Somnia Anesthesia Blog

Preop Visits with Anesthesiologists Likely to Reduce Cancelled Surgeries

Somnia Anesthesia Services — Thu, 17 May 2012 20:25:00 GMT

You’ve heard the statistic before: according to various estimates, 60-70% of all hospital revenue is generated by the operating room. Thus, it’s a given that the need for surgeries to be conducted as scheduled is a very high priority for hospital administrators.

Not surprisingly, a recent study showed that hospitals lose millions each year when surgeries are cancelled, a trend that has a significant impact on the facility’s bottom line. Reasons for cancellations varied from patient no-shows (i.e., forgetting the surgery, lack of transportation) to issues at the hospital.

An interesting finding of this study is that when patients have a preoperative visit with an anesthesiologist, the cancelled surgery percentage decreases by two-thirds, from 11% to 4%. Among other recommendations, researchers suggested that hospitals require all patients to have the preoperative visit to ensure they are medically ready for surgery and are aware of the proper steps to take on the day of the procedure. Previous research has shown this method to be a useful strategy for hospitals.

Robert Goldstein, MD, chief medical officer of Somnia Anesthesia, was not surprised by the findings, but did stress caution that this may not be the optimal solution.

“There was a study many years ago that showed a preoperative visit from an anesthesiologist was more effective than the use of anti-anxiety medications alone in calming patients down before surgery,” said Dr. Goldstein. “So it is not a surprising result to see that cancellation rates are lower after a visit with an anesthesiologist.

“It may be simply calming fears and answering questions, and it may also be picking up on actual medical conditions that could unexpectedly prevent surgery from progressing. However, the balance here is that the cost of every patient having a preoperative visit could exceed the savings resulting from fewer cancellations.”

Somnia Anesthesia

Blog Editor

Growth of ACO Movement Prompts AAAHC to Introduce New Accreditation Program

Somnia Anesthesia Services — Mon, 30 Apr 2012 12:56:00 GMT

At its core, the accountable care organization (ACO) healthcare model is designed to provide high-quality patient care at the best possible cost. With its introduction in 2010’s healthcare reform, the concept spurred a sweeping number of changes to hospital operations.

As the effects of the change still become evident, organizations nationwide are taking the necessary steps to adjust to their new environment. In one such case, the Accreditation Association for Ambulatory Health Care (AAAHC), a nationwide accreditating agency for ambulatory health care organizations, recently announced the creation of a pilot program designed to oversee small hospitals located in rural, urban, and suburban regions in the U.S.

Known as the Accreditation Association for Hospital/Health Systems (AAHHS), according to a press release from the association, the program will:

Evaluate health care services against nationally recognized standards of care
Provide an educational, consultative program rather than a punitive approach
Help develop the skills and competencies of hospital staff
Offer opportunities for quality improvement based on survey observations and related best practices
Include a peer-based on-site survey conducted by surveyors who themselves are hospital leaders

AAAHC president and CEO, John Burke, PhD pointed to the proliferation of ACOs, and a related trend toward primary care physicians and free-standing ambulatory care facilities moving back into hospitals, as reasons for creating the new organization. He stated that the AAAHS is intended to “improve patient care by offering a program that addresses both outpatient and inpatient hospital care and the ambulatory care offered by small hospital systems.”

Somnia Anesthesia

Blog Editor

Somnia Breaks Ground With New App for Anesthesia Evaluation

Somnia Anesthesia Services — Tue, 24 Apr 2012 18:51:00 GMT

Anyone with a smartphone can tell you the thousands – literally – of apps available that range in usefulness from very helpful to downright gratuitous. In the ever-expanding digital tsotchke landscape that is an app store, you’d be hard-pressed to find a program hospital administrators would find useful enough to gauge performance of their anesthesia group.

Until now.

That’s because Somnia has introduced the first-ever web-based app for anesthesia evaluation. The tools provides hospital executives with a comprehensive, confidential method in measuring the effectiveness of their anesthesia group in four critical areas – leadership, financial management, quality improvement, and clinical services. Five survey-style questions are devoted to each area (for a total of 20) and upon completion, a recommendation of next steps is offered based upon the final score.

All told, the application’s benefits are innumerable. Start to finish, the evaluation takes no longer than 20 minutes, suitable for time-strapped executives who require an understanding of their anesthesia’s group performance in a timely fashion. And because no one is on the premises to perform the review, the app removes the awkward discomfort that a current group would have if a consultant was judging their performance. Finally, the evaluation app is free, a much more cost-effective offer than an on-site evaluation which runs several thousand dollars.

Highlighting the app’s features in a recent YouTube video, Somnia’s CEO Marc Koch, MD, MBA said, “It’s done confidentially. It’s not a big production. We’re not alienating the current group, and we’re also not creating any discord. It allows hospitals to really get a sense of how their anesthesia group is impacting overall hospital performance.”

