The Supreme Court's decision to uphold the Patient Protection and Affordable Care Act increases the need for hospitals to partner effectively with their physicians for optimal patient care delivery. The operating room is one area that will be particularly critical for hospital-physician collaboration, because it contributes to a significant portion of hospitals' revenue and costs. Unfortunately, a history of distrust and misunderstanding has made this collaboration challenging for both parties. Howard Greenfield, MD, and Robert Stiefel, MD, principals of Enhance Healthcare, share three common sources of conflict between hospitals and anesthesia providers and solutions to resolve them.
1. Subsidies. The need to pay subsidies for anesthesia services has plagued hospitals for many years. "That has been a very obvious and ongoing issue that has created conflict," Dr. Stiefel says. While the past 10 years have seen an increase in subsidy payments, the increases now seem to be slowing, according to Dr. Stiefel. Hospitals can further reduce these subsidies by working with anesthesia providers to align incentives and create efficiencies in the operating room that will drive savings.
2. Value-added services. Another area of conflict is value-added services — services beyond intraoperative care expected of anesthesia providers. For example, preoperative patient preparation, perioperative throughput and postoperative pain management are services that anesthesia providers are expected to offer although the services lack direct reimbursement. "One of the challenges with these value-added services is that while they do offer significant improvement in patient preparation, satisfaction and in aggregate OR performance, too often there is little incentive for anesthesia providers," Dr. Stiefel says.
The issue of value-added services has increased as health reform puts more pressure on hospitals to meet certain quality and cost metrics. Clearly communicating expectations can help hospitals and anesthesia providers identify common goals and establish payment models that reward meeting those goals. For example, hospitals can offer financial incentives to anesthesia providers for achieving high scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which measures patient satisfaction.
3. Additional locations. Hospitals and anesthesia providers also may have a conflict over the number of anesthetizing locations. Hospitals may want to open additional anesthetizing locations as a strategy to increase patient volume and revenue, but the anesthesia providers may not be able to cover all the locations or get reimbursed for covering additional sites. "Even in the absence of a significant increase in case volume, the rationale sometimes for an increase in location is increased capacity and an increase in local market share," Dr. Stiefel says. "That may or may not make sense as a business initiative for a hospital, but relative to the anesthesia group, it doesn't necessarily come along with associated revenue."
To avoid this conflict, hospitals should examine their OR utilization to determine their true need for additional rooms or locations. Open communication about expectations and abilities is also crucial for developing an OR strategy relative to capacity. "[Hospitals] need to effectively communicate their expectations to the anesthesia department. In addition, the anesthesia department has to understand very clearly what these expectations are and their own ability to meet the expectations," Dr. Greenfield says. "If they're not able to meet expectations, they have to have the ability to have an open dialogue with OR nursing, surgeons and hospital administration to create an atmosphere that can resolve conflict and cause a more productive operating room environment and better patient care."
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1. Subsidies. The need to pay subsidies for anesthesia services has plagued hospitals for many years. "That has been a very obvious and ongoing issue that has created conflict," Dr. Stiefel says. While the past 10 years have seen an increase in subsidy payments, the increases now seem to be slowing, according to Dr. Stiefel. Hospitals can further reduce these subsidies by working with anesthesia providers to align incentives and create efficiencies in the operating room that will drive savings.
2. Value-added services. Another area of conflict is value-added services — services beyond intraoperative care expected of anesthesia providers. For example, preoperative patient preparation, perioperative throughput and postoperative pain management are services that anesthesia providers are expected to offer although the services lack direct reimbursement. "One of the challenges with these value-added services is that while they do offer significant improvement in patient preparation, satisfaction and in aggregate OR performance, too often there is little incentive for anesthesia providers," Dr. Stiefel says.
The issue of value-added services has increased as health reform puts more pressure on hospitals to meet certain quality and cost metrics. Clearly communicating expectations can help hospitals and anesthesia providers identify common goals and establish payment models that reward meeting those goals. For example, hospitals can offer financial incentives to anesthesia providers for achieving high scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which measures patient satisfaction.
3. Additional locations. Hospitals and anesthesia providers also may have a conflict over the number of anesthetizing locations. Hospitals may want to open additional anesthetizing locations as a strategy to increase patient volume and revenue, but the anesthesia providers may not be able to cover all the locations or get reimbursed for covering additional sites. "Even in the absence of a significant increase in case volume, the rationale sometimes for an increase in location is increased capacity and an increase in local market share," Dr. Stiefel says. "That may or may not make sense as a business initiative for a hospital, but relative to the anesthesia group, it doesn't necessarily come along with associated revenue."
To avoid this conflict, hospitals should examine their OR utilization to determine their true need for additional rooms or locations. Open communication about expectations and abilities is also crucial for developing an OR strategy relative to capacity. "[Hospitals] need to effectively communicate their expectations to the anesthesia department. In addition, the anesthesia department has to understand very clearly what these expectations are and their own ability to meet the expectations," Dr. Greenfield says. "If they're not able to meet expectations, they have to have the ability to have an open dialogue with OR nursing, surgeons and hospital administration to create an atmosphere that can resolve conflict and cause a more productive operating room environment and better patient care."
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