As models for healthcare reform continue to evolve, value-based care is rising as a viable option for ensuring cost-effective, but efficacious, care to patients. Anesthesia is at the forefront of this discussion. For a total surgery, anesthesia often drives cost upwards — in fact, studies report that about 6% of perioperative costs are attributed to anesthesia alone[1]. Moreover, anesthesia is central to the success of the surgery, and thus is a strong value driver for assessing outcomes. Anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), and anesthesia management companies will be wise to consider the implications of value-based care on the field of anesthesia.
The first major point of analysis for anesthesia professionals to consider is that value-based care will require a high level of standardized data. Anesthesiologists would likely be required to report several measures of quality and clinical practice improvement. Naturally, one of these categories would be comprised of an objective measure of patient outcomes. This data would include the patient’s state before, during, and after the surgery, with a particular emphasis on adverse events such as nausea, gastrointestinal events, or consciousness during surgery. Electronic Medical Records, which Xenon has written on prior to this article, could assist throughout this stringent reporting mechanism. In such a manner, hospitals and medical centers would be assigned a value that is an average of the physician and CRNA medical reports. This average would provide an aggregate, standardized measure of the practice’s value for anesthesiology, which is then utilized to dictate reimbursement in a value-based care model.
In addition, value-based care will necessitate an increase in team-based delivery. While the prior model for care depends on intervention, value-based care focuses on prevention as a means for smoothing costs across a patient population while also driving up outcomes. Anesthesiologists and CRNAs have a crucial role to play in this evolution. Instead of working in silos, anesthesia professionals must be willing to engage in disease-based teams — for example, an oncology team, or a heart disease team. When expert clinicians come together and follow a patient through the medical journey, it is more likely that the patient will receive the appropriate and timely care he/she needs[2]. Moreover, through this method, anesthesia professionals are more highly informed about the patient’s state, thus improving their assessment of how the patient’s care should be delivered. Clinical team models are essential to moving towards value-based care, and anesthesia professionals will prove to be invaluable to this initiative.
Along with specific data requirements and delivery reform, anesthesia professionals can support the implementation of value-based care initiatives by engaging in leadership at the administrative level. Streamlining is essential to maintaining the continuum of care required for a high-value operation. While there are many options for leadership in the medical community, anesthesiologists and CRNAs have the unique expertise to lead in this role, engaging with other medical personnel to ensure a successful surgery.
If executed correctly, value-based care can result in better outcomes for the patient, greater reimbursement to the hospital or healthcare center, and minimized risk across a population. Payers and patients alike will look favorably upon healthcare practices that have made a transparent commitment to increasing the value delivered to their patients. Furthermore, in the often risky and costly perioperative world, anesthesiologists and CRNAs are crucial leaders for promoting an outcomes-driven practice that places the patient at the center.
References
[1] https://www.ncbi.nlm.nih.gov/pubmed/8533904
[2] https://www.hbs.edu/faculty/Pages/item.aspx?num=50278
