High quality anesthesia care is an indispensable element of a hospital’s procedural services. Whether it’s the operating room, the OB suite, or non-operating room anesthesia services (NORA), the demands for these services are continually increasing. Provided by anesthesia clinicians—anesthesiologist and/or CRNAs—these services are typically available 24-hours daily, year-round.
Currently, greater than 80% of US hospitals provide a stipend to their anesthesia departments. Stipends can range from a few thousand to greater than $100,000 per anesthesia provider. These un-reimbursed financial supplements are required to maintain anesthesia services by ensuring optimal staffing and retention of anesthesia clinicians. Stipends can take on many forms; e.g., fixed, variable based upon volume/productivity, chairman/director salaries, etc. Some hospitals take on the expensive ownership and management of CRNA’s, which becomes an indirect stipend to the anesthesiologists.
With nearly all hospitals experiencing downward revenue trends, associated with ever increasing costs, reducing or eliminating the anesthesia stipend is becoming a priority for many C-suites. Here are several tips on addressing the stipend issue:
Billing, Collection and Services:
Less than optimal billing and collection for anesthesia services can, of course, have a negative impact on revenue. It is within the hospital’s authority to insist on regular external audits (at least every two years) by an experienced and vetted anesthesia auditing firm.
These audits should include a review of revenue cycle management practices of the group’s billing firm as well as an in-depth assessment of clinician charge capture; i.e., submission should be both timely and complete.
Optimal Anesthesia Staffing:
Recent data from MGMA reveals that 85% of U.S. anesthesia services are provided by a care team model; i.e., an anesthesiologist providing either direction or supervision of CRNAs. Unless, your anesthesia department is functioning as a group at greater than 1:3 (anesthesiologist : CRNA) staffing ratio, the revenue per provider is less than optimal.
Groups functioning at less than a 1:3 ratio, will often complain that their patients are too sick for less anesthesiologist coverage. Multiple studies and institutions have demonstrated that these higher staffing ratios, are not associated with lesser quality of care, if there is good cooperation and collaboration between the anesthesiologist and CRNAs.
Patient Preparation:
Inadequate and inconsistent patient preparation is associated with excessive cancellations, delays, and problematic recovery. Your anesthesia department should be managing a high-functioning patient assessment and preparation unit that accomplishes timely patient prep in a consistent high-quality fashion.
Working closely with the surgeon’s office and the medical community, the anesthesia department, should insist upon a more centralized approach to patient preparation. Removing variability by implementing universally agreed upon best practice anesthesia questionnaires, algorithms, and standardized orders will significantly reduce costs while improve quality of care as well as patient and surgeon satisfaction.
Daily Operations Management:
Close daily cooperation between empowered anesthesia and nursing leadership, working with surgeons, their office staffs, and patients, can significantly improve OR productivity and patient throughput.
The daily operational leadership team should also proactively manage the elective schedule. The ‘daily huddle’, reviewing the schedule up to 5 days in advance, that includes representatives from anesthesia, OR nursing, scheduling, the patient preparation unit, sterile processing, discharge planning, materials management, can identify and address issues early, avoiding costly disruption of the schedule.
NOTE: The most effective frontline operations management is sponsored and supported by a multidisciplinary leadership group; the administration-sponsored Surgical Services Executive Committee or SSEC. For more information on this governance model, visit A New Leadership Model for the Struggling Operating Room
Operating Room and NORA Productivity:
The greatest ‘bang for the buck’ in maximizing collective and individual anesthesia productivity/revenue is well-designed surgeon access, usually referred to as a block time system. OR productivity is usually measured as ‘adjusted utilization’, calculated by adding up surgery time (wheels in to wheels out) plus turnover time (wheels out to wheels in) divided by the length of allocated block. If your operating room is running at less than 75% adjusted utilization during weekday prime time, both you and your anesthesia group can benefit from an in-depth assessment and reallocation of surgeon block.
Surgical Directions recommends a SSEC-like leadership group, using accurate utilization data/analytics to re-engineer better surgeon access. This redesign effort should work to improve surgeon access, balanced against the hospital’s need for optimal productivity. Well managed surgeon access will substantially reduce weekend and after-hour case stacking.
Finally, managing the demands of offsite NORA cases can significantly improve revenue per anesthesia provider. NORA sites can include endoscopy, interventional radiology, cath lab, MRI, nuclear med, etc. Bringing together representatives of each of these units and collectively managing access to anesthesia services can significantly improve anesthesia clinician productivity, reducing stipend demand.