To evaluate your current anesthesia department, access www.somniaevaluation.com using your mobile device to begin the process.

Somnia Anesthesia

Blog Editor

Drug Shortage Crisis Affecting Hospital Operations

Somnia Anesthesia Services — Fri, 13 Apr 2012 15:52:00 GMT

The drug shortage crisis in the United States is no mystery. For the past six years, the problem has become an increasingly difficult situation to address, culminating last year with record levels of shortages. Spurred by a variety of manufacturing issues – notably cutbacks in production and expiration of patents – a lack of proper medication is reaching epidemic levels at some healthcare facilities.

As highlighted in a recent Washington Post article, one hospital in the D.C. area describes the situation where hospital staff rushes to address the issue through time-consuming substitute preparations, and even then, it only provides enough leeway for several days. Industry estimates figure that pharmacists spend eight to nine hours a week dealing with drug shortages, triple the time spent in 2004 for the same issue.

The problem has become so severe that injuries and multiple mortalities have been attributed to shortages. With more than 210 drugs in diminishing supply or simply non-existent, the question of how to continue the practice of safe, high-quality patient care in such a difficult climate is heightened.

In a recent interview with Becker’s Hospital Review, Robert Farrar, MD, JD, Somnia’s vice president of medical affairs, discussed the shortage of anesthesia drugs and offered methods to combat the problem.

"It must be a shared burden; no one hospital or surgery center can address drug shortages alone," said Dr. Farrar. "Providers must work together to reallocate resources."

He also urged healthcare providers to take the issue to the highest levels of government and stress the dire need to address the issue.

"This is an unprecedented time for us in healthcare in general, and we're faced with a number of challenges, including drug shortages; however, challenges always present opportunities, and this is a time for us to proactively deal with a negative issue by enacting legislation and taking steps to ensure our supply of critical and anesthesia medications are subjected to a more transparent processes.”

Somnia Anesthesia

Blog Editor

Study Shows Need for Anesthesiologists to Supervise Cases Highest At the Start of the Day

Somnia Anesthesia Services — Thu, 29 Mar 2012 20:01:00 GMT

Anesthesia staffing models are a chief concern of many hospital executives, leading to a number of questions about how to best ensure maximum efficiency of the operating room. For example:

How many clinicians does my facility need to employ?

What is the most appropriate clinician mix of MDs and CRNAs that fosters cost-effective, high-quality care?

Is a care team model suitable for my hospital?

Perhaps the biggest question, or at least the one that has generated much discussion in the industry, is the supervision ratios of MDs to CRNAs. In recent years, as hospitals have searched for the most effective way to deliver anesthesia, the supervision ratio has frequently been adjusted. Some contend that by extending the ratio of one MD supervising more CRNAs, quality of patient care may diminish.

A recent study published in the March issue of Anesthesiology supports that notion, but also shows that lapses in supervision occur most frequently during first-start cases because of concurrent times of critical care even if the ratio is 1 MD to 2 CRNAs. Simply, if two cases started around 8am, the anesthesiologist may not be able to monitor both patients during critical portions of the case, which occur right around the same time.

Researchers concluded that staggered starts or more MDs on staff at the start of the day would reduce the likelihood of supervision lapses.

Robert Goldstein, MD, Somnia Anesthesia’s chief medical officer, understands the recommendation of staggering start times, but believes it may not be the ultimate solution.

“Staggered morning starts are an interesting suggestion but may run counter to patient and surgeon wishes and could ultimately be more costly the facility,” says Dr. Goldstein. “Similarly, changing staffing ratios is probably not cost effective and patient safety is no more guaranteed. The ideal use of a care team model would allow Anesthesiologists and CRNAs more flexibility (then currently afforded by the CMS rules of medical direction) to allocate professional resources according to the case intensity, patient physical status and the competency of the clinicians assigned.”

Somnia Anesthesia

Blog Editor

Webinar Presenters Answer Questions About Anesthesia Care Team Model

Somnia Anesthesia Services — Thu, 15 Mar 2012 17:33:00 GMT

Somnia Anesthesia’s first webinar of 2012, “How the Anesthesia Care Team Model Can Contribute to Clinical Quality Excellence in Your OR,” was extremely well attended and generated a large number of questions that could not be addressed during the 15-minute long Q&A session.

If you missed the webinar, you can download the entire presentation and the Q&A session by clicking here.

Below, two of the presenters address some of the questions that were not covered during the webinar. Additional questions will be addressed by Somnia’s VP of Medical Affairs, Robert Farrar, MD, JD, in an upcoming video to appear on our YouTube channel.

