Someone Wants Your Practice! (And they’ll take it with help from your CEO and surgeons…)
I know, I know, a bold statement that surely does not apply to YOUR particular anesthesiology group, at YOUR particular practice. Sorry, but guess again and read on…
The following is a very accurate synopsis of a real phone call between the national sales director of a national anesthesia management company, and your hospital’s CEO or CMO – Please, PLEASE read this. It matters.
“Hi Mr. CEO, I am Dr So-and-So, from Such-and-Such Anesthesiology Services, the leading national provider of professional anesthesia services in the United States. I am calling to make sure you are completely satisfied with your anesthesia providers.”
[CEO inserts statement confirming satisfaction.]
“Oh good, I am glad you are. So many CEOs we call are not satisfied, and do not have anesthesia groups that not only save hospitals money, but MAKE money for their hospitals. We know how hard a job you have, with less than a 4% margin, and most anesthesia groups do nothing to help contribute to that. Often times we are called when hospitals are reviewing the groups they supplement and stipend, and are asked how we can help.”
[CEO inquires how anesthesia can make money for the hospital.]
“Well pardon me, but I assumed that if you were happy with your group, they helped substantially with the new value based purchasing (VBP) and did everything possible to avoid taking a stipend from your facility. We know the financial difficulties facing hospitals everywhere (through our local California and national experience) and do everything we can to assist you in maximizing your deserved collections from the government and private payors. In addition, we really do not want a stipend if we can avoid one (legal Medicare Anti-Kickback issues, etc.) We can help you with recruitment and retention of anesthesia personnel, and are able to reduce substantially any stipend via excellent management of the highly expensive and rare resources available to you.”
[CEO inquiries how this can all be done…]
And with the CEO’s attention captured, the sales director proceeds to sell the merits of his company’s professionally managed anesthesia department. The points of the argument include the following: by hiring medical directors with management education and experience, operating with cost efficiency by physician supervision of CRNAs in a care team model, requiring professional standards of conduct for all, continual tracking of patient and surgeon satisfaction, will make the CEO’s job easier by helping the hospital to function at the highest level of efficiency. Furthermore, this anesthesia management company realizes that the Department of Anesthesiology is the lynchpin for most hospital procedures, both in and out of the OR, so it ensures that their anesthesiologists sit on all relevant committees and boards, and are proactively involved in seeking and implementing cost savings measures. To drive home the arguments, the sales director will close the conversation with the offer to send sample satisfaction and performance reports, testimonials and blinded financial projections, as well as make a presentation to the hospital Board of Directors.
If you think I have fabricated the essence of this sales pitch, think again. Virtually all of this information is readily available in current white papers of leading national anesthesia service providers.
So what to do? Here is a checklist to take back the future of your anesthesia department:
- RELATIONSHIPS. Develop an excellent one with your CEO and CMO: The value of friends in high places and early warning of something amiss in your group (giving you time to fix it) is invaluable.
- ACT LIKE A PROFESSIONAL. Show up for work in tie, white jacket or sport coat. Dress like you want to be treated.
- ACT LIKE A DOCTOR. Call patients the night before their procedure and find a way to talk with them again post-op – even if it is by phone. Patients love this and it counts!
- MEMBERSHIP IN THE CSA AND ASA. Use them if you get into trouble – we have excellent resources that can both rescue a group and get it prepared for negotiations – you do NOT have to be alone!
- INVOLVEMENT. Get and stay very involved in your hospital’s day-to-day operations, by joining committees:
- OR Management
- Quality Improvement
- Surgical Care Improvement Project (SCIP)
- Pharmacy and Therapeutics
- Emergency/Trauma
- ICU
- If you have someone with some experience or knowledge try for finance board committees and hospital board committees (i.e. quality, etc.)
- Take the lead when there is a problem – infection issue? Anesthesiology wants to chair the committee looking into that.
- SAVE MONEY. Find ways to save your hospital money and tell them about it. Use the concept of VPB and your group’s commitment to that concept. (For example, continuous peripheral nerve blocks, epidurals, pain consults and other things that allow patients to receive early therapy and earlier discharge.)
- EDUCATE. Send a member of your group to the ASA’s Certificate in Business Administration Course – and tell the hospital you are doing it to find ways to help the OR run better and more efficiently.
- GET EVIDENCE. Develop a satisfaction survey for patients and surgeons and share it with the hospital, including follow up action taken to improve any deficiencies. (They will discover these anyway and you might as well as be the first to notice.)
- BE PERFECT. Specifically on quality metrics such as antibiotics, temperature control, beta blockade, and tell the hospital how well you are doing!
- GET A CONSULTANT. if you receive a stipend, make sure you have an outside consultant, hired by you, do the math and analysis of what the hospital wants, what it needs, and what it can afford, It is complicated and you need to let the facility know you are aware of the complications, your responsibility, and the Department of Justice rules and regulations.
This is very, very real and happening in multiple places in California and nationally. You must do for your department what these anesthesia service providers claim they can do in your place, and do it better. You can stop it. Get involved, get on the committees, and support your societies. If you don’t, someone else will be camping in your back yard.
by Keith Chamberlin, M.D. – Jan. 30, 2012 California Society of Anesthesiologists
Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality, Study Finds
April 17th, 2013, 4:00 PM by Jordan Rau The SCAN Foundation
You may have found your doctor to be a great communicator, your hospital room clean and quiet and your pain well controlled. Yet a study finds these opinions are not barometers of whether your hospital’s surgical care is any good.
The study, led by researchers at the Johns Hopkins University medical and public health schools, looked at patient satisfaction and surgical quality measures at 31 urban hospitals in 10 states. Patient satisfaction was determined by the results of standard Medicare surveys given to patients after they left the hospital. Quality was judged by how consistently surgeons and nurses followed recommended standards of care, such as giving antibiotics at the right time and taking precautionary steps to avert blood clots. The researchers also looked at how hospital employees evaluated safety attitudes at their hospital.
The researchers found little relationship between a hospital’s patient satisfaction scores and most quality ratings. “At present, little evidence supports its ability to predict the quality of surgical care,” Heather Lyu, Dr. Martin Makary and the other researchers wrote in JAMA Surgery.
Makary said that while patient satisfaction scores are a valuable component of evaluating a hospital, they are getting excessive attention because they are among the few quality measures available to the public. “It’s going to mislead patients because they’re going to think the hospital with the best lobby and the best parking and customer service is going to have the best heart surgery,” he said in an interview.
Previous studies of the relationship between patient views and the quality of care also have found that they are not necessarily correlated, but Medicare views them as useful. The patient assessments account for 30 percent of bonuses and penalties given to hospitals in the first year of Medicare’s “value-based purchasing” program, which was created by the federal health law.
Some of the surgical measures are also included in the calculations that make up the other 70 percent of the bonuses and penalties this year. Hospitals can gain or lose 1 percent of their regular Medicare payments under the quality program. All those individual scores are available to the public on Medicare’s Hospital Compare.
The researchers found that there was some relationship between how patients rated their experiences and whether hospital workers considered themselves part of a team approach to caring for patients and felt their work environment was not excessively stressful. There was no relationship between patient scores and hospital workers’ overall assessment of the hospital’s safety culture, which also included job satisfaction, working conditions and perception of management.
This article was produced by Kaiser Health News with support from The SCAN Foundation.
