Anesthesia & OR Review

August 2021

Enhance Healthcare Consulting welcomes Maria Pizzini as Associate Director of Operations & Consulting

August 10, 2021
Enhance Healthcare Consulting welcomes Maria Pizzini as Associate Director of Operations & Consulting  Aventura, FL –Enhance Healthcare Consulting is pleased to welcome Maria Pizzini as Associate Director of Operations & Consulting. Maria Pizzini is a business professional who has extensive... read more »
July 2021

Is Your Operating Room SUPER?

Let us partner with you to improve your OR!

July 20, 2021
Let us partner with you to improve your OR! Contact Us today to learn more! read more »
June 2021

Enhance Healthcare Consulting

Perioperative Services

June 10, 2021
  Surgical Services is the key financial driver for all hospitals, often generating 70% of annual revenue. At the same time, the Operating Room is also considered one of the hospital's most challenging departments clinically and operationally. In an era... read more »

Anesthesia Subsidies

Putting it all on the table series!

June 8, 2021
Hospitals are experiencing a dramatic increase in requests for financial support from their anesthesia service providers, a situation that has been exacerbated by the pandemic. The Enhance Healthcare database, which contains over 120 hospitals, shows the average subsidy per anesthetizing... read more »

Anesthesia Revenue Cycle Performance

Putting it all on the table!

June 1, 2021
  Anesthesia Revenue Cycle Performance is the fourth and final installment of the "Putting it all on the table series". Anesthesia Revenue Cycle Performance does not receive enough attention before or during contract negotiations between the hospital and the anesthesia... read more »
May 2021

Anesthesia Staffing Model

Putting it all on the table!

May 25, 2021
The Anesthesia Staffing Model is the third installment of the “Putting it all on the table” series. Take a look at our first two installments: Fair Market Value Compensation and Staffed Anesthetizing Locations. While OR and NORA coverage requirements are... read more »

Required Staffed Anesthetizing Locations

Putting it all on the table!

May 19, 2021
This is the second installment of our "Anesthesia Subsidies" series. The first installment on fair market value compensation can be found here. The second key driver of Anesthesia Subsidies is Required Staffed Anesthetizing Locations. That is the number of locations anesthesia is... read more »

Fair Market Value Compensation

Putting it all on the table!

May 11, 2021
Fair market value for anesthesia provider compensation is determined by supply and demand.  We have access to numerous internal and external surveys of anesthesia compensation that we use to conduct commercial reasonableness assessments. These surveys offer guidance and parameters based... read more »

Anesthesia Subsidies

Putting it all on the table!

May 5, 2021
The Enhance Healthcare database shows the average subsidy per anesthetizing location skyrocket to $185,000 for contracts signed in the last 3 years, a dramatic 30% increase from the $132,000 per anesthetizing location the 2 years prior read more »
March 2021

SUPER: Resource Support

Make your Operating Room SUPER!

March 31, 2021
To ensure optimal patient safety and OR performance, nursing leadership must foster and maintain strong relationships and communication with multiple departments. These key resources include surgical scheduling, anesthesia, central supply, sterile processing and the preoperative and postoperative areas. The operating... read more »

SUPER: Ensure Data Integrity

Make your Operating Room SUPER!

March 24, 2021
You have revamped your OR Scheduling procedures to increase accuracy, matched your clinical staff and resources to actual Utilization, and implemented Processes that are consistent and hold your team accountable. How do you know if your efforts worked and can... read more »

SUPER: Process Consistency

Make your Operating Room SUPER!

March 17, 2021
The efficient delivery of processes will maximize throughput of cases in your operating room.  Using LEAN methodology to map current processes is the first step. Once you have examined the current state, it is essential to visualize the goals of... read more »

LEAN Daily Board

March 15, 2021
Track your OR Improvement Processes with a LEAN Daily Board. Share it with your team working on the process improvement initiative. Click here to download and print your copy: OR Efficiency Board read more »

SUPER: Utilization Optimization

Make your Operating Room SUPER!

March 10, 2021
Analysis and interpretation of utilization is a foundational component of identifying opportunities for Operating Room efficiency and monitoring progress of improvement initiatives. The most common methodologies for calculating utilization are “pure” utilization (actual patient in room time divided by staffed... read more »

SUPER: Scheduling Accuracy

Make your Operating Room SUPER!

March 3, 2021
Accurate scheduling of surgical cases is a key component of a highly efficient and profitable operating room (OR). Best practice is for surgical schedulers to use sophisticated software to accurately predict the length of time each surgeon will take for... read more »
February 2021

Is Your Operating Room SUPER?

Let us partner with you to improve your OR!

February 18, 2021
Let us partner with you to improve your OR! Contact Us today to learn more! read more »
January 2021

10 Keys to Successful Anesthesia Employment Models

What you should know before considering a transition to hospital employed anesthesia services

January 28, 2021
Having advised and supported several anesthesia employment arrangements in the last few years, we developed the top 10 areas hospitals and anesthesia providers should focus on when considering their own transition. read more »
December 2020

Is Your Anesthesia Group an Asset or a Liability?

