SUMMARY: The end of the year may be a good time for anesthesia practices to come together to consider their plans and priorities for the coming year. Included in this year-end think-a-thon should be the topics of services, staffing and budgeting.
As many of us celebrate the end of a year that has seen many positive developments for the specialty of anesthesia and its practitioners, there are a few ominous forebodings on the horizon. Medicare has proposed a three-plus percent reduction in the anesthesia conversion factor. There continues to be talk of an anesthesia manpower shortage. Hospital expectations continue to be defined by scope creep. As contract negotiations grind on, the sense is that administrators want more for less as they compete against other facilities.
As is so often the case in medicine, two steps forward often result in at least one step backwards. Just as anesthesia providers are used to preparing for “never events” in the management of their patients, so, too, is it ever appropriate to contemplate such events in the management of the practice. This is why strategic planning is always an important and useful exercise.
Defining Our Terms
The term strategic planning is often associated with the need to bring in an outside expert with slides, but it need not be taken quite so seriously. The basic objective is to take a step back and look at the practice in its larger context. As we have all come to understand, it is what happens outside the operating room that ultimately determines the ongoing viability and long-term success of the practice. A clear focus on three primary topics will provide a particularly useful framework for an effective discussion. These should be regular meeting agenda items.
- Scope of Services. How are client expectations changing and how is the practice willing or able to accommodate them?
- Manpower and Staffing. How is your team, and are all your providers confident that they are part of the best practice?
- Budgeting for the new year. How will you make it through the year to come, financially? Will it be a profitable year, or will you be struggling to make ends meet?
Scope of Services
It is often said that the only constant in medicine is change. Anesthesia has been a particularly interesting specialty in that its evolution has happened on multiple levels simultaneously. As the pharmacology has evolved over the years, anesthesia providers have been called upon to manage many aspects of patient pain from intra-operative pain control to postoperative pain management. The increased use of nerve blocks has minimized the need for narcotics and changed the nature of general anesthesia. At the same time, the market for anesthesia services has been changing dramatically as an ever-larger percentage of cases move from traditional inpatient venues to outpatient settings and doctor’s offices. The days of a small practice dedicated to a specific facility are gradually fading away.
A term that often frustrates anesthesia practices is scope creep. A contract gets written and signed for a specific scope of services only to be constantly amended with requests for additional services. Some of the examples that come to mind are neo-natal, stroke, cath-lab, etc. Hospital administrators are particularly prone to requesting additional anesthesia coverage as they develop new lines of business. Sometimes, these additional services simply entail more manpower; and, sometimes, they require the recruitment of a specialist, such as a pediatric anesthesiologist or a cardiovascular specialist. The fact is that each practice is unique, and each facility may be pursuing a slightly different strategic plan.
Perhaps the most challenging aspect of all this evolution is the fact that the specialty is viewed increasingly as an integral part of the surgical team. Quality of care is a given. It is customer service that matters most. The ultimate goal is to ensure that every patient has a quality surgical experience. Anesthesia providers who are outliers and who don’t communicate with their patients are the new bane of anesthesia practices.
Manpower and Staffing
The current manpower shortage affects each practice differently. Some practices have a solid team of providers who have tremendous confidence in the organization, but many others are struggling. We had a number of clients who lost a significant percentage of providers over the past couple of years. Many factors can contribute to such levels of defection but typically lifestyle and income top the list.
The fact is that every anesthesia practice must have a clear staffing plan that anticipates the changing needs of the team. Some practices have a long history of a care-team approach in which the use of CRNAs provides some financial assistance, but the economics of such practices have changed dramatically due to rising CRNA compensation. Clearly, a national manpower shortage results in higher provider compensation. This is why it is so challenging to recruit providers to some practices. If you don’t need to recruit any new providers to your practice, you are lucky and stand as the exception.
The specific problem that haunts many practices is that it is usually the best providers, with the best employment options, who leave first. This is why manpower requirements have become such a significant part of every hospital contract renewal. Not having enough qualified staff is the best argument for financial support from the facility.
Budgeting
It has been said that the greatest challenge facing most anesthesia practices is generating enough income to recruit and retain an appropriate team of qualified providers. Too many practices simply focus on their income, without giving adequate attention to their expenses. Amr Abouleish, MD, of ASA notoriety, was famous for reminding providers of the following:
Healing is an art.
Medicine is a science.
Healthcare is a business.
Successful practices understand this well and have implemented cost-accounting as a way of managing the practice more effectively. With each year that passes, this becomes increasingly important. American medicine has become increasingly competitive, and only the most efficient practices can survive. This is why a growing number of private anesthesia practices have decided to merge with a larger group, sell the practice or simply let the hospital take them over and employ the providers.
The irony of this discussion is that, as providers of care, anesthesiologists and CRNAs are trained to evaluate every case for its potential risks and challenges. They must constantly evaluate the needs of the patient, the preferences of the surgeon and their own skillset. What makes providers so effective in their clinical decision-making is the availability of timely and accurate information about the patient’s vital functions. They just need to apply the same focus and discipline to the management of the practice.
If you have any questions on this topic, please contact your account executive or email info@coronishealth.com.