Thomas Wherry, MD, principal of Total Anesthesia Solutions and medical director for Health Inventures, discusses six ways surgery centers can involve anesthesiologists in cutting costs.
Labor costs
Staffing costs represent the number one cost to most surgery centers, and Dr. Wherry says inefficiencies involving anesthesia can add up to significant expense over time. "When you stop wasting one or two hours every day, that can add up to significant savings," he says. "What anesthesia can do to help save money on labor costs is very under-discussed and under-reported."
1. Work with staff to shorten the pre-operative phone call. According to Dr. Wherry, most surgery centers spend a lot of time on patient triage, a process that proves costly when nurses or front desk staff members spend more time on triage than necessary. "If anesthesiologists do not take ownership of the process, the center spends a lot of wasted time on the phone call asking questions that aren't as directed as they could be," Dr. Wherry says. "They may be gathering labs and data that aren't necessary." He says the first thing ASCs should do is look at how much time and how many FTEs are devoted to the process of the pre-op phone call. He says for a center performing 200-300 cases per month, 1-1.5 FTEs should be sufficient. Additional savings could be realized if the pre-op admitting and recovery room staff makes the calls versus a full-time phone call nurse.
ASC anesthesiologists should then work with those responsible for the pre-op phone call. They should explain which information is necessary for the procedure and try to reduce the phone call to less than 10 minutes. "[Staff members] are trying to do their best, but these calls can turn into half hour conversations," Dr. Wherry says. "Anesthesia has to step in and say, 'This is all we need.'"
2. Rely on several core anesthesiologists to streamline OR processes. To save money on intra-operative processes, Dr. Wherry says ASCs must focus on recruiting anesthesiologists who are willing to perfect their technique and make the OR more efficient. "The skill level of a provider can really impact the flow of the room, and if they're doing eight or nine cases in a day and the anesthesia provider is really slow, that could add an hour to the day easily," he says. "A provider that can get the patient prepared and under anesthesia more efficiently can be a huge cost-savings."
In order to make the OR more efficient, Dr. Wherry says anesthesiologists must build relationships with nursing staff and help them address inefficiencies. This can only be accomplished if an anesthesiologist spends a good amount of time at the center, he says. "A lot of centers will insist that out of a group of 20 anesthesiologists, they use a few core providers and one provider that's there on a regular basis," he says. "Without that consistency, you don't get any traction on some of these initiatives." He says the facility should take responsibility for encouraging the core anesthesiologists to identify problems and work with nursing staff and surgeons to fix them.
3. Work with nurses to draw up patient discharge guidelines. According to Dr. Wherry, nursing staff may hold patients longer than necessary after surgery without guidance from an anesthesia provider. "Anesthesiologists should help determine discharge guidelines," he says. "Without the direction and leadership from anesthesia, I find that the nursing staff may keep a patient an excessively long time. If it's all on [the nurses'] shoulders, they'll take the more conservative approach and keep the patient an extra half hour." He says all these "extra half hours" add up to significant extra staffing hours over time.
To speed up patient discharge and therefore save money on staffing, Dr. Wherry recommends anesthesiologists and nurses work together to draw up discharge guidelines. He says nurses should be discharging patients based on physiologic criteria rather than time criteria — meaning when a patient is ready, rather than when an hour has passed. "You want the anesthesiologists to work towards coming up with a clear criteria on when the patient can be safely discharged," he says.
Supply costs
While anesthesia supplies should only represent 5-10 percent of the supply costs per case, anesthesia providers can still be involved in seeking out less costly alternatives and eliminating waste, Dr. Wherry says.
1. Look for less costly drug alternatives. Dr. Wherry says anesthesiologists should regularly assess the drugs they use to determine whether cheaper, quality alternatives exist. "For example, propofol is not as expensive as it used to be, but you still want to make sure you're using smaller vials to minimize waste," he says. "You can only use one vial per patient, so if you're cracking open a lot of bigger vials, you're probably wasting a lot." He says some drugs have less costly counterparts that anesthesiologists might consider — for example, bupivacaine costs significantly less than ropivacaine and can often be used in its place.