How your group can increase the value of perioperative services at your hospitals and ambulatory surgery centers

December 1, 2020
In this whitepaper, Enhance Healthcare outlines four key strategies for anesthesia groups to become an indispensable asset to their hospitals and ambulatory surgical centers. read more »
October 2020

EHC welcomes Yvette Stanley as Senior Perioperative Consultant

October 9, 2020
Enhance Healthcare Consulting welcomes Yvette Stanley as Vice President of Perioperative Consulting Aventura, FL –Enhance Healthcare Consulting is pleased to welcome Yvette Stanley as Vice President of Perioperative Consulting. Yvette brings more than 20 years of healthcare consulting experience to... read more »

Mistakes Hospitals Make When Issuing and RFP

October 5, 2020
“As board-certified anesthesiologists and experienced nurse and business executives, we are able to combine our clinical expertise with nationwide management and consulting experience to assist our clients with streamlining the entire RFP process.” read more »
June 2020

EHC’s QA Series Question 4

We All Have Questions. Let's Work to Answer Them Together!

June 24, 2020
Our anesthesia group received funds from the Paycheck Protection Program and due to reduced case volume and collections, we are still well below our typical cash flow required for payroll. At the same time, our hospital says they want to reduce our fixed subsidy which will only make the situation worse. Suggestions? Thoughts? read more »

EHC’s QA Series Question 3

We All Have Questions. Let's Work to Answer Them Together!

June 17, 2020
As a result of the elective case moratorium our anesthesia group has indicated they are no longer financially viable, and we are considering employment. We already employ a number of physicians in other specialties, but what do we need to consider in regards to anesthesiologists? read more »

EHC’s QA Series Question 2

We All Have Questions. Let's Work to Answer Them Together!

June 11, 2020
What type of anesthesiologist and CRNA movement are you seeing around the country? read more »

EHC’s QA Series Question 1

We All Have Questions. Let's Work to Answer Them Together!

June 11, 2020
As a CFO of a hospital paying our anesthesia group on a (revenue) guarantee, our contractual payments have gone up 300% this month as anesthesia revenue has dropped dramatically. How are other facilities handling this scenario? read more »
May 2020

Enhanced Recovery for Anesthesia Services

The time to plan for the Post COVID-19 OR is now!

May 27, 2020
The time to plan for the Post COVID-19 OR is now. During this time of uncertainty, we are here to assist your Operating Room leadership and OR Governance teams at no cost to you. read more »

Enhance COVID Recovery Pathway

The time to plan for the Post COVID-19 OR is now!

May 6, 2020
The time to plan for the Post COVID-19 OR is now. During this time of uncertainty, we are here to assist your Operating Room leadership and OR Governance teams at no cost to you. read more »
April 2020

Anesthesia Finances in the Age of COVID-19 4

PART 4 – The Journey After COVID-19

April 17, 2020
In Part 4 of our series, we will now consider the likely New Normal in the immediate aftermath of COVID-19 and explore a number of reasons why that sudden surge in volume and revenue may not materialize in the manner anticipated. read more »

Anesthesia Finances in the Age of COVID-19 3

PART 3 – Impact of Responses on Post Virus Performance

April 14, 2020
In Part 1 and Part 2 of Anesthesia Finances in the Age of COVID-19, we described the impact a projected 80% decrease in anesthesia group professional revenue would have on anesthesia financials in three distinct scenarios. read more »

Anesthesia Finances in the Age of COVID-19 2

Part 2 - Impact of Common Early Responses

April 7, 2020
Realistically, most anesthesia groups and hospitals are not going to be able to absorb such a significant financial hit for long. Most facilities have significantly reduced the number of anesthetizing locations as elective cases have disappeared, and many previous subsidy support levels have been dramatically reduced or eliminated. Our objective for this installment of our series is to model the impact of several examples of these changes on anesthesia group finances. read more »

Anesthesia Finances in the Age of COVID-19 1

Part 1 - Impact of Maintaining Existing Subsidy Structures

April 3, 2020
Subsides may be structured in many ways, the most common being fixed stipends and revenue guarantees. Each structure has pros and cons, but in a sudden financial upheaval caused by COVID-19, hospitals or anesthesia groups will be significantly harmed depending on the structure chosen. read more »
March 2020

CMS Fact Sheet: Accelerated and Advanced Payments

March 30, 2020
The Centers for Medicare and Medicaid Services (CMS) expanded their current Accelerated and Advance Payment Program for the duration of the COVID-19 public health emergency. Follow the link to see the entire Fact Sheet: COVID-19 Accelerated and Advanced Payments Fact... read more »

A Note from Enhance Healthcare Consulting

March 18, 2020
Dear Enhance Healthcare clients, partners, and friends, As we, side by side with our clients and colleagues, navigate the challenges and impact of COVID-19 it is clear we must come together as a community in any way we can. First and... read more »
February 2020

Enhance Healthcare to Participate in Upcoming Private Equity Panel

February 12, 2020
Our very own Enhance Healthcare Principal Robert Stiefel will be a panelist at the McGuireWoods' 17th Annual Healthcare and Life Sciences Private Equity and Finance Conference February 19th in Chicago, IL! Contact Us Today To Schedule a Meeting 954.242.1296 | info@enhancehc.com | enhancehc.com read more »
December 2019

Top Article Review of 2019: What does the QZ Modifier Really Mean?

