Anesthesiologists serve as the cornerstone of the perioperative arena. The current role of the anesthesiologist goes beyond that of anesthetic delivery; anesthesiologists must also have expertise in pre-operative planning, pain management, and patient population analyses in order to execute their functions effectively. Like other physicians and healthcare providers (HCPs), anesthesiologists are subject to healthcare policies, specifically with regards to reimbursement mechanisms and utilization. As the United States healthcare system broadens its scope of practice, anesthesiologists should heed developments in care models, utilization, and payment mechanisms, each of which have the ability to significantly impact the future role of the anesthesiologist.
We have written previously on collaborative care delivery. Most notably, we examined the perioperative surgical home (PSH), which is a care delivery model that moves from a disease-centered approach to care to a patient-centered approach to care. In the PSH model, anesthesiologists comprise the care team for a patient alongside primary care physicians, nurses, surgeons, and social workers.1 In this way, the treatment plan is arrived at collaboratively, allowing for a decision to be made that is optimal for the patient. The PSH model has faced polarizing support and criticism from physician leaders as it becomes increasingly recognized in the medical literature. In order to measure anesthesiologist attitudes, researchers conducted a longitudinal, quantitative, survey-driven study to gauge provider attitudes toward changes in care delivery, including PSH.2 Multiple iterations of the survey were administered over two years in order to capture several data points. Study participants (n=6000) were all board certified anesthesiologists and active members of the American Society of Anesthesiologists. At the end of two years, the researchers concluded that knowledge of the PSH model had increased among all participants, notably across a range of geographies and care center modalities. Moreover, anesthesiologists were more likely to express support for the implementation of a multidisciplinary approach to PSH, as opposed to a strictly physician or medical care-based team. These findings suggest a potential opportunity for anesthesiologists to serve as leaders in the PSH movement, especially given the systems approach to medicine that many anesthesiologists employ in their practices already. Therefore, as care centers begin to transition to PSH care delivery models, anesthesiologists may find value in leading the movement.
In addition to changes in care delivery models, anesthesiologists will encounter changes to payment mechanisms that may influence their future practicing regimens. While the majority of healthcare financing in the United States is currently fee-for-service (FFS), changes in workforce allocation, such as adoption of the PSH, may also render a difference in billing and healthcare financing.3 Bundled payments are one potential payment mechanism that may pick up traction in the United States healthcare system in the coming years. Since anesthesiologists are often employed in shift work, bundled payments may not seem like the most compatible model at first; however, a salaried workforce may be better equipped to combat the complicated world of co-payments, deductibles, and holistic payments. Hence, until healthcare policies can provide a clearer picture of how healthcare is financed in the United States, anesthesiologists should stay informed on how payment mechanisms can impact their own remuneration.
As a result of shifts toward collaborative care and per-patient compensation models, the role of anesthesiologists continues to move away from isolated practices towards integrated developments in the field. Healthcare in the United States is changing rapidly and anesthesiologists are well-equipped with the background and skills to serve at the helm.
References:
- Kain ZN et al. “The Perioperative Surgical Home as a Future Perioperative Practice Model.” Anesthesia & Analgesia. 2014 May. 118(5):1126–1130,
- Raphael DR et al. “Two-Year Follow-up Survey: Views of US Anesthesiologists About Health Care Costs and Future Practice Roles.” Anesthesia & Analgesia. 2018 Feb;126(2):611-614.
- Scott BC and Eminger TL. “Bundled Payments: Value-Based Care Implications for Providers, Payers, and Patients.” American Health and Drug Benefits. 2016 Dec. 9(9): 493-496
