BOOK
Practice Management: Successfully Guiding Your Group into the Future, An Issue of Anesthesiology Clinics, E-Book
(2018)
Additional Information
Book Details
Abstract
This issue of Anesthesiology Clinics focuses on Practice Management, with topics including: Measuring Clinical Productivity; OR Throughput and Efficiency; Measuring Quality of Individual Anesthesia Clinicians; Challenges in outcome reporting; Reporting Quality; Quality and The Health System; Value Proposition and Anesthesiology; Bundled Payments and the Hidden Costs; Pre-Anesthesia Assessment and Pre-Facilitation Process; Perioperative Surgical Home and the Role of Pain Medicine; Anesthesiology’s future with Population Health; Successful Negotiations; and Challenges of merging academic and private-practice cultures.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Practice Management:\rSuccessfully Guiding\rYour Group into the\rFuture\r | i | ||
| Copyright | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Practice Management: Successfully Guiding Your Group into the Future | vii | ||
| Preface: Managing Your Anesthesiology Practice for the Future | vii | ||
| I: Operating Room Management | vii | ||
| Measuring Clinical Productivity143 | vii | ||
| Overlapping Surgery: A Case Study in Operating Room Throughput and Efficiency161 | vii | ||
| II: Quality and Reporting | vii | ||
| Measuring Quality for Individual Anesthesia Clinicians177 | vii | ||
| Challenges in Outcome Reporting191 | viii | ||
| Quality Reporting: Understanding National Priorities, Identifying Local Applicability201 | viii | ||
| Quality and the Health System: Becoming a High Reliability Organization217 | viii | ||
| III: Anesthesiology’s Value Proposition | viii | ||
| Value Proposition and Anesthesiology227 | viii | ||
| Bundled Payments and Hidden Costs241 | ix | ||
| Comprehensive Preoperative Assessment and Global Optimization259 | ix | ||
| Perioperative Surgical Home for the Patient with Chronic Pain281 | ix | ||
| Comprehensive Acute Pain Management in the Perioperative Surgical Home295 | ix | ||
| Anesthesiology’s Future with Specialists in Population Health309 | x | ||
| Integrating Academic and Private Practices: Challenges and Opportunities321 | x | ||
| ANESTHESIOLOGY CLINICS | xi | ||
| FORTHCOMING ISSUES | xi | ||
| September 2018 | xi | ||
| December 2018 | xi | ||
| March 2019 | xi | ||
| RECENT ISSUES | xi | ||
| March 2018 | xi | ||
| December 2017 | xi | ||
| September 2017 | xi | ||
| Foreword:\rPractice Management: Successfully Guiding Your Group into the Future | xiii | ||
| Preface:\rManaging Your Anesthesiology Practice for the Future | xv | ||
| OPERATING ROOM MANAGEMENT | xv | ||
| QUALITY AND REPORTING | xvi | ||
| ANESTHESIOLOGY’S VALUE PROPOSITION | xvi | ||
| Measuring Clinical Productivity | 143 | ||
| Key points | 143 | ||
| INTRODUCTION | 143 | ||
| GENERATION OF AMERICAN SOCIETY OF ANESTHESIOLOGISTS UNITS PER FULL-TIME EQUIVALENTS | 145 | ||
| ASSESSMENT OF DEPARTMENTAL PRODUCTIVITY | 145 | ||