Frank Schramm, MD, Chief of Anesthesia
Providence Regional Medical Center
Everett, WA

Q: In the context of the anesthesia care team what are some of the biggest problems you have faced regarding overall management of the team? What is the biggest advantage of the anesthesia care team model?

A: The most significant advantage of the ACT is the practice efficiency of the model. An Anesthesiologist-only model is significantly more expensive per patient care episode and is, typically, made up of fewer providers. The blending of the complementary skill sets of the Anesthesiologist and CRNA allows for the maximization of benefit to the patient and the facility. The Anesthesiologist is uniquely suited to the role of director and consultant charged with the optimization and preparation of the patient for the operating room as well as to the direct care of those with more critical needs. In addition the collaborative nature of the Anesthesiologist/CRNA team allows for the provision of high quality, cost efficient care with the needs of the patient being met through the blending of training and skill sets. CRNAs are well trained and frequently highly experienced in the practice of intraoperative patient management and act as “force multipliers” in the ACT. CRNAs involved in the ACT frequently benefit from access to case types which they might, in another setting, not have exposure to. The ACT model represents a true “win-win” for all stakeholders. The major problem encountered in establishing an ACT model at a facility where one has not previously existed is the overall acceptance of the presence of the CRNAs in the operating rooms.

Q: Do you get much push-back from surgeons relative to the use of the CRNA as opposed to the anesthesiologists?

A: As mentioned above, the push-back from surgeons tends to be the biggest concern with ACT model implementation. This is generally driven by fear of two things; change and the unknown. Surgeons are creatures of habit and generally become accepting of the model once they are helped to understand the structure and potential benefits inherent therein. Excellent support during startup is essential to the success of the transition; this comes in the form of pre-transition facility needs/wants assessment and provider selection using rigorous, thorough, time proven screening techniques and on-the-ground support from team members with prior transition experience during the initial implementation.

Brent Sommer, CRNA, MPHA
Desert Regional Medical Center
Palm Springs, CA

Q: Why are 10 MDs needed at your facility if you are using a 4 to 1 CRNA to MD ratio with 10 CRNAs?

A: The 4:1 ratio is an ideal and often realistic staffing goal for our particular practice arrangement. Patient and case acuity and complexity, along with particular case demands, and provider availability can all influence this ratio.

Case demands, including those scheduled in diagnostic areas such as the Cardiac Catheterization Lab, Interventional Radiology, Endoscopy Suites, MRI, CT scan, combined with Obstetrics and Trauma service needs all demand dedicated providers. These "out of OR" assignments also impacts departmental staffing and workflow ratios. Daily team management by the lead facilitator directs and manages provider assignments and overall team work flow.

Somnia Anesthesia

Blog Editor

Lack of Debriefing Session for Anesthesia Provider After Adverse Event Potentially Harmful

Somnia Anesthesia Services — Fri, 09 Mar 2012 19:41:00 GMT

A recent study released in the March issue of Anesthesia & Analgesia indicated that more than 80% of anesthesiologists have been involved in an adverse event – defined as causing death or injury – to a patient during surgery.

While that number may appear startling, it must be mentioned that translates to an average of 4.4 events over an entire career - many of which last more than 25 years – including many incidents that are unavoidable.

70% experienced some form of guilt or anxiety following the incident, even if it was unpreventable. That percentage can certainly be attributed to human nature coming into play, as it is with 67% of MDs who believed their work was compromised in the immediate hours afterwards.

What may be unnerving about the study isn’t the aforementioned. After all, unforeseen incidents do happen and doctors are bound to have some sort of emotional response as outlined in past research projects.

What is surprising, however, is the response by hospital administration to quell the clinicians’ emotions. Only seven percent of MDs were given time off and most were required to go about their business as usual. The overwhelming majority of respondents believed that a debriefing session after the event would have been beneficial.

Robert Farrar, MD, Somnia Anesthesia’s vice president of medical affairs, has been a board-certified anesthesiologist for 25 years and was a featured speaker on Somnia’s latest webinar. Discussing the benefits of the anesthesia care team model, he touched upon a decrease in burnout and fatigue for clinicians who practice in that type of care.

Addressing the problem is a dual-focused initiative, with one area focused on alleviating staffing shortages and the other a quality control concern, Dr. Farrar believes.

“Besides being beneficial to the facility, use of the Anesthesia care team model can be beneficial to the anesthesia care provider as well,” said Dr. Farrar. “The ability to have available “down time” when there is a critical event is of incalculable advantage to the provider. Moreover, patients get better care since their provider is not preoccupied with other events.”

Somnia Anesthesia

Blog Editor

Anesthesia in 2012 – What to Expect

Somnia Anesthesia Services — Wed, 07 Mar 2012 18:26:00 GMT

With the first quarter of 2012 nearly complete, the key healthcare issues and trends that will impact anesthesiology this year are quite clear. And much like last year, the 2010 Patient Protection and Affordable Care Act will be a marquee concern.