December 17, 2019
An article co-authored by EHC principal Howard Greenfield, MD and published in Anesthesia Business Consultants Anesthesia Fall Communique takes a deep dive into the “QZ” anesthesia modifier.  Once a simple billing modifier, QZ has taken on an increasingly significant role... read more »

Top EHC Article of 2019: Anesthesia Revenue Cycle for Groups and Hospitals

Billing Optimization: The Foundation of Improving Anesthesia Financial Performance

December 17, 2019
Whether you are a hospital paying an anesthesia subsidy or a group trying to maximize profitability, it is in your best interest to monitor and optimize anesthesia revenue realized from payers and patients. Read the full article here.  read more »

ICU or no ICU? If that is the question, we may soon ask AI

December 17, 2019
A pilot study of 50 patients conducted at NYU Langone Medical Center and presented at the 2019 American College of Surgeons Clinical Congress tested the appropriateness of ICU triage by an artificial intelligence program compared to that of clinicians.  Using... read more »

States Explore Bundling

December 17, 2019
Bundled payments of surgical services has been slow to take hold with private insurers.  However, as detailed in Modern Healthcare, bundling platform Carrum Health will offer its’ preferred network of providers to State employees in both Maine and Connecticut.  The... read more »

Follow-Up: Supreme Court Judge upholds $2M malpractice verdict against surgeon with overlapping surgeries

December 17, 2019
In our August Anesthesia and OR Review we shared a story “Overlapping surgery deemed negligent in $2M jury award” discussing a New York Supreme Court jury’s unanimous decision to issue a 2 million dollar malpractice verdict against a surgeon (Dr.... read more »

Ear Tubes in the Office? FDA approves a New “Breakthrough” System

December 17, 2019
The US Food and Drug Administration has approved a new system for Tympanostomy Tubes in patients 6 months or older.  The so called “Tubes Under Local Anesthesia” (TULA) system, which uses a small electrical current to deliver local anesthetic, was... read more »

OR teams work to save patients while putting themselves in danger of surgical smoke inhalation

December 17, 2019
Surgical smoke is an ongoing danger in operating rooms across the country. A long-time orthopedic surgeon in Arizona told AZ family the story of how this dangerous smoke nearly cost him his life. Dr. Anthony Hedley had been a practicing... read more »

YouTube Video Break – OR Efficiency: The Surgeon Matters

December 17, 2019
A presentation based on a study from Cleveland Medical Center is posted here.  The study focused on the impact of in-room to incision time and closure to out-of-room time on OR throughput.  The point was made that these two components... read more »

Doctors at MD Anderson replace traditional anesthesia with hypnosis

December 17, 2019
An article written in the Daily Mail reports that doctors at MD Anderson Cancer Center in Texas are replacing traditional anesthesia with hypnosis techniques combined with local anesthesia in order to reduce the need for harmful anesthetics in breast cancer... read more »
October 2019

Health insurance costs far outpace wages/inflation over the past decade – approaching a “fork in the road”?

October 29, 2019
An article in UPI discusses health insurance cost data based on a survey by the Kaiser Family Foundation.  The survey found a 54 percent hike in family premiums (total cost now $20,500) and a 71% increase in employee share (to... read more »

3-D modeling system designed to support structural heart procedures – Obvious and more subtle implications

October 29, 2019
Use of complex structural cardiac procedures have significantly increased over recent years, expanding options for sicker patients.  Supported by advanced imaging, these procedures by nature are performed without direct cardiac visualization. Now, in yet another application of computer image capture... read more »

United Health weaponizes prior authorization, taking aim at surgical care

October 29, 2019
In a potentially damaging policy shift for hospitals, United Healthcare (UHC) is ramping up its’ prior authorization requirements for some common surgical procedures frequently performed in a hospital outpatient setting.  As detailed in a Modern Healthcare story, the UHC policy... read more »

What does the QZ Modifier Really Mean?

October 29, 2019
An article co-authored by EHC principal Howard Greenfield, MD and published in Anesthesia Business Consultants Anesthesia Fall Communique takes a deep dive into the “QZ” anesthesia modifier.  Once a simple billing modifier, QZ has taken on an increasingly significant role... read more »

Is propofol for colonoscopy sedation worth the cost? Insurance company says no.

October 29, 2019
Last year, Independent Health, the second-largest insurer in the Buffalo Niagara region discovered that Gastroenterology Associates, a private practice with endoscopy centers in Amherst and Niagara Falls, was using an anesthesia group to administer propofol to their patients instead of... read more »

USAP Opens the Kimono on Patient Satisfaction with Anesthesia Providers

October 29, 2019
In our increasingly patient-centric world, opinions and perceptions of patient experience are a major focus of perioperative stakeholders.  A meaningful component of this experience is driven by satisfaction with anesthesia providers. An October 2019 article in Anesthesia and Analgesia explores... read more »

Leveraging internet and smartphones for Enhanced Recovery

October 29, 2019
Increased use of the internet and smartphones now makes it possible to capture post-discharge perioperative patient-reported outcomes (PROs) outside of the clinical setting. Two feasibility studies presented at the 2019 annual meeting of the American Society of Enhanced Recovery and... read more »

Women physicians leaving the workforce at an alarming rate

October 29, 2019
An increasing number of female physicians are walking away from their full-time jobs after only a few years of practice. According to an article written in AAMC, a few years after completing medical school and their residency program, women are... read more »
September 2019

Consumerism and Price Transparency in Healthcare – Real World and Theoretical Challenges