| Organizational (Facility-Based) Productivity and Benchmarking | 149 | ||
| Group (Division) Productivity and Benchmarking | 151 | ||
| Individual Productivity and Benchmarking | 152 | ||
| Statistical Methods | 155 | ||
| DISCUSSION | 155 | ||
| Billable Hour Efficiency/Organizational Factors | 155 | ||
| Staffing Efficiency | 156 | ||
| Operating Room/Anesthetizing Location Efficiency | 156 | ||
| Non–American Society of Anesthesiologists Generating Activities | 156 | ||
| Productivity-Based Compensation | 158 | ||
| SUMMARY | 158 | ||
| ACKNOWLEDGMENTS | 159 | ||
| REFERENCES | 159 | ||
| Overlapping Surgery | 161 | ||
| Key points | 161 | ||
| MANAGEMENT GOALS FOR THE SURGICAL SUITE | 162 | ||
| OVERLAPPING SURGERY DEFINITIONS | 163 | ||
| OVERLAPPING SURGERY AND OPERATING ROOM ACCESS | 167 | ||
| OVERLAPPING SURGERY AND PATIENT SAFETY | 168 | ||
| PARALLEL ROOMS AND OPERATING ROOM EFFICIENCY | 170 | ||
| PARALLEL ROOMS AND OPERATING ROOM THROUGHPUT AND PRODUCTIVITY | 171 | ||
| OVERLAPPING SURGERY AND FINANCES | 172 | ||
| OVERLAPPING SURGERY AND OTHER CONSIDERATIONS INCLUDING PROCEDURE TIME | 173 | ||
| SUMMARY | 174 | ||
| REFERENCES | 174 | ||
| Measuring Quality for Individual Anesthesia Clinicians | 177 | ||
| Key points | 177 | ||
| INTRODUCTION | 177 | ||
| DATA COLLECTION AND REPORTING | 178 | ||
| WHY QUALITY DATA SHOULD BE SEPARATED FROM PRIVILEGING DATA | 181 | ||
| SAFETY CULTURE | 182 | ||
| SUMMARY | 187 | ||
| REFERENCES | 187 | ||
| Challenges in Outcome Reporting | 191 | ||
| Key points | 191 | ||
| INTRODUCTION | 191 | ||
| WHAT IS AN OUTCOME AND WHAT IS A GOOD OUTCOME? | 192 | ||
| RISK ADJUSTMENT: PROBLEM OR SOLUTION? | 193 | ||
| THE EFFECT OF DEFINITION ON THE INDIVIDUAL PROVIDER | 194 | ||
| UNINTENDED CONSEQUENCES | 195 | ||
| OUTCOME REPORTING HAS INTRINSIC VALUE | 195 | ||
| SUMMARY | 196 | ||
| REFERENCES | 197 | ||
| Quality Reporting | 201 | ||
| Key points | 201 | ||
| UNDERSTANDING MEASURE INFLUENCERS | 202 | ||
| KEY COMPONENTS OF MEASURE DEVELOPMENT | 203 | ||
| QUALIFIED REGISTRIES AND QUALIFIED CLINICAL DATA REGISTRIES | 207 | ||
| REGISTRY DATA CAPTURE AND SUBMISSION | 208 | ||
| ANESTHESIA REGISTRY REPORTING CHALLENGES | 208 | ||
| NATIONAL ANESTHESIA CLINICAL OUTCOMES REGISTRY DATA SOURCES | 210 | ||
| MERGING DATA FILES | 213 | ||
| KEYS TO SUCCESSFUL REGISTRY PARTICIPATION | 213 | ||
| PRACTICE AND REGISTRY RESPONSIBILITIES | 214 | ||
| QUALITY REPORTING | 215 | ||
| REFERENCES | 216 | ||
| Quality and the Health System | 217 | ||
| Key points | 217 | ||
| INTRODUCTION | 217 | ||
| HIGH RELIABILITY ORGANIZATIONS | 218 | ||
| COMMUNICATION AND PATIENT SAFETY | 221 | ||
| ANESTHESIOLOGY | 223 | ||
| REFERENCES | 224 | ||
| Value Proposition and Anesthesiology | 227 | ||
| Key points | 227 | ||
| WHY DOES AN ANESTHESIA GROUP NEED A VALUE PROPOSITION? | 227 | ||
| THE VALUE PROPOSITION | 228 | ||
| UNDERSTAND YOUR BUSINESS | 228 | ||
| Strengths | 228 | ||
| Weaknesses | 228 | ||
| Opportunities: Leadership, Patient Satisfaction, Perioperative Surgical Home | 229 | ||