He says anesthesia providers should also be critical about which drugs should be kept on the anesthesia cart. For instance, he says Romazicon, which is used for the reversal of sedative effects of benzodiazepines in conscious sedation, should not be kept on the anesthesia cart. "It's not a drug we should have because we'll tend to reach for it, and it costs over $100 per vial," he says. "When it's being used, an incident report should be filed. It may be helpful, but it's something you want to track."
2. Watch the flow of inhalation agents. According to Dr. Wherry, one of the biggest supply costs for anesthesia is inhalation agents, which can be wasted when flows are kept high and distributed into the atmosphere. "You should be working with the group and making sure that high flow isn't just being wasted by going into the atmosphere," he says. He says inhalation agents can be used up very quickly if groups don't keep an eye on oxygen flows — not to mention the harmful effects of pollution when agents are consistently released into the air.
3. Seek out cheaper versions of breathing circuits and IV tubing. Dr. Wherry says there is a huge variety of breathing circuits and IV tubing available on the market, and many hospital-based providers are "used to using the latest and greatest," he says. "It's really not necessary, and I really think you have to work with the providers and see if they'll accept something that's just as safe but significantly less expensive." He says ASC leaders must educate anesthesiologists on supply pricing. If you can save $5-$10 per case on supplies and the anesthesiologists are doing 4,000 cases a year, those cuts will mean a significant savings to the bottom line, he says.
He says anesthesia providers will be more likely to accept cheaper alternatives to equipment if they are encouraged by the center's medical director. Anesthesia providers should be involved in going over the various options with the medical director so that they are happy with supply choices. "You don't want to have a materials manager with a surgical tech background ordering something that may be inferior or something they won't use," he says. "Getting buy-in from the medical director is the best way, then educating them on the pricing and hopefully getting them to take something less costly."
Learn more about Total Anesthesia Solutions.
Learn more about Health Inventures.
Labor costs
Staffing costs represent the number one cost to most surgery centers, and Dr. Wherry says inefficiencies involving anesthesia can add up to significant expense over time. "When you stop wasting one or two hours every day, that can add up to significant savings," he says. "What anesthesia can do to help save money on labor costs is very under-discussed and under-reported."
1. Work with staff to shorten the pre-operative phone call. According to Dr. Wherry, most surgery centers spend a lot of time on patient triage, a process that proves costly when nurses or front desk staff members spend more time on triage than necessary. "If anesthesiologists do not take ownership of the process, the center spends a lot of wasted time on the phone call asking questions that aren't as directed as they could be," Dr. Wherry says. "They may be gathering labs and data that aren't necessary." He says the first thing ASCs should do is look at how much time and how many FTEs are devoted to the process of the pre-op phone call. He says for a center performing 200-300 cases per month, 1-1.5 FTEs should be sufficient. Additional savings could be realized if the pre-op admitting and recovery room staff makes the calls versus a full-time phone call nurse.
ASC anesthesiologists should then work with those responsible for the pre-op phone call. They should explain which information is necessary for the procedure and try to reduce the phone call to less than 10 minutes. "[Staff members] are trying to do their best, but these calls can turn into half hour conversations," Dr. Wherry says. "Anesthesia has to step in and say, 'This is all we need.'"
2. Rely on several core anesthesiologists to streamline OR processes. To save money on intra-operative processes, Dr. Wherry says ASCs must focus on recruiting anesthesiologists who are willing to perfect their technique and make the OR more efficient. "The skill level of a provider can really impact the flow of the room, and if they're doing eight or nine cases in a day and the anesthesia provider is really slow, that could add an hour to the day easily," he says. "A provider that can get the patient prepared and under anesthesia more efficiently can be a huge cost-savings."
