Monday, April 1, 2013

Surgical Homes Led by Anesthesiologists May Reduce Costs and Improve

According to Adam Marcus over at Anesthesiology News, there’s pushback against the “forces now buffeting” anesthesiologists. These forces include ACOs and the burdensome and numerous quality-care initiatives being implemented. The pushback is a radically new care model known as the surgical home that’s being proposed by the American Society of Anesthesiologists (ASA).

“The society in recent years has pushed the surgical-home model, a coordination of perioperative care that improves efficiency, as a way for anesthesiologists to demonstrate their value within a healthcare institution,” Marcus writes. “Yet it has had little in the way of data to support the argument—until now.”

This data was relayed to attendees of the ASA’s 2012 annual meeting and was culled from several new studies. Although preliminary in nature, the studies support the idea that anesthesiologists should be more involved with the provision of care to surgery patients, both for reduced costs and better patient outcomes.

For example, the University of Southern California Keck Medical Center out of Los Angeles focused its surgical-home study on 30-day mortality. Basically, anesthesiologists were involved in every stage of care for surgery patients, even helping the surgeons map out the care plan. They and their residents were also present for each step of the plan.

“…The focus is on a good long-term outcome, not simply immediate success in the operating room,” Marcus explains. “The entire team is present for every induction, line placement, and critical event during the case.”
Early results indicated great success for the Keck model, with 30-day mortality rates down 47 percent from 2010 and 2011. Those behind the study expect the model will cut back on the average length of stay by half-a-day.

Beginning in 2010, Ochsner Medical Center out of New Orleans conducted the second study discussed at the ASA meeting. This study gave anesthesiologists the responsibility to “review medical records, order laboratory and other preoperative tests, and manage consultations for patients undergoing knee and hip replacements at the facility.” The goal here was to see if an “anesthesiology-directed perioperative triage can eliminate redundant testing…while boosting throughput and efficiency on the day of surgery.”

The finding was a savings of $18,000 in testing costs per 100 patients, along with care that “was more focused, more based on evidence and on clinical need.”

Finally, the University of Alabama at Birmingham (UAB) focused its study on total hip arthroplasty and how the preoperative anemia management program could affect the patients going through it.

“Under the program, called PAMP, anesthesiologists ensure that patients receive testing for anemia before surgery,” Marcus reports. “If their hemoglobin and iron levels are low, the anesthesiologist orders weekly doses of erythropoietin and IV iron.”

“Will this testing normalize a patient’s hemoglobin and cut back on needed blood transfusions?” the researchers wondered. If so, rehabilitation for these patients would go much more smoothly.

39 percent of the study’s participants were found to be anemic and needed 352 units of red blood cells during the surgery to the tune of $352,000. With anemia therapy, it would have only cost $245,000.
With these three studies, ASA is hoping to gain some leverage with the idea of an anesthesiologist-led surgical home and the potential benefits that such a model can bring to healthcare organizations.

What do you think? Do these studies prove anything? What is your opinion of the surgery-care model?

Majority of Medicare Providers Face Penalties under PQRS Standards

There’s developing news regarding the ongoing battles between physicians and Medicare, as The Hill reports that “more than 80 percent of Medicare providers will face penalties for failing to meet quality thresholds if current performance trends continue.”

This is based on a study conducted by the Harvey L. Neiman Health Policy Institute. According to the article, the study found “that fewer than one in five Medicare providers meet the program's Physician Quality Report System (PQRS) standards and are eligible for related bonus payments.”

Those bonuses become penalties this year under healthcare reform, and Institute CEO Richard Duszak believes that only “near-term improvements in documentation and reporting” will prevent “widespread physician penalties.” He stresses that physician compliance, while showing signs of improvement over the last few years, needs to happen now, because 2015’s penalties will be determined by 2013’s performance.

The Hill’s Elise Viebeck writes, “The requirements encourage doctors to improve patient care by following evidence-based clinical procedures, such as administering aspirin to someone suffering a heart attack or ordering a tuberculosis screening for rheumatoid arthritis patients.”

Performing the best in the Institute’s study were radiologists, “with nearly 24 percent of imaging docs eligible for PQRS incentives that year compared to 16 percent of others.” This translates into possible 2016 penalties of $100 million for radiologists, and over $1 billion for nonradiologists.

The AMA, among others, is fighting the government over PQRS penalties, requesting that they not be enacted in 2013 and instead be delayed until 2015.

As always, we’d like to get your perspective on this issue. What is your general opinion on these penalties? Should they be enacted this year? For those of you who are gainfully employed, what have you done to qualify under PQRS or what are you improving in order to qualify?