September 24, 2019
In July we ran a story related to President Trumps’ push for price transparency in healthcare,  concluding that “any price transparency proposals should be pulled from the theoretical world of DC and discussed with folks on the front lines of healthcare... read more »

Technology Expands Anesthesia Perioperative Information Flow

September 24, 2019
A September 2019 Anesthesia and Analgesia article looks at the ability to marry improving remote monitors and evolving artificial intelligence to expand and fine-tune the real-time data available to anesthesia providers.  Building on remote surveillance capabilities in other medical specialties,... read more »

Follow Up: Trinity Health and Anesthesia Group, A4 reach a new agreement

September 24, 2019
In our August Anesthesia and OR Review we shared a story “Anesthesia group relationship with Trinity Health devolves into flurry of lawsuits” discussing the dispute between Trinity Health and Anesthesia Associates of Ann Arbor (A4). The lawsuits filed by both... read more »

Virtual Reality Shows Promise as a Pain Management Tool

September 24, 2019
Investigators at Cedars-Sinai Medical Center completed a randomized clinical trial evaluating the impact of on demand Virtual Reality viewing on pain scores for hospitalized patients.  Results, published in a paper in PLOS-ONE evaluated the impact on 120 patients with pain scores... read more »

The 5 C’s of Physician Leadership

Keys to Successful Hospital-Based Physician Leadership

September 24, 2019
Read our article on the keys to successful hospital-based provider leadership! https://enhancehc.com/wp-content/uploads/2019/05/The-5-Cs-of-Leadership.pdf read more »

Augmented Reality gets a chance to optimize surgical procedures

September 24, 2019
The trend toward the use of technology applications in surgery continues with a partnership between the George Washington University Hospital and Novorad, detailed in a recent article in Health Data Management.  Novorad has developed a system which can apply Augmented... read more »

Same-day knee replacements becoming common practice

September 24, 2019
UAB News reports that the University of Alabama at Birmingham hospital is now consistently offering same-day total knee replacement surgery. The UAB’s Department of Orthopaedic Surgery currently performs more than 1,000 hip and knee replacements annually, and this number is... read more »

WakeMed Successfully Adapts ERAS Protocols for Cardiac Surgery

September 24, 2019
Enhanced Recovery After Surgery (ERAS) has been growing dramatically for many case types in many surgical specialties.  While use has lagged in Cardiac Surgery, results from WakeMed detailed in a recent Modern Healthcare article show impressive results for these cases... read more »

Incisional Hernia Risk – now there’s an app for that

September 24, 2019
Researchers at the Perelman School of Medicine at UPenn have developed an app designed to assess the risk of incisional hernias in a variety of abdominal procedures.  A previous analysis from UPenn shown that care related to incisional hernias cost... read more »
August 2019

Not too Good to be True! – Go to Cancun, Have Knee Replacement by US Surgeon, Come Home with a Check for $5K

August 27, 2019
An interesting twist on Medical Tourism is detailed in a New York Times article. A patient from Mississippi, Donna Ferguson, arranged her care through Denver-based North American Specialty Hospital (“NASH”).  Ferguson was flown to Cancun, had her knee replaced by... read more »

“Our Rural Hospital Has Difficulty Recruiting” – Factors to Focus on When Recruiting Physicians

August 27, 2019
It is well-known that recruiting providers of any kind to rural locations can be a challenge. A survey conducted by Jackson Physician Search presents the similarities and disparities between what attracted rural physicians to rural hospitals and what rural administrators... read more »

Anesthesia Group relationship with Trinity Health devolves into a flurry of lawsuits

August 27, 2019
Trinity Health is facing possible losses of millions of dollars per month as a cautionary tale unfolds which highlights the high stakes in the relationship between Health Systems and their anesthesia providers.  Anesthesia Associates of Ann Arbor (A4), which is... read more »

$6.4M award to Surgeon in Defamation Lawsuit

August 27, 2019
A Cardiac Surgeon won a $6.4M judgement against Memorial Hermann Hospital (MH).  An article in Becker’s Hospital Review describes the case in which Dr. Miguel Gomez had his outcomes reviewed by a new cardiac service line administrator in 2009. The... read more »

EHC’s Anesthesia 101 Building Blocks: Service Expectations

August 27, 2019
We are often asked to describe the basic building blocks of creating an anesthesia agreement.  In response, we created a series of brief articles designed to give a foundational understanding of the process and some of the common areas to... read more »

Overlapping Surgery Deemed Negligent in a $2M Jury Award

August 27, 2019
A New York Supreme Court jury in Syracuse issued a $2M malpractice verdict against a surgeon (Dr. Greenky) who routinely staggered Joint Replacements in two to three OR’s.  According to an article on the topic in Syracuse.com, the patient suffered... read more »

A New Foundation for 3-D Organ Printing Shows Promise

August 27, 2019
An article in Science (August 2, 2019) details breakthroughs made in 3-D printing of organs at Carnegie Mellon University. Researchers have utilized a new technique called “FRESH” to build stable collagen “scaffolding” which has proven challenging with previous bio-printing approaches.... read more »

The Anesthesia angle on the impending physician shortage

August 27, 2019
The Association of American Medical Colleges (“AAMC”) conducted a study on the significant shortage of physicians in the U.S. workforce. The study analyzed primary care physicians and specialists and determined that between 2017 and 2032 there would be a shortage... read more »