The implementation of accountable care organizations (ACOs) could possibly lead to a lack of interest in the anesthesiologist profession. During a recent interview with Beckersasc.com, Dr. Adam Dorin, a practicing anesthesiologist, echoed this view. For an industry that’s already at the mercy of a staffing shortage, the hope is that Dr. Dorin’s premonition won’t come to fruition.

Another area of concern has been the significant drug shortage dilemma. An issue that has triggered action at the highest of levels, Dr. Dorin cites three factors that will continue to fuel this development: proliferation of lawsuits against pharmaceutical companies; the impact of drug patent terminations; and declining reimbursements for drug companies.

Marc Koch, MD, CEO of Somnia Anesthesia, shares Dr. Dorin’s view on staffing shortages and postulates that as an increasing number of patients are covered by Medicare and Medicaid, the cost for hospitals to maintain optimal anesthesia services could become exorbitant.

“The provider supply-and-demand kinetics has assaulted the hospital space,” said Dr. Koch. “Influenced by the migration of providers from the hospital space to the ASC and office-based venues, and magnified by the bottleneck of provider supply due to limited physician and CRNA training programs, the compensation for hospital anesthesiologists and CRNAs has skyrocketed.

“As if this was not bad enough, the current payer mix of hospitals is heavily weighted toward Medicare – and Medicare reimbursement for anesthesia is poor. The proposed component of healthcare reform that converts commercial patients to variants of Medicaid could prove to be the tipping point for hospitals already paying high subsidies to anesthesia groups to help cover their staffing costs.”

Somnia Anesthesia

Blog Editor

Application Offers Realistic Testing Experience for Anesthesiology Residents

Somnia Anesthesia Services — Thu, 01 Mar 2012 14:16:00 GMT

If you’re thinking about a career in anesthesiology, be prepared to devote years – 12 to be exact – before you can take the American Board of Anesthesiology (ABA) board-certification examination. Because the industry-standard of eight years of schooling and four years of formal training (i.e. residency) for exam qualification makes the process a long, arduous one, there is a shortage of MDs that has exacerbated the increasing demand for anesthesia services nationwide.

So any news that can help streamline the process – like the new study tool for anesthesiology residents announced recently – should be considered good news for aspiring anesthesiologists and the healthcare industry.

AnesthesiaPrep, LLC has unveiled an application for physicians seeking board-certification in anesthesiology that provides an interactive, realistic testing experience that is functional on web-based and mobile platforms.

With the switch from paper to a computer-based exam in 2008, there hasn’t been a study tool that simulates the new exam procedure. The application will replicate the ABA (Part I) Written Examination with featured questions written and edited by board-certified anesthesiologists that are similar to those found on the test.

Somnia Anesthesia

Blog Editor

A Likely Remedy for Postoperative Sore Throat and Cough – Licorice?!

Somnia Anesthesia Services — Thu, 09 Feb 2012 20:07:00 GMT

Next time you’re at the movies and are deciding between Twizzlers and Sno Caps, you may want to choose Twizzlers, especially if you have surgery planned in the near future.

Okay, it’s not that simple, but a new study shows that gargling with a licorice solution before surgery significantly reduces postoperative sore throat and coughing following the removal of an endotracheal tube.

Surveying patients undergoing elective thoracic surgery, which required a double-lumen endotracheal tube, they were instructed to gargle for at least thirty seconds with the licorice compound or sugar water (the solutions were assigned randomly).

After surgery, patients were examined by independent researchers for 30 minutes, 90 minutes, and four hours after their arrival in the postanesthesia care unit (PACU).

In each time frame, the incidence of sore throat and cough when gargling with licorice was significantly less as compared to sugar water. After 30 minutes, the rate was 22% with licorice, 40% with sugar water. At 90 minutes, the sugar water percentage stayed the same while licorice decreased the frequency to 14%. Both rates increased after four hours, although licorice remained relatively low (21%) compared to sugar water (46%).

Daniel Sessler, MD, professor and chair of the Department of Outcomes Research at the Cleveland Clinic, conducted the study in conjunction with a research team based out of the Medical University in Vienna, Austria.

Dr. Sessler highlighted the considerable effect the findings can have on post-op recovery, stating, “Licorice gargling is something that is dirt cheap, risk-free, simple to use and has a substantial effect on a very real complication.

“Furthermore, substantial efficacy is now well documented. So, why wouldn’t you use it?”

Somnia Anesthesia

Blog Editor

US Air Force Grants CRNAs Independent Practice at USAF Facilities Internationally

Somnia Anesthesia Services — Fri, 03 Feb 2012 20:33:00 GMT

In an effort to improve patient safety while providing the most-cost effective anesthesia care, the U.S. Air Force has instituted a new policy that allows Certified Registered Nurse Anesthetists (CRNAs) to perform independently based on their scope of practice.