In order to make the OR more efficient, Dr. Wherry says anesthesiologists must build relationships with nursing staff and help them address inefficiencies. This can only be accomplished if an anesthesiologist spends a good amount of time at the center, he says. "A lot of centers will insist that out of a group of 20 anesthesiologists, they use a few core providers and one provider that's there on a regular basis," he says. "Without that consistency, you don't get any traction on some of these initiatives." He says the facility should take responsibility for encouraging the core anesthesiologists to identify problems and work with nursing staff and surgeons to fix them.
3. Work with nurses to draw up patient discharge guidelines. According to Dr. Wherry, nursing staff may hold patients longer than necessary after surgery without guidance from an anesthesia provider. "Anesthesiologists should help determine discharge guidelines," he says. "Without the direction and leadership from anesthesia, I find that the nursing staff may keep a patient an excessively long time. If it's all on [the nurses'] shoulders, they'll take the more conservative approach and keep the patient an extra half hour." He says all these "extra half hours" add up to significant extra staffing hours over time.
To speed up patient discharge and therefore save money on staffing, Dr. Wherry recommends anesthesiologists and nurses work together to draw up discharge guidelines. He says nurses should be discharging patients based on physiologic criteria rather than time criteria — meaning when a patient is ready, rather than when an hour has passed. "You want the anesthesiologists to work towards coming up with a clear criteria on when the patient can be safely discharged," he says.
Supply costs
While anesthesia supplies should only represent 5-10 percent of the supply costs per case, anesthesia providers can still be involved in seeking out less costly alternatives and eliminating waste, Dr. Wherry says.
1. Look for less costly drug alternatives. Dr. Wherry says anesthesiologists should regularly assess the drugs they use to determine whether cheaper, quality alternatives exist. "For example, propofol is not as expensive as it used to be, but you still want to make sure you're using smaller vials to minimize waste," he says. "You can only use one vial per patient, so if you're cracking open a lot of bigger vials, you're probably wasting a lot." He says some drugs have less costly counterparts that anesthesiologists might consider — for example, bupivacaine costs significantly less than ropivacaine and can often be used in its place.
He says anesthesia providers should also be critical about which drugs should be kept on the anesthesia cart. For instance, he says Romazicon, which is used for the reversal of sedative effects of benzodiazepines in conscious sedation, should not be kept on the anesthesia cart. "It's not a drug we should have because we'll tend to reach for it, and it costs over $100 per vial," he says. "When it's being used, an incident report should be filed. It may be helpful, but it's something you want to track."
2. Watch the flow of inhalation agents. According to Dr. Wherry, one of the biggest supply costs for anesthesia is inhalation agents, which can be wasted when flows are kept high and distributed into the atmosphere. "You should be working with the group and making sure that high flow isn't just being wasted by going into the atmosphere," he says. He says inhalation agents can be used up very quickly if groups don't keep an eye on oxygen flows — not to mention the harmful effects of pollution when agents are consistently released into the air.
3. Seek out cheaper versions of breathing circuits and IV tubing. Dr. Wherry says there is a huge variety of breathing circuits and IV tubing available on the market, and many hospital-based providers are "used to using the latest and greatest," he says. "It's really not necessary, and I really think you have to work with the providers and see if they'll accept something that's just as safe but significantly less expensive." He says ASC leaders must educate anesthesiologists on supply pricing. If you can save $5-$10 per case on supplies and the anesthesiologists are doing 4,000 cases a year, those cuts will mean a significant savings to the bottom line, he says.
He says anesthesia providers will be more likely to accept cheaper alternatives to equipment if they are encouraged by the center's medical director. Anesthesia providers should be involved in going over the various options with the medical director so that they are happy with supply choices. "You don't want to have a materials manager with a surgical tech background ordering something that may be inferior or something they won't use," he says. "Getting buy-in from the medical director is the best way, then educating them on the pricing and hopefully getting them to take something less costly."
Learn more about Total Anesthesia Solutions.
Learn more about Health Inventures.