Post-op death rates sheds light on need for increased post-operative focus

August 27, 2019
A study reviewed in Reuters Health claims that recovery at home is one of the riskiest times for post-surgical patients. The study examined outcomes for major complications and death intra-operatively and up to 30 days post-operatively in 40,000 patients 45... read more »
July 2019

Trump Pushes for Price Transparency

July 30, 2019
In June, President Trump signed an executive order requiring price transparency in health care. He is quoted as saying "Hospitals will be required to publish prices that reflect what people pay for services," in an NPR article on the topic. ... read more »

Hospitals struggle to meet Leapfrog Group volume targets

July 30, 2019
The Leapfrog Group, with the help of an expert panel, has identified eight high-risk surgical procedures where there is a high “volume to outcome relationship” and established minimum hospital and surgeon volume standards for each. In their Inpatient Surgery Report... read more »

Upgrade your (Anesthesia) technology support staff

July 30, 2019
The news is filled with the latest high technology gizmos, gadgets and apps, but Anesthesia Technology is not often in the headlines.  However, the July 2019 edition of the ASA Monitor has two articles devoted to these invaluable support professionals. ... read more »

Growth of Enhanced Recovery After Surgery (ERAS) across the US

July 30, 2019
According to an article written in Anesthesiology News, Enhanced Recovery After Surgery, or ERAS, is seeing continued growth and adoption in hospitals across the United States. A survey conducted by Dr. Sunitha Singh, ERAS coordinator at Stony Brook University Medical... read more »

EHC’s Anesthesia 101 Building Blocks #1: Anesthesia Subsidy Drivers

July 30, 2019
We are often asked to describe the basic building blocks of creating an anesthesia agreement.  In response, we created a series of brief articles designed to give a foundational understanding of the process and some of the common areas to... read more »

Reimbursement scenarios for Medicare for All

July 30, 2019
Adding to the issue we discussed in our article in the June Review, Dr. Zirui Song from Harvard Medical School in JAMA Network offers this timely analysis of the impact of a Medicare for All transition on reimbursement under various... read more »

Review of Financial Incentive Programs for Anesthesiologists

July 30, 2019
Dr. David Lubarsky et al. provides a detailed review article in the January 2019 issue of Anesthesiology.  They look at financial incentives for physicians in general, with many specific examples related to anesthesiologists. Utilizing the framework of behavioral economics as... read more »

Cybersecurity: Now an anesthesia machine problem

July 30, 2019
As if we didn’t already have enough to worry about, now faceless hackers can possibly take control of our anesthesia machines!  In a scenario which sounds like it was dreamed up by a novelist, The Department of Homeland Security’s Cybersecurity... read more »

5G – Coming Soon to an OR Near You?

July 30, 2019
We’ve all heard of the impending 5G roll out. Soon to be a reality in major cities, it is said to offer vastly increased speed and responsiveness compared to current “4G” cellular capabilities.  A recent Health Data Management article considers... read more »
June 2019

Medicare for all-apalooza: controversial proposal stirs conflict in Chicago and Washington

June 25, 2019
The latest “fix” for all that ails US Healthcare is “Medicare for All” which certainly fuels strong reactions along political and professional lines. Among the latest events are a contentious hearing in Washington summarized in The Hill and a protest... read more »

Maximizing safety of non-OR anesthesia

June 25, 2019
The Anesthesia Patient Safety Foundation brings us a detailed article focused on safety considerations for Non-Operating Room Anesthesia (NORA). For most hospitals, NORA represents the most rapidly growing area of need for anesthesia services. Closed claims data show that NORA... read more »

Anesthesia Revenue Cycle for Groups and Hospitals

Billing Optimization: The Foundation of Improving Anesthesia Financial Performance

June 25, 2019
Whether you are a hospital paying an anesthesia subsidy or a group trying to maximize profitability, it is in your best interest to monitor and optimize anesthesia revenue realized from payers and patients. Read the full article here.  read more »

Virtual Reality Hypnosis Distraction used to reduce the need for intravenous sedation

June 25, 2019
An article written in “HIT Infrastructure” describes the possible positive effects of using Virtual Reality Hypnosis Distraction (VRHD) to minimize the need for sedation during surgery. Dr. Dragos Chirnoaga from CUB Erasmus Hospital, Brussels, Belgium led the trial which consisted... read more »

An inside look into why hospitals seek new anesthesia providers

June 25, 2019
Enhance Healthcare Consulting surveyed hospital executives across the country to discover how and why they seek new anesthesia providers. Take a look at the results!     read more »

Big bucks and big backers for Surgical VR firm Vicarious Surgical

June 25, 2019
Virtual reality combined with surgical robotics and micro-incisions is proving to be a valuable mix for the startup Vicarious Surgical. According to Mobihealth News, the company received a second round of funding from A-list investors including the Gates Foundation, Khsola... read more »

Does quality pay? The link between SCIP performance and hospital profitability

June 25, 2019
Using nationwide financial data for all US hospitals in the AHA Annual Survey and Surgical Care Improvement Project (SCIP) measure performance from the Hospital Compare site, Beauvais et. al. examined the association between quality metrics performance and hospital financial performance.... read more »

Changes in process of First Case On Time Starts drives improvement at a SC hospital

June 25, 2019
Dramatic improvements in First case On Time Starts were the focus of a study published in the Journal of Healthcare Management, by Allen et. al. from Greenville Health System. They describe redesign of first cases which highlighted a change in on-time... read more »

Is anesthesia used in surgery linked to breast cancer recurrence?