The landmark studies that supported the utilization of CRNAs in patient care – an Institute of Medicine report in 2010, "The Future of Nursing: Leading Change, Advancing Health," and a 2010 Health Affairs study titled "No Harm Found when Nurse Anesthetists Work Without Supervision by Physicians” – were valuable resources that assisted the Air Force Medical Service (AFMS) in their decision.

This new guideline follows protocols set forth by other American military service branches as well as 16 states that currently have exemption from federal regulation of physician supervision of CRNAs.

While the new rule change enables CRNAs to administer anesthesia services without medical direction from an anesthesiologist, the anesthesia care team (ACT) model is highlighted as the preferred practice model of the AFMS, citing studies that show a reduction in mortality and morbidity rates when an ACT model is utilized.

In the traditional sense, ACT refers to a CRNA performing duties under medical supervision, but the AFMS will allow any combination of anesthesiologist or CRNAs working collaboratively.

Another wrinkle of the updated policy is that directors of Air Force treatment facilities can appoint an MD or CRNA as chief of anesthesia as long as the clinician is the most experienced and competent provider in a medical treatment facility (MTF). However, in an MTF with three or more operating rooms, the assigned chief will most likely be a board-certified anesthesiologist.

“It’s nice to see the Air Force recognize the excellent capabilities of CRNAs and allow these clinicians to practice within a model that emphasizes their skill set and experience,” said Robert C. Goldstein, MD, Somnia’s Executive Vice President and Chief Medical Officer. “As highlighted in our latest white paper, the inclusion of CRNAs in a care team model carries enormous benefits for facilities, clinicians, and patients.”

Somnia Anesthesia

Blog Editor

New Somnia White Paper Explains the Benefits of the Anesthesia Care Team Model

Somnia Anesthesia Services — Wed, 18 Jan 2012 17:26:00 GMT

Exceptional quality in the delivery of anesthesia in the OR is as vital to a hospital’s clinical and financial success as virtually any other component of a facility’s day-to-day operations. That is about as unquestionable and iron-clad of a statement as you can make in the healthcare industry. The debate, however, isn’t about the importance of anesthesia services, but rather, who is the one providing patient care.

Namely, the inclusion of certified registered nurse anesthetists (CRNAs) in a blended care team model has drawn a line in the sand. On one side stands those who feel CRNAs can consistently deliver high quality care. On the other are those who are of the opinion that nurse anesthetists aren’t capable of handling complex cases.

Whatever the viewpoint may be, the growing number of CRNAs in anesthesia delivery is here to stay, thanks in large part to several factors, notably staffing shortages and the greater focus on value under 2010’s healthcare reform.

Somnia’s latest white paper, “CRNAs in the Care Team Model”, explores the history of the profession as well as the educational, licensing, and experience requirements and examines why and how the blended care team model can be beneficial to healthcare facilities nationwide.

To download now, click here.

Somnia Anesthesia

Blog Editor

OIG Report Shows Most Adverse Events at Hospitals Go Unreported

Somnia Anesthesia Services — Tue, 17 Jan 2012 19:32:00 GMT

The Office of the Investigator General (OIG) for the Department of Health & Human Services published a report a few weeks ago titled, “Hospital Incident Reporting Systems Do Not Capture Most Patient Harm,” in which an in-depth study of adverse event reporting in almost 200 hospitals disturbingly revealed significant underreporting of adverse events and incidents. The study reported that an astonishing 86% of Medicare adverse and temporary harm events go unreported to CMS due to a host of reasons including staff misperceptions as to what constitutes patient harm and unremarkable patient outcomes that were ultimately not affected by the adverse event. What’s more is that this report is on the heels of a 2010 study in which the OIG found that 13.5 percent of hospitalized Medicare beneficiaries experienced adverse events with an additional 13.5 percent experiencing temporary harm events that required treatment. So in reality, approximately 27% of all Medicare patients experience some sort of hospital related event resulting in additional treatment and/or prolonged hospitalization.

“This is unconscionably alarming”, says Hugh Morgan, Director of Quality for Somnia Anesthesia and the company’s Patient Safety Organization. “This era of health reform is very much focused on quality and safety, but it’s clear that the numbers that really matter, the numbers that are affecting patients, are simply not being reported.” Mr. Morgan adds, “CMS has terrific, value-add quality and safety programs such as participation as a Patient Safety Organization, but these programs are voluntary and often require extensive resources that present incident reporting obstacles for most organizations. At Somnia, we have developed a non-punitive culture of continuous self- assessment through which our clinicians are accountable and committed to 100% incident reporting that is reconciled daily by our clinical and administrative leadership. Our clinicians recognize their honest and valued contributions to raising the national bar of quality and safety, which is further validated thru Somnia’s participation with the Anesthesia Quality Institute and recent recognition as a Patient Safety Organization.”

