Q: How do you assess the financial viability for an institution of adding anesthesia coverage for a new service?
Dr. John Di Capua: Overall, it's somewhat difficult to assess the financial viability of adding anesthesia for a new service. Typically, the new service is performed outside of the operating room and lacks much of the discipline that exists in the OR. When anesthesia coverage for a new service is initiated, the finances as they exist are typically much different than they will be once efficiencies have been brought to the service.
One of the things I'm amazed about is how many anesthesia groups in the country do not embrace the growth of hospital programs outside of the operating room. It's almost as if they've put blinders on. An immense number of surgical procedures are moving out of the OR and they're providing tremendous benefits for patients and as technology improves, the types of procedures done in a non-operating room setting will continue to grow.
At some of the tertiary hospitals I supervise, a full 50 percent of anesthesia volume is now for cases performed outside of the OR. We are providing services for new and expanding programs, such as electrophysiology or interventional radiology. What anesthesia brings to the table and what our expectations are for the department chairmen to do in these out-of-the-OR locations is to run these new programs and define a structure based on the lessons learned in the OR. We help to make them safe and efficient procedural areas.
Radiologists and cardiologists don't train in a surgical environment, which has embedded into them processes like case turnover time management. Turnover time in a cardiology or interventional radiology suite has a different definition than in an OR. Our leaders have taken programs where turnover time may be as long as two hours between cases and honed it down close to OR norms. At the end of the day, everyone is very amazed and happy with the fact that they can get the same number of cases done by 2:00 that used to take until 7:00 p.m. This provides bandwidth for increased growth and decrease costs of your staff.
The proactive anesthesia department can be critical in facilitating these out-of-the-OR locations and really maximizing what they can be. With a simple infusion of OR traditions into what are typically medical, non-procedural/surgical environments, you can take a service that is at a loss to a break-even point, to anesthesia, and make it a profitable location. It's a very healthy infusion, and to do this requires an anesthesia group to do two things: 1) to provide leadership to the service, much the way anesthesia should do in the OR; and 2) invest the upfront time to help the transition into that efficient anesthetizing location you're used to seeing.
Once you've decided to make the investment into the service, the biggest challenge you will face is changing the culture that exists. Sometimes these cultures are so ingrained it may take up to a year to get the efficiencies you expect. But if you do it, once the service is efficient, everyone including the hospital, administration, surgeons, patients, nursing, all constituents, are absolutely happier in the end.
Some anesthesia groups try to avoid providing services to these programs, but that gets in the way of hospital growth. As a hospital-based group that, when properly engaged, is leading the entire peri-operative service at a hospital, it's your responsibility to support the growth of these programs.
Stemming from OR programs are a growing source of revenue for the hospital and can be the same for the anesthesia department. Since most anesthesia departments are subsidized, the ability to go outside of the OR and provide better care to patients in those locations will increase volume and provide additional revenue to the department of anesthesia. It is a win-win situation and something we've found very, very positive.
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