June 25, 2019
A retrospective study reviewed in Anesthesiology News reported no correlation between the type of anesthesia used in breast cancer surgery and the rate of recurrence. The study retrospectively analyzed 5,331 patients who were split into two groups; the IV group... read more »

Same Day Discharge for Joint Replacement is achievable while minimizing opioid use

June 25, 2019
A study from Northside Hospital in Atlanta and reported on in Anesthesiology News showed that a high percentage of Hip and Knee replacement patients can be successfully discharged on the day of surgery using a Multi-Modal Analgesic Protocol (MMAP). Over... read more »
May 2019

“Lean” toward reducing OR Turnover Time

May 28, 2019
The Annals of Thoracic Surgery reports on a study from NYU Langone Medical Center which applied the concepts of Lean process improvement to OR Turnover. A multi-disciplinary team was converted into a turnover time (TOT) “Performance Improvement Team (PIT Crew)”.  This... read more »

White House joins the discussion on surprise medical billing

May 28, 2019
President Trump weighed in on “surprise medical billing” on May 9th. The Washington Post reported that the President called for Democrats and Republicans alike to work quickly to stop surprise billing, quoting him as saying that “these practices are bankrupting... read more »

The 5 C’s of Physician Leadership

Keys to Successful Hospital-Based Physician Leadership

May 28, 2019
Read our latest article on the keys to successful hospital-based provider leadership! https://enhancehc.com/wp-content/uploads/2019/05/The-5-Cs-of-Leadership.pdf read more »

All (non-robotic) hands on deck at struggling rural NY hospital

May 28, 2019
In a tale which is becoming all too common, a small, rural hospital is considering several concurrent strategies as it struggles for financial survival. Part of the strategy is to shave $460,000 in annual cost by jettisoning lease payments on... read more »

Improving quality and profitability through OR Efficiency

May 28, 2019
Take a look at Dr. Randy Fagin's take on improving operating room efficiency! https://www.youtube.com/watch?v=TCisWVDg22g read more »

Cannabis use linked to need for higher doses of anesthesia

May 28, 2019
An article written by CNN describes a study conducted by the Journal of the American Osteopathic Association that followed 250 patients receiving minimally invasive surgery in Colorado, where recreational marijuana has been legalized. The study found that patients using marijuana... read more »

Reducing “low-value” preop care. Good or bad?

May 28, 2019
An interesting study from JAMA looks at the financial impact of reducing “low-value” preoperative care for cataract patients. Approximately 500 cataract patients from two Los Angeles area academic safety net hospitals were tested. One facility underwent “intervention” whereby a quality... read more »

United Healthcare expands bundling program for Medicare Advantage patients

May 28, 2019
United Healthcare will offer a bundled payments program for providers caring for Medicare Advantage patients in over 30 states. The program (which will include certain procedures, including hip and knee replacements, spinal fusions and coronary bypasses) builds upon UnitedHealthcare’s existing... read more »

Washington State Health System cites EHR and Revenue Cycle as key factors leading to bankruptcy

May 28, 2019
Astria Health, based in Washington state has filed for Chapter 11 bankruptcy, laying blame on issues with their EHR and with an outside contracted Revenue Cycle provider.  According to the Yakima Herald-Republic, in the months leading up to the filing... read more »

Incisional Hernia Risk – now there’s an app for that

May 28, 2019
Researchers at the Perelman School of Medicine at UPenn have developed an app designed to assess the risk of incisional hernias in a variety of abdominal procedures.  A previous analysis from UPenn shown that care related to incisional hernias cost... read more »
April 2019

Atrium reports savings after tumultuous anesthesia group change

April 30, 2019
In a follow up to a contentious and public anesthesia transition in 2018, the Charlotte Observer reports that both Atrium Health System and its patients have realized savings.  Atrium CEO Gene Woods is quoted in the article indicating that patients... read more »

You think you have revenue challenges? This international hospital charges $14 for an endoscopy and $2,000 for a CABG

April 30, 2019
Bloomberg Business reports  on Narayana Health, a 23-hospital chain in India.  Cardiac Surgeon and founder/Chairman of the Health System, Dr. Devi Shetty opened the first Narayana Hospital in 2000. Originally devoted only to Cardiac Surgery the hospitals now have expanded... read more »

American College of Surgeons assesses frailty as a pre-op screening tool

April 30, 2019
The American College of Surgeons has released information on a study involving 14,530 surgical patients which was designed to assess frailty as an independent risk factor.  Using a common frailty index, researchers deemed 5.3 percent of inpatients and 2.5 percent... read more »

National provider compensation according to Enhance Healthcare’s EHCdata

April 30, 2019
Enhance Healthcare Consulting EHCdata is one of the largest collections of internal facility and provider group data in the country, including specific information on compensation, subsidies and more. According to EHCdata, the national average physician base compensation is $408,000 and... read more »

In-network hospitals burden patients with surprise out-of-network bills

April 30, 2019
An article written in Modern Healthcare describes the surprising frequency with which in-network hospital admissions result in at least one out-of-network claim. About 1 in 7 patients receive unexpected out-of-network bills when obtaining inpatient care at an in-network hospital. The... read more »

