Amid the ongoing COVID-19 pandemic, hospital and health system executives face enormous financial pressures. Labor costs are up across the board, including for anesthesia services, and anesthesiologists must recognize that hospital and health system executives typically view the anesthesiology department as either a barrier – and a costly one at that – or an asset. It's vital to ensure your hospital executives understand the role the specialty can play in helping address their financial challenges.

The “Be the Solution: Sell Your C-Suite on the Value and Leadership of Anesthesiologists” program helps you do just that by positioning yourselves as leaders in hospitals and health systems and promoting your value with the C-suite. The program – created by a working group of anesthesiologists who are health care executives ourselves – provides tools and resources to help you champion the specialty and patient-centered, physician-led anesthesia care. One of the toolkit topics – “Controlling Costs and Maximizing Your Institution's Financial Health” – provides details on the role anesthesiologists can play in improving your hospital's bottom line, talking points to help introduce the issue, and a downloadable leave-behind to share with your C-suite that highlights the research-backed value of physician-led anesthesia care. The backgrounder highlights how anesthesiologists can make a difference by saving lives, controlling costs, leading safe perioperative care, and assessing and improving the quality of care.

The materials can help you remind your C-suite that anesthesiologists touch every specialty in caring for patients and play a vital role in the OR, the economic engine of the hospital, as well as the ICU, both of which are high-margin areas. Anesthesiologists who provide solutions are viewed as trusted advisors and respected leaders, and executives will seek them out to assist in improving care and efficiency as well as the financial bottom line of the hospital. Here are some of our insights on ways to provide solutions.

Dr. Peterson: Hospitals do not like it when surgeries and procedures are canceled or start late, which creates gaps in the schedule and inefficiencies, costing the institution money. Preoperative clinics can help with decreasing cancellation rates. Anesthesiology departments can also create guidelines that all the anesthesiologists agree to regarding when it is safe for a patient to undergo surgery, e.g., time to wait for surgery after an uncomplicated upper-respiratory tract infection. There is nothing more frustrating to a surgeon and a patient than to have one anesthesiologist give the go-ahead for surgery and then another anesthesiologist cancelling.

Dr. Schweitzer: One anesthesiologist I worked with noticed that patients who had high blood sugar or low hemoglobin on the day of surgery were more likely to have complications or have their surgery canceled. She worked with surgeons and hospitalists to enhance their preadmission testing clinic by establishing a preoperative care clinic that identifies patients with high hemoglobin A1Cs or anemia weeks before their surgical date. The hospital supported this clinic with a nurse practitioner who met with all identified patients in person or by phone and directed patients to appropriate care to address those issues well before surgery. This clinic was so successful at decreasing same-day cancellations that it was expanded to a perioperative care clinic optimizing care for many patients prior to surgery.

Hospital executives also appreciate when anesthesiologists help address labor issues that can lead to backlogged care. For example, children's hospitals need to provide sedation for patients in a variety of areas, but often the anesthesia department doesn't have the capacity to be with every child for every sedation need.

Dr. Peterson: Some of our newer specialists, such as oncologists and cardiologists, didn't feel they had the skill to comfortably provide sedation, and I don't have enough people in my department to be with every child who is having a lumbar puncture or a fracture set. We got behind on procedures like MRIs and audio brainstem response testing for hearing loss. Our anesthesia department solved the problem by developing a training program for these specialists. We also trained pediatric intensivists to provide these other sedations, and they've gotten very good at it. While I can't get Texas Medicaid to pay for that, I make it up in my facility fees. And patients and physicians report they are much more satisfied.

One of the most impactful avenues for improving care is by establishing or growing Perioperative Surgical Home (PSH) or Enhanced Recovery After Surgery (ERAS) pathways. These programs have been shown to improve on-time starts for the first case of the day, reduce unnecessary imaging and lab tests, provide evidence-based blood and blood utilization protocols to eliminate unnecessary transfusions, and foster early discharge and early transfer out of the ICU.

Dr. Schweitzer: A case study presented in March at the American College of Healthcare Executives (ACHE) annual Congress on Healthcare Leadership reported that the implementation of a PSH pathway saved a hospital up to $12 million in one year and improved patient satisfaction.

If your hospital does not have a PSH or ERAS pathway, educate yourself and your colleagues about them and work on establishing one or the other. Start by identifying and partnering with surgeons who are interested in optimizing perioperative care. Once the anesthesia department and surgeons agree on the specific approach to this care, propose it to your hospital executives. Together, you can demonstrate to the C-suite how these pathways save lives, reduce complications, improve patient, physician, and staff satisfaction, decrease length of stay, and save money. The Be the Solution toolkit provides resources you can reference in your presentation.

The proven benefits of physician-led care we've noted have positive financial implications for your institution and are especially beneficial as U.S. health care continues to shift from fee-for-service to value-based care. The Centers for Medicare & Medicaid Services (CMS) withhold payment based on specific quality measures (e.g., length of stay, central line infections, readmissions), which costs the hospital millions. While it's not important for all anesthesiologists to understand every detail of value-based care, it is important they have a basic understanding of the concepts as well as the central role they play in the delivery of this care.

Dr. Peterson: I encourage everyone to understand how their hospital is financed – that includes payments by Medicare and Medicaid and commercial contracts. You may think the measures that hospitals are held accountable to don't have anything to do with you but, in fact, surgical site infections, sterile insertion and access to central lines, and control of pain, nausea, and vomiting are areas where anesthesiologists are involved and can make a difference.

Dr. Schweitzer: There are three hospital merit-based programs: the Inpatient Prospective Payment System (IPPS), Hospital Readmissions Reduction Program (HRRP), and Hospital-Acquired Condition (HAC) Reduction Program. When combined, these value-based care programs account for 6% of the Medicare reimbursement rate. If the measures are not met, the cost to your institution could be massive. For example, if a hospital has a 50% Medicare patient population and $1 billion in annual revenue and fails to meet the standards of these three programs, the potential financial impact could be $30 million in lost reimbursement.

As anesthesiologists, you can protect the institution's bottom line and be the solution by learning more about these important quality measures and how the anesthesiology department addresses them through perioperative care protocols that reduce mortality, readmission rates, health care-associated infections, and other complications, and improve patient safety and experience. As a first step, consider having one person in the anesthesiology department become an expert on these topics. Learn more about value-based care by visiting the Medicare (asamonitor.pub/3Ctc4Ds) and Medicaid (asamonitor.pub/3RvnVFb) websites.

The Be the Solution toolkit includes talking points and member resources to help you demonstrate your value to the C-suite on this topic as well as others, including innovation and leadership during COVID-19 and addressing health equity. It also outlines five overall action steps you can take and provides backgrounders that you can share with your hospital or health system executives when appropriate.

For more information, visit the Made for This Moment member page at asahq.org/member-center/madeforthismoment-executives-toolkit.

Mary Dale Peterson, MD, MHA, FACHE, FASA, ASA Past President (2020), Executive Vice President and Chief Operating Officer, Driscoll Children's Health System, Corpus Christi, Texas. She was ASA President in 2020.

Mary Dale Peterson, MD, MHA, FACHE, FASA, ASA Past President (2020), Executive Vice President and Chief Operating Officer, Driscoll Children's Health System, Corpus Christi, Texas. She was ASA President in 2020.

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Mike Schweitzer, MD, MBA, Healthcare Executives Workgroup, Be the Solution Working Group, and President, SH+, LLC, Tucson, Arizona.

Mike Schweitzer, MD, MBA, Healthcare Executives Workgroup, Be the Solution Working Group, and President, SH+, LLC, Tucson, Arizona.

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