| Threats: Large Groups and Discounted Groups | 231 | ||
| UNDERSTAND YOUR MARKET | 231 | ||
| Porter’s 1: Threat of New Entrants | 232 | ||
| Porter’s 2: Bargaining Power of Suppliers | 232 | ||
| Porter’s 3: Bargaining Power of Customers | 232 | ||
| Porter’s 4: Competitive Rivalry | 233 | ||
| Anesthesia management companies | 233 | ||
| Porter’s 5: Substitute Product or Service | 234 | ||
| UNDERSTAND YOUR CUSTOMER | 234 | ||
| Silence | 235 | ||
| Satisfied | 235 | ||
| No Complaints About You | 235 | ||
| Actually Help the Chief Executive Officer and Be a Partner with the Hospital | 236 | ||
| Reduce the Stipend | 236 | ||
| Take a Leadership Role in Your Facility | 237 | ||
| Clinical | 237 | ||
| Are you indeed clinically excellent? | 237 | ||
| Nonclinical | 238 | ||
| Costs | 238 | ||
| SUMMARY | 239 | ||
| REFERENCES | 239 | ||
| Bundled Payments and Hidden Costs | 241 | ||
| Key points | 241 | ||
| INTRODUCTION | 241 | ||
| ANESTHESIA ECONOMICS 101 (1992 TO 2016) | 243 | ||
| Anesthesia Revenue | 243 | ||
| Anesthesia Costs | 244 | ||
| ANESTHESIA ECONOMICS 201 (2017 AND BEYOND?) | 244 | ||
| Assumptions | 247 | ||
| Using Your Practice Data | 247 | ||
| Anesthesia Economic Modeling | 252 | ||
| ALTERNATIVE PAYMENT MODEL OPPORTUNITIES | 257 | ||
| SUMMARY | 257 | ||
| REFERENCES | 258 | ||
| Comprehensive Preoperative Assessment and Global Optimization | 259 | ||
| Key points | 259 | ||
| INTRODUCTION | 259 | ||
| PREOPERATIVE RISK FACTOR ASSESSMENT AND STRATIFICATION | 260 | ||
| DESCRIPTION OF A PERIOPERATIVE ASSESSMENT AND GLOBAL OPTIMIZATION PROGRAM | 262 | ||
| ROLE OF TELEMEDICINE AND TELEHEALTH | 265 | ||
| CONVENTIONAL COMORBID RISK FACTOR OPTIMIZATION | 266 | ||
| Coronary Artery Disease | 266 | ||
| Anemia | 268 | ||
| Diabetes and Glycemic Control | 268 | ||
| Opioid Use, Misuse, and Abuse | 269 | ||
| PREHABILITATION | 269 | ||
| Physical Exercise | 270 | ||
| Nutritional Support | 270 | ||
| Psychological Support | 271 | ||
| Practical Considerations | 271 | ||
| SUMMARY | 271 | ||
| REFERENCES | 272 | ||
| Perioperative Surgical Home for the Patient with Chronic Pain | 281 | ||
| Key points | 281 | ||
| INTRODUCTION | 281 | ||
| OVERVIEW OF THE PERIOPERATIVE SURGICAL HOME | 282 | ||
| PERIOPERATIVE MANAGEMENT OF THE PATIENT WITH CHRONIC PAIN | 282 | ||
| PATIENT IDENTIFICATION | 282 | ||
| PREOPERATIVE ASSESSMENT AND OPTIMIZATION | 285 | ||
| INTRAOPERATIVE MANAGEMENT | 287 | ||
| Ketamine | 287 | ||
| Alpha-2 Agonists | 288 | ||
| Intravenous Lidocaine | 288 | ||
| Opioids | 288 | ||
| POSTOPERATIVE MANAGEMENT | 288 | ||
| POSTOPERATIVE PAIN CONTINUUM | 289 | ||
| PERIOPERATIVE CONSIDERATIONS FOR PATIENTS WITH INTRATHECAL DRUG DELIVERY SYSTEMS AND SPINAL CORD STIMULATORS | 290 | ||
| Perioperative Management of the Patient with Intrathecal Drug Delivery Systems | 290 | ||
| Perioperative Management of the Patient with Spinal Cord Stimulators | 290 | ||
| PERIOPERATIVE MANAGEMENT OF THE PATIENT ON THERAPY FOR OPIOID USE DISORDER | 291 | ||
| SUMMARY | 292 | ||