Somnia Anesthesia

Blog Editor

Learn More About Anesthesia Patient Safety During Cosmetic Surgery From Expert Barry Friedberg, MD

Somnia Anesthesia Services — Fri, 13 Jan 2012 19:25:00 GMT

In recent years, Barry Friedberg, MD has become the face of anesthesia patient safety through his informative, engaging appearances on multiple media platforms. Dr. Friedberg’s 30 years as a board-certified anesthesiologist have provided him with a wealth of knowledge and first-hand experience that make him a respected expert in the field. Practicing exclusively in office-based anesthesia for elective cosmetic surgery for almost twenty years, Dr. Friedberg has been at the forefront of several innovative techniques, such as the utilization of PK (propofol ketamine) anesthesia and the routine monitoring of brain activity during procedures.

In his book released in 2009, Getting Over, Going Under: 5 Things You Must Know Before Anesthesia, Dr. Friedberg examined the complexities of anesthesia delivery for cosmetic surgeries. The publication is often cited as useful resource in discussions concerning patient safety during cosmetic surgery.

Visit http://www.drfriedberg.com/ or pick up a copy of his book to learn more about Dr. Friedberg and his practice techniques.

Risk of Stopping Smoking Before Surgery Unsubstantiated

Somnia Anesthesia Services — Thu, 05 Jan 2012 20:59:00 GMT

It is not often that you receive a caution against stopping smoking. However, despite medical evidence to the contrary, some medical literature supported the concept that stopping smoking before surgery posed a risk.

Interpretations of prior studies linked increased postoperative pulmonary complications to stopping smoking less than eight weeks before surgery. One study of 39 patients, published in 1989, that suggested “stopping smoking leads to a decrease in coughing and an increase in sputum production,” helped perpetuate the belief of an increased risk.

Mayo Clinic recently released a study, published in Anesthesia & Analgesia, that finds the claim unsubstantiated.

New Study

Researchers reviewed previous smoking studies and compared patients who recently quit smoking to those who continue to smoke. Nine studies met the selection criteria. Results revealed one study showed a benefit of recent quitting while none showed any harm associated with stopping smoking within eight weeks of surgery.

Researchers agreed that patients who quit smoking several months before surgery receive a greater pulmonary benefit than those who recently quit. They also acknowledge the small sample of studies and reviewed data does not provide a definitive answer to the proposed risk.

Reviewers of the study recommend large, high-quality perioperative tobacco-use studies, particularly in light of the estimated 70 million adult smokers who have surgery every year, many of them under anesthesia.

Somnia Anesthesia

Blog Editor

Pioneers for Health Care Model Chart New ACO Territory

Somnia Anesthesia Services — Thu, 29 Dec 2011 17:48:00 GMT

Health care organizations were not exactly jumping on the bandwagon when the Centers for Medicare and Medicaid Services (CMS) initially proposed its Accountable Care Organization (ACO).

CMS circled the wagons and regrouped to release its Final ACO Regulations. The changes may have worked - at least enough to entice health care organizations into applying for participation in an ACO designed to improve health care and reduce costs for Medicare patients.

Pioneer Groups

CMS named 32 "pioneer" health care groups to its ACO with six of the groups from California, five from Massachusetts, one from Arizona and Florida and additional groups from 15 other states. CMS selected the pioneer groups from 80 applicants who will test-drive the new ACO.

Shared Savings Program

Springing from healthcare reform's Affordable Care Act, the Shared Savings Program offers incentives to physicians and hospitals that deliver high quality health care at lower costs for better outcomes.

Applications for the larger Shared Savings Program are due in January. Although CMS estimates 50 to 270 ACOs will sign up, a recent poll of hospital executives show most are not so sure.

The November poll of over 100 hospital and health system executives revealed 57 percent of the respondents are not sure how the final ACO rules will affect their decision to join.

Responses indicated there is still a lack of a comprehensive understanding about the CMS programs and the financial impact of joining the ACOs.

A pdf list of the pioneer groups and Fact Sheet from CMS is available for download here.

Somnia Anesthesia

Blog Editor

NQF-RAND Study Seeks to Understand Use of Performance Measures

Somnia Anesthesia Services — Tue, 27 Dec 2011 18:31:00 GMT

In an attempt to gain in-depth feedback about the most commonly used performance measures around the country, the National Quality Forum (NQF) recently contracted with the RAND Corporation to conduct an independent study of healthcare end-users to better understand how these measures are being used and more importantly, how to improve the systems and processes responsible for the reporting of these measures.

To conduct their research, RAND surveyed 70 healthcare end-users (i.e. hospitals, physicians and health plans) over a six month period.