Arkansas pushes to allow CRNAs to practice without supervision

April 30, 2019
According to an opinion article written in the Arkansas Democrat Gazette, SB184/HB1238, a bill in the Arkansas legislature, aims to remove the anesthesia care team model requirement in Arkansas and allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without... read more »

Perioperative nutrition offers significant opportunity for improvement

April 30, 2019
A wide ranging article in Anesthesiology News focuses on the state of perioperative nutrition.  The article references several studies and features quotes from leading nutrition researchers and clinicians.  The consensus is that perioperative nutrition is in dire straits and that... read more »

INTEGRIS “drives” a smooth transition for pediatric patients to the OR

April 30, 2019
https://www.youtube.com/watch?v=P6jk6FlzO60   read more »

Let the TAVR Battles begin

April 30, 2019
An article in the Wall Street Journal on March 18, 2019 describes a battle among doctors, hospitals and insurers over federal reimbursement for TAVR. Up until now, due to the reimbursement policies of CMS, the procedure has been limited to... read more »

Hospitalist takes on Medical Director role at multi-facility pre-op center

April 30, 2019
Hospitalist Holly Ray, MD has taken on the role of Medical Director at the “Surgery Navigation Center” at New Hanover Regional Medical Center (“NHRMC”) in Wilmington, NC.  According to an article in the Star Line News, the center opened in... read more »

Geisinger improves orthopedic outcomes and length of stay through telehealth integration

April 30, 2019
The Department of Orthopedics at Geisinger has expanded integration of the technology Force Therapeutics into perioperative care.  For three years, the system has been used to deliver education, communication and monitoring to patients undergoing hip and knee surgeries. Throughout their... read more »
March 2019

Robotically Assisted Surgery Risky for Certain Cancer-Related Procedures

March 25, 2019
Robotically Assisted Surgical Devices are being used at an increased rate in operating rooms for minimally invasive surgeries. They are said to reduce scarring, bleeding, infection and recovery time. According to an article in NBC News, these devices may be... read more »

CMS Mandatory Bundled Payment Program for Joint Replacements yield early cost savings

March 25, 2019
An article in the New England Journal Of Medicine looked at results from the first two years of the Comprehensive Care for Joint Replacement (CJR) program by comparing results for joint replacements in large data sets.  The study compared data... read more »

“Overlapping Surgeries” generally safe, with two important exceptions

March 25, 2019
Researchers from Harvard Medical School and Stanford University analyzed outcomes in over 65,000 patients in a study designed to evaluate the impact of the common practice of overlapping surgery.  They found that for most patient groups and procedures the practice of... read more »

How does your hospital stay profitable?

March 25, 2019
A study released in December 2018 by Juniper Advisory analyzed audit data from 90 independent hospitals throughout the US. They found that 61% of these facilities had operating margins under 3% which is the threshold for the ability of a... read more »

The Hierarchical Nature of the Operating Room and its Consequences

March 25, 2019
The operating room (OR) team consists of nurses, surgeons, anesthetists, respiratory therapists, scrub techs and more. Oftentimes, hierarchy and fear discourage junior (or lower hierarchical level) members of the team from speaking up when they notice something wrong. A narrative... read more »

Anesthesia Revenue Cycle for Groups and Hospitals

Billing Optimization: The Foundation of Improving Anesthesia Financial Performance

March 25, 2019
Whether you are a hospital paying an anesthesia subsidy or a group trying to maximize profitability, it is in your best interest to monitor and optimize anesthesia revenue realized from payers and patients. Read the full article here.  read more »

Comparing Apples to Apples – a deep dive into Anesthesia productivity

March 25, 2019
A review article by Dr. Amr Abouleish et. al. in the February 2019 issue of Anesthesiology offers an in depth analysis of anesthesia group productivity. Their focus is only on surgical anesthesia (non-obstetric care) and points out the nuances of... read more »

Expanding the role of the Anesthesiologist to include Hospitalist

March 25, 2019
An article in Anesthesiology News discusses a pilot project at the Loma Linda University Medical Center in California. The Departments of Anesthesiology and Urology teamed-up to establish a perioperative program using anesthesiologists, who are known to be experts in all... read more »

Interview with Dr. Brian Woods, President & CMO, NorthStar Anesthesia

March 25, 2019
Known as a resourceful, strategic, and inspirational executive leader, Brian Woods, MD seeks to add value to any endeavor or relationship he enters. He graduated with his medical degree from the University of Texas Health Science Center at San Antonio... read more »

Ochsner is named Walmart’s 12th Center of Excellence for Joint Replacements

March 25, 2019
Retail giant Walmart has named Ochsner Health System their 12th Center of Excellence for Joint Replacements. In a press release, the organizations indicate that “Walmart chooses Centers of Excellence locations through a selective process, which requires hospitals to demonstrate an... read more »
February 2019

Artificial Intelligence shows strong early predictive capabilities for LV dysfunction

February 26, 2019
A CNBC interview with Dr. Paul Friedman, the Chair of Cardiovascular Medicine at the Mayo Clinic, describes his work with Artificial Intelligence as an early predictor of Asymptomatic Left Ventricular (LV) Dysfunction.  Using only EKG readings, the computer system has... read more »

Can you imagine…Uber Anesthesia?

