruitment benefit (life style)
ConsTypically salaried, so center assumes risk of compensation even when volumes are lowRecruitment can be difficult in some markets
Owner Provider Model (not common in Midwest)
A separate anesthesia corporation is established under the same ASC ownership as facility. Anesthesia technical and professional fees are billed thru this corporation and profits are set up as distributions to the owners. The income for anesthesia providers is typically less than if they billed separately. –model is prevalent in GI centers in southern states.
Potential for corruption of medical judgment and potential for kickback concerns
Current and Future Supply and Demand of Anesthesia Providers
Anesthesia Supply Side
Average age of MDA and CRNA in United States is 49
Steady decline in # of graduating anesthesiologists
54% of states report shortage on MDAs 60% of states report shortage of CRNAs Surplus of CRNAs predicted by 2020
Anesthesia Demand Side
Demand for anesthesia service in ASCs grew 300% in last ten years
Aging population increases need for anesthesia services
Anesthesia Clinical Models
Anesthesia Care Team (ACT) is prevalent in most prevalent in Midwest
MDA supervising CRNAs (up to four per MDA) Data to show cost effective as well as quality
delivery model Minnesota has been “opt out” state since 2002
The “Culture” of Anesthesia
Are anesthesia providers in the service business providing anesthesia?
OR
Are anesthesia providers in the anesthesia business providing service?
Strategies for “On Boarding” Anesthesia
Clinical competence, safety, patient outcomes are assumed.
Selection and control on specific anesthesia providers in the ASC
Clinical competence in ancillary services such as pain management program, regional anesthesia
Provides the same culture of flexibility that you expect from ASC employees
“On Boarding” Anesthesia – cont’d
Engagement in ASC center activities– Policies and Procedures– Compliance with Infection Control Policies– Protocols for pre op phone calls and patient management– Engagement in QI– Mandatory education compliance – Expectations for expense management
(supplies & pharmaceuticals)
Some Potential Hills to Die On
Restrictive clinical guidelines for patient acceptance (i.e. BMI) Restrictive policies on surgery schedule start and end times Restrictive policies on opening another OR Restrictive policies on same day add- ons Rush to discharge or transfer patients late in the day
Anesthesia Providers as ASC Shareholders
Align Incentives Wherever Possible Anesthesiologist who perform pain procedures as
ASC Investors Safe Harbor Implications
If anesthesia providers are not performing procedures per se, may consider model of real estate investment opportunity
Conclusion
An effective anesthesia model should be a thing of beauty