The study divided the use of performance measures into four categories: 1) public reporting, 2) quality improvement (QI), 3) payment applications, and 4) accreditation, certification, credentialing, or licensure. The most commonly reported uses of the NQF endorsed measures were QI at 69% followed by public reporting requirements at 64%. Conversely, uses for payment and accreditation, certification, credentialing, or licensure were much less used at 33% and 16% respectively.

The study revealed that the single most important factor cited as either facilitating or impeding the use of measures was the “availability of data to construct performance measures”. Factors noted for impeding the use of the NQF endorsed measures were lack of measure prioritization across all reporting agencies often resulting in “measure fatigue” due to lack of alignment. End users also noted lack of timely data, the cost of measurement, and the challenge of measuring individual physician performance as additional barriers to effectively using the performance measures.

Many end-users cited the increasing use of electronic health records (EHRs) as a better means to improve the efficiency and effectiveness of capturing and reporting these important measures yet few reported that they had conducted formal studies of their own to document the results or R.O.I. on the use of their measures.

“I’m pleased to see this sort of formal monitoring conducted by the NQF,” said Hugh Morgan, director of quality assurance for Somnia, Inc. “It clearly shows their commitment to the basic QI principle that we can only improve upon what we can measure.

“This study is a solid first attempt by the NQF to help us all better understand how and why we have been using the vast array of performance measures so that hopefully the agencies responsible for the measures will better align and prioritize the measures for more relevant and value-add purposes.”

Somnia Anesthesia

Blog Editor

Patient Experience in Healthcare Means More Than Being Nice

Somnia Anesthesia Services — Fri, 09 Dec 2011 19:06:00 GMT

When a patient has a poor healthcare experience, there is more at stake than just an unhappy patient. The fallout could have serious repercussions to the bottom line.

A new white paper from the Beryl Institute, Return on Service: The Financial Impression of Uncomplaining Experience, examines the impact on the financial, marketing and clinical side of health care.

Financial Fallout

Certainly, the regulatory environment attempts to put a price on service with pay-for-performance initiatives and outcomes-based reimbursement.

Medicare's Value-based Purchasing Program includes performance measurements for the patient experience by means of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. A new, surgery-focused patient survey includes eight anesthesia-related questions.

The white paper shares results of studies, like a 2008 J.D. Power study, that demonstrate the financial implications of patient satisfaction.

Marketing Matters

In today's 24/7 connected world, businesses have learned first-hand the danger of an unhappy customer. The healthcare industry is not exempt from the "power found in word-of-mouth."

The authors warn of not only the patient who complains, but also the silent, dissatisfied patients who simply do not return. Ignoring the patient experience drives patients away.

Clinical Concerns

A cited Duke University study showed starling results of the clinical side effect of patient satisfaction. Using responses to HCAHPS questions, the findings showed HCAHPS scores on patient experience were not only reliable, but even more predictable indicators of readmissions than quality indicators.

The white paper offers additional studies and articles providing evidence-based support for the value of improving the patient experience. It is available for download here.

Somnia Anesthesia

Blog Editor

Anesthesia & Analgesia App Now Available

Somnia Anesthesia Services — Fri, 02 Dec 2011 19:25:00 GMT

It's here - video on demand for anesthesia.

It may not be the latest sci-fi flick, but it is one of the features of the new iPad application (app) for Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society (IARS).

Editors unveiled the new software, which offers the entire content of each edition of the journal in an electronic format. And that's not all. The iPad app offers added bells and whistles.

Integrated video and images
Email and social media sharing options
Pinch-to-zoom text adjustment
Quick scrolling navigation
Quick-view browsing capabilities

The journal's press release suggests the added video features open the door for enhanced communications of scientific discoveries and shared clinical insight.

The Anesthesia & Analgesia app is available to anyone, free of charge at the iTunes Apps Store. But, you better hurry if you want to take advantage of the free offering. It is a limited time offer, and once it expires, only IARS members will have access.

Is it on your holiday shopping list?

Somnia Anesthesia

Blog Editor

Anesthesia Plays Key Role in Hospitals of the Future

Somnia Anesthesia Services — Tue, 22 Nov 2011 16:13:00 GMT

The shift from a volumes-based business model to one based on outcomes has anesthesia providers and hospitals speculating on the future.

The American Hospital Association (AHA) shares ideas for shaping the delivery of health care in its new report, Hospitals and Care Systems of the Future. The report offers recommendations on what AHA describes as "must-do" strategies, metrics for measuring success, and organizational core competencies with self-assessment questions.

Anesthesia's Role

With the anesthesia professional as a key provider for managing a patient’s continuum of care in surgical, procedural and obstetrics areas, the decisions made by hospitals have a huge impact on the provider. There is a tremendous value in collaboration between the two.

