Roots of Request
What causes a hospital administration to question the value of its anesthesia department? Usually, it is the cost of the service. Administrators often grouse about the amount they have to pay for anesthesia subsidies. Anesthesia used to be a free service for most facilities because the providers collected enough from insurance and patients to cover the cost of providing the services required. In recent years, however, most practices now need hospital support to stay afloat. For a variety of reasons, the amount required had grown significantly. Eventually, many administrations get tired of the endless renegotiation of a reasonable level of support and start looking for other options.
The reality is that once hospitals start paying for anesthesia services, they become increasingly concerned about the value of the services received. Renewing a hospital contract starts as a financial exercise but becomes something much more involved. The exercise may begin as a review of coverage requirements. In other words, how many anesthetizing locations must be covered each day for how long, and how many providers does this require. This is where the discussion can get challenging. Ideally, each anesthetizing location should generate enough revenue to cover the cost of providing the care but this is rarely the case. Hospitals often want to provide additional services that are not so profitable. Not only do these services increase the cost for the practice, but they may also be part of what is referred to as scope creep. In other words, what is agreed to today is not what may be required tomorrow.
False Sense of Security
It used to be the case that the longer a practice had held a contract with a given facility the greater its security. While there is some truth to this assumption, there are frequent exceptions, especially when there are substantial subsidies at stake.
There are many anesthesia practices that appear to have worn the administration down over time trying to negotiate a reasonable subsidy. Sometimes, the administration just decides to find a new provider group for the sake of finding a new business partner. The new solution may either be a different anesthesia practice, such as one of the many anesthesia staffing companies or by creating an employed anesthesia department.
Creating the Value
As the market for hospital services becomes more competitive, customer service becomes an ever more important aspect of anesthesia care. The reality is that anesthesia providers do more to enhance the patients’ overall surgical experience than the surgeons. Obviously, having happy patients who are eager to come back to the facility is a key objective to all facilities.
It is not enough to provide safe and comfortable anesthesia care to patients; the anesthesia department is expected to play a critical role in the management of the operating suite. They should enhance the efficiency and effectiveness of the ORs. Anesthesiologists and CRNAs are critical team players in their interactions with the surgeons and the operating room staff. Anesthesia service contracts now often include performance metrics related to such issues as average start time and turnover time.
The fact is that the market for anesthesia services has evolved significantly over the past decade. While the market used to be defined by private anesthesia practices seeking to secure their relationship with hospital administrators, the market is experiencing significant aggregation. The focus has shifted from quality, which is assumed, to cost. The reality is that every practice should consider themselves at risk. It has never been so important for anesthesia practices to be constantly exploring ways to enhance their relationship with their administration.