February 26, 2019
In the Winter 2019 Communique from Anesthesia Business Consultants, Jody Locke offers an article considering the possibilities of an Uber-type service in anesthesia.  The entertaining article draws the analogy between consumers’ appetite for on-demand transportation to the desire of hospital... read more »

Review of Financial Incentive Programs for Anesthesiologists

February 26, 2019
Dr. David Lubarsky et al. provides a detailed review article in the January 2019 issue of Anesthesiology.  They look at financial incentives for physicians in general, with many specific examples related to anesthesiologists. Utilizing the framework of behavioral economics as... read more »

Just like a baseball star? Arbitration proposed as a solution for Out-of-Network bills

February 26, 2019
The focus on “surprise” or out-of network bills continues, with many potential solutions being considered and implemented in a number of states.  Bloomberg reports on a solution based on a Major League Baseball style arbitration which is in effect in... read more »

ACS updates patient and procedure-specific Risk Calculator

February 26, 2019
The American College of Surgeons has updated a free, internet-based  Risk Calculator which may be used by surgeons and/or patients to determine the risks associated with an anticipated procedure. The calculator, which incorporates data from 3.2 million procedures done between... read more »

Skills for a successful transition into Clinical Nurse Management

February 26, 2019
The American Association of Nurse Anesthetists (AANA) found that there was two times more turnover among nurse managers than with clinical nurses. They conducted a study involving 18 CRNA’s to determine why turnover was so high and what knowledge, skills,... read more »

Providers caught in the crossfire in Pennsylvania management company transition

February 26, 2019
In a concerning turn of events in a hospital based physician service, Emergency Department coverage has been disrupted at three Pennsylvania hospitals and providers left without pay for months.  The situation, detailed in the Philadelphia Inquirer, relates to an emergency... read more »

Interview with Dr. David Bergman – CEO of ePreop

February 26, 2019
David E. Bergman is the CEO and co-founder of ePreop. He practiced as an attending anesthesiologist at St. Jude Medical Center in Fullerton, California, where he also served as chairman for two years. Dr. Bergman co-founded ePreop in 2008 to... read more »

Automated text messaging and video system shows impressive results in Total Joint Replacement patients

February 26, 2019
A randomized, controlled trial performed at Rush University medical center tested the impact of an automated text and video “bot” on patients undergoing hip and knee replacements.  The study published in the Journal of Bone and Joint Surgery, randomized 159... read more »
January 2019

EHCdata shares impact of OB services on hospital subsidy

January 15, 2019
EHCdata is Enhance Healthcare Consulting’s growing database of over 100 hospitals and anesthesia practices. This database provides real-time impactful information on anesthesia services across the United States, including information on hospital subsidies, provider compensation and more. Multiple variables impact anesthesia... read more »

ASA expands resources for Sedation Education for Non-Anesthesiologists

January 15, 2019
The American Society of Anesthesiologists has expanded its suite of educational offerings for non-anesthesiologists to now include resources for providing deep sedation. The original offering in 2015 provided simulation based training for non-Anesthesiologist physicians and care team members in moderate... read more »

UCHealth adopts innovative method of scheduling surgery that results in an increased revenue of $10M

January 15, 2019
UCHealth’s University of Colorado Hospitals have adopted a machine learning system for their operating room (OR) that has resulted in an increase in revenue of $10 million. In an article describing the results in Rev Cycle Intelligence, UCHealth’s Chief Operating... read more »

5 Areas Standardization Can Be Used to Create High Value in the OR

January 15, 2019
In a letter published in the Anesthesia Patient Safety Foundation newsletter, a physician leader affiliated with a large national anesthesia company suggests five areas that can be standardized in the OR to promote patient safety, patient satisfaction and efficiency. 1.... read more »

JAMA study shows that very low volume surgeons have worse outcomes and longer LOS for several vascular procedures

January 15, 2019
A study published in JAMA in August 2017 shows that for over 75,000 Abdominal Aortic Artery (AAA) repairs and Carotid Endarterectomies (CEA), outcomes of very low volume surgeons were significantly worse. The study was for all cases in NY state... read more »

Health System Executive Interview: Mark Penkhus, HCA

January 15, 2019
HEALTH SYSTEM EXECUTIVE INTERVIEW Mark L. Penkhus is a Vice President of the Physician Services Group for HCA overseeing several hospital-based physician services, including anesthesiology for the organization since 2007. Mark has extensive healthcare experience, previously serving as CEO for... read more »

To Pregnancy Test or Not to Pregnancy Test?…That is the Question

January 15, 2019
We commonly see confusion as to requirements for pregnancy testing prior to surgical procedures. Some institutions mandate testing for females in certain age groups, sometimes supported, sometimes not supported by their anesthesia provider group. Many refer to the American Society... read more »

Geisinger embraces components of Perioperative Surgical Home to re-imagine surgical patient experience and reduce Opioid use

January 15, 2019
Geisinger announced the launch of what they are calling “ProvenRecovery”, a surgical redesign program aimed at expediting healing, improving pain management and reducing opioid use. The program will be implemented across 42 surgical procedures impacting approximately 15,000 surgical cases annually,... read more »

Welcome to the Anesthesia & OR Review

January 15, 2019
Welcome to the inaugural edition of Enhance Healthcare Consulting’s Anesthesia & OR Review! As your anesthesia and operating room partners we take pride in keeping our clients, friends and the healthcare community up-to-date on issues and events... read more »