Anesthesia Teams: A Source of Surgery Center Leadership

Ambulatory Surgery Centers (ASCs) continue to grow in facility numbers, patient volumes, and the procedures they perform. A recent study by Bain & Co. cites a 35% growth in ASC patients between 2015 and 2021, in line with the 41% of surgical procedures now conducted in ambulatory surgery centers. Demand isn’t showing a slowdown. Earlier this year, CMS announced that by 2024 all 1,700 procedures on the inpatient-only list would be phased out and made permissible to be performed in outpatient settings. A recent reversal by CMS regarding eliminating the inpatient-only list creates uncertainty as to where this will land. Additionally, 70% of orthopedic surgeries are expected to be performed at surgery centers over approximately the next five years. To meet this critical shift, ASCs should turn, in part, to their anesthesia teams for leadership and innovation to drive their center’s ability to capitalize on this opportunity and succeed.

Leading Change and Continual Improvements

A good anesthesia program starts with the goals of the surgery center, which often include patient volume growth and community reputation. You want community members to leave feeling, “That’s a good place. I got my surgery there, and it went so well. I felt so cared for, and I would encourage you to go there.” To create such an experience, the right mix of anesthesiology physicians and CRNAs needs to be in place, along with a cost-effective model aligned to patients’ needs and the surgeons’ goals. Another foundational trait of an effective/efficient ASC is standardizing care by leveraging evidence-based medicine. Anesthesia teams can create a protocol-driven culture in the ASCs and reduce, if not eliminate, surprises or what we refer to as “adventures in anesthesia.” Determining the best way to manage a case, getting provider buy-in ahead of time, and measuring the results will also help drive quality and efficiency.

Outside of the macro concerns, it’s critical to understand the needs of each individual in the process, starting with the patient. Anesthesia teams need to think broader than simply managing schedules, putting patients to sleep, and waking them up. There should be a significant focus on patient safety and comfort. This means a patient is waking up with as little pain and nausea as possible and going home as quickly and safely as they can. We also know that insurance coverage is a real challenge for patients, and anesthesia programs need to consider that. Care has to be 100% in-network, and giving patients an estimate of their anesthesia bill, the norm. By 2023 we will be talking about bundled billing and consistent pricing.

Skill sets and staffing mixes in ASCs will also need attention to address both routine and increasingly complex outpatient cases. You need people who know how to administer regional anesthesia. We expect ASCs to see more cardiology patients and perform cardiology procedures in the centers. On the orthopedic side, you’ve got to have people who know how to take care of these patients in a consistent way. To do that, you need continuity. What ASCs need to avoid is continually changing anesthesia teams unfamiliar with the surgeon’s preferences versus a team who knows what their surgeons need and want.

The needs of the ambulatory surgery center itself need attention too. Is the anesthesia team aligned with the surgery center’s objectives? Is there collaboration between the surgeons and the administrators running the surgery center? Are the right things being measured and reported? Far too often, most anesthesia teams and ambulatory surgery centers are not thinking along these lines today. Today’s ASCs need to become stronger on OR efficiency and revenue cycle issues.

Cultivating a leadership mindset should also be a priority, and this starts with onboarding and identifying clinicians who take an ownership perspective. Today’s ASCs should account for those interested in the business side, which is different from expecting clinical teams to have their MBAs!  But, those providers who understand and embrace the basic concepts of efficiencies and repeatable processes are more apt to drive quality, improve outcomes, and increase patient satisfaction.

Team-Based Care

Team-based anesthesia is a collaborative approach between CRNAs and physicians. If CRNAs are empowered to function at their highest scope, education, and capability, anesthesia teams will realize new successes that benefit the patient, team, and center. It’s a mindset in which egos are left at the door. Regardless of credentials, whether a CRNA or physician, everybody has a significant contribution to elevating the practice. Such a collaboration within the anesthesia team is fostered through trust, engagement, and training so that, for example, we can have CRNAs perform regional anesthesia. A collaborative anesthesia approach marshals the right provider in the proper clinical context to deliver the best quality and efficiency.

There is also essential collaboration outside the anesthesia team, including surgeons and nursing staff. Especially in the close-knit community of an ASC, a united front of providers will help ensure clinical continuity and improved patient experience.

Patients are becoming more informed as healthcare consumers, and they expect a quality experience, whether from a doctor’s office visit, an ambulatory surgery center, or a hospital. If we only start delivering care when they arrive, it drives up anxiety and impacts the overall experience. After the preoperative screening, it’s critical a CRNA or physician calls the day before to say, “Hey, this is so and so, and I’m going to be doing your anesthesia tomorrow. Do you know where the surgery center is? Do you know where to park? Do you know when to stop eating and drinking? This is what we’re planning on doing tomorrow. Do you have any questions?” This customer service mentality should then carry over to the day of the procedure. Greeting the patient with a warm blanket, helping with IV starts, and administering regional anesthesia before the patient enters the OR expedites the process, increases patient comfort, and creates a consistently smooth experience for surgeons. When care teams work together with the patient at the center, the bottom line is that it elevates the patient experience.

A better work culture, built on mutual respect, is created when CRNAs and physicians team up to complement one another’s skill sets. A more engaged team benefits everyone involved, the patient, the ASC, and the care team itself. A collaborative environment and common goals create career satisfaction and better alignment between physicians and CRNAs. Such a model also helps attract the best talent.

Based on a recent webinar, we created this blog to help ASCs identify new approaches to the opportunities and challenges ahead. For a more detailed account of how Ambulatory Surgery Centers can meet growing demand, don’t miss our complimentary webinar, led by several of our leaders at Sound Physicians. “Anesthesia: An Opportunity to Deliver Positive Experiences in Your ASC.”

To speak to someone regarding Sound Physicians’ Anesthesia program, you can reach out to Phil Eichenholz, CEO, Anesthesia Services (peichenholz@soundphysicians.com), or Andi Damron, Chief Nurse Anesthesia officer. (adamron@soundphysicians.com)