Anesthesia & OR Review

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 »