| REFERENCES | 292 | ||
| Comprehensive Acute Pain Management in the Perioperative Surgical Home | 295 | ||
| Key points | 295 | ||
| INTRODUCTION | 295 | ||
| CONSEQUENCES OF UNCONTROLLED ACUTE PAIN | 296 | ||
| THE ACUTE TO CHRONIC PAIN TRANSITION | 296 | ||
| PERSISTENT POSTSURGICAL OPIOID USE | 297 | ||
| IDENTIFICATION OF AT-RISK POPULATIONS | 297 | ||
| PREOPERATIVE ASSESSMENT | 298 | ||
| MULTIMODAL ANALGESIA | 298 | ||
| PREEMPTIVE ANALGESIA VERSUS PREVENTATIVE ANALGESIA | 299 | ||
| INTRAOPERATIVE MANAGEMENT | 300 | ||
| INTRAOPERATIVE OPIOID MINIMIZATION | 300 | ||
| INTRAOPERATIVE MULTIMODAL ANALGESIA | 301 | ||
| POSTOPERATIVE MANAGEMENT | 302 | ||
| MANAGING REGIONAL ANALGESIA | 302 | ||
| POSTOPERATIVE MULTIMODAL ANALGESIA | 302 | ||
| PERIOPERATIVE PAIN SERVICE WITHIN THE PERIOPERATIVE SURGICAL HOME | 303 | ||
| THE PERIOPERATIVE SURGICAL HOME MODEL AND ITS IMPACT ON THE OPIOID CRISIS | 304 | ||
| SUMMARY | 304 | ||
| REFERENCES | 304 | ||
| Anesthesiology’s Future with Specialists in Population Health | 309 | ||
| Key points | 309 | ||
| INTRODUCTION | 309 | ||
| HEALTH POLICY ACCELERATING SHIFT TO POPULATION HEALTH | 310 | ||
| POPULATION HEALTH MANAGEMENT ORGANIZATION FRAMEWORK | 311 | ||
| RISK-STRATIFIED CARE MANAGEMENT | 312 | ||
| POPULATION HEALTH PERIOPERATIVE/PERIPROCEDURAL RISK PYRAMID | 313 | ||
| PREOPTIMIZATION PHASE | 314 | ||
| ALTERNATIVE PAYMENT MODELS-MERIT-BASED INCENTIVE PAYMENT SYSTEM QUALITY REPORTING | 316 | ||
| INTRAOPERATIVE OR PROCEDURE PHASE | 316 | ||
| IMMEDIATE POSTOPERATIVE PHASE | 317 | ||
| LONG-TERM RECOVERY PHASE | 317 | ||
| POSTACUTE CARE NETWORK DEVELOPMENT | 318 | ||
| PALLIATIVE CARE AND END OF LIFE | 318 | ||
| POPULATION HEALTH INFORMATICS AND TECHNOLOGY | 318 | ||
| GOVERNANCE AND OPERATIONS | 319 | ||
| PAYER PARTNERSHIPS | 319 | ||
| SUMMARY | 319 | ||
| REFERENCES | 320 | ||
| Integrating Academic and Private Practices | 321 | ||
| Key points | 321 | ||
| INTRODUCTION | 321 | ||
| DIFFERENTIATING THE ACADEMIC MEDICAL CENTERS | 322 | ||
| Traditional Academic Medical Center Revenue Streams | 322 | ||
| Financial Implications | 322 | ||
| ACADEMIC MEDICAL CENTERS IN THE NEW LANDSCAPE | 324 | ||
| Value-Based Care | 324 | ||
| Funding Threats | 324 | ||
| DRIVERS FOR CONSOLIDATION | 324 | ||
| Achieve Regional Dominance and National Recognition | 324 | ||
| Benefit from Economies of Scale | 325 | ||
| SHIFTING CONSOLIDATION MODELS | 325 | ||
| CHALLENGES FACING ACADEMIC–COMMUNITY MERGERS | 326 | ||
| Culture: The Neglected Pitfall | 326 | ||
| Understanding Culture in Organizations | 326 | ||
| Layers of organizational culture | 326 | ||
| Competing values | 327 | ||
| Communication | 328 | ||
| Leadership | 328 | ||
| Other Challenges | 328 | ||
| Theoretic Versus Realized Economies | 328 | ||
| Brand Dilution | 328 | ||
| Impacts of Consolidation on Anesthesia Groups | 329 | ||
| Productivity and Efficiency | 329 | ||
| Academic Mission | 330 | ||
| Impact When Merging Residency Programs | 330 | ||
| SUMMARY | 330 | ||
| REFERENCES | 331 |