The AHA report underscores that value with its number one "must-do" strategy of aligning hospitals and providers across the care continuum. Accountable Care Organizations reflect the type of "core organization" described in the AHA report that implement the "must do" strategies by achieving competencies in the delivery and management of health care.

Somnia is adapting to the future with the creation of the Accountable Anesthesia Organization^SM (AAO). The AAO is a transparent, collaborative partner in the delivery of high-quality, cost-effective anesthesia care.

The AAO promotes excellence by focusing on five key areas:

Alignment with the structure of ACOs
Transparency
Resource utilization
Quality metrics
Cost containment
Patient experience

The AAO utilizes many of the same recommendations as those made in the AHA report.

With the challenges in today's healthcare environment, collaboration is critical in delivering high quality, cost-effective care that builds a solid foundation for a future that focuses on improved outcomes.

Somnia Anesthesia

Blog Editor

New Somnia Resource Material Provides Guide for Hospitals Exploring Anesthesia Options

Somnia Anesthesia Services — Fri, 18 Nov 2011 16:15:00 GMT

It is no secret that the operating room is usually the hospital’s largest revenue source. By proxy, the delivery of anesthesia services is a pillar of every facility’s success, not only financially but for patient satisfaction and quality outcomes. Suffice to say, changing anesthesia providers is a major undertaking that causes many administrators to hesitate to even initiate the process.

When the time does come for a facility to reevaluate its anesthesia needs, one of the best practices to employ is the request for proposal (RFP) process, according to a new resource document published by Somnia Anesthesia. As a way to pinpoint issues and identify potential solutions, the RFP process allows a facility to take a figurative step back and determine what is needed to achieve and maintain clinical and financial excellence.

The new Somnia publication is a how-to guide for hospitals exploring anesthesia options, providing suggestions in all areas to consider, including:

Recommended personnel for selection committee
Timing deadline models
Sample RFP questions
What to look for when evaluating proposals
Transition and implementation tips

For more details, download a free copy here.

Somnia Anesthesia

Blog Editor

Ambulatory Surgical Procedures Show Little Effect on Driving Abilities

Somnia Anesthesia Services — Thu, 10 Nov 2011 16:39:00 GMT

Ambulatory surgical procedures are becoming more common. A recent study examined the effect of short-acting anesthetics on patients' driving abilities pre- and post-surgery.

Study Findings

Researchers tested 198 patients scheduled for minor, same day surgery. They used a driving simulator that reproduced a drive similar to one from the hospital to the patient's home.

The primary measurement used for evaluation was the amount of weaving while driving. Other measurements included the number of accidents or driving violations, such as running red lights.

Researchers found very little change in the amount of weaving before (1.63 feet) and after (1.64 feet) surgery. They concluded that the anesthesia drugs administered during surgery had worn off by the time of the discharge of the patient.

An interesting finding was that older patients drove more cautiously, which led to better overall scores than those of younger patients. Researchers also noted that patients who drove safely before the surgery continued their safe driving after the minor surgery.

The Anesthesia Patient Safety Foundation funded the study, which researchers presented at the recent Anesthesiology 2011 meeting.

Somnia Anesthesia

Blog Editor

Pain Management Multimodal Approach Underutilized

Somnia Anesthesia Services — Thu, 03 Nov 2011 16:39:00 GMT

Pain following surgery is a concern for many patients. A multimodal approach, or balanced analgesia, has been the recommendation for pain control. Treatment strategies include the use of more than one method for controlling pain, such as the use of drugs from two or more classes, or a combination of drug and non-drug treatment.

The American Society for Anesthesiologists issued recommendations supporting a multimodal approach; however, a recent study shows a less than 25 percent utilization rate prior to surgery.

The Study

The study conducted by researchers from Thomas Jefferson University, consisted of 15 questions regarding the multimodal approach for pain management. Respondents included anesthesiologists from a variety of care settings.

The findings revealed that use of the approach is not standard practice. Additional findings included the following.

Despite potential side effects, opioids are the most commonly used pain treatment
Alternatives, such as acetaminophen and nonsteroidal anti-inflammatory drugs are underutilized
75 percent of respondents use only two agents, typically a narcotic and non-narcotic

That last finding is despite the fact that evidence has shown combining three or more treatments significantly improves pain control after surgery.

Researchers presented the study and its findings at Anesthesiology 2011, the annual meeting held in Chicago last month.

Somnia Anesthesia

Blog Editor

Final ACO Regulations Revealed

Somnia Anesthesia Services — Mon, 31 Oct 2011 14:08:00 GMT

How does that saying go? If at first you don’t succeed, try again? Evidently, that is the prevailing theory in Washington as the Centers for Medicare and Medicaid Services (CMS) revised the protocol for Accountable Care Organizations (ACOs) following a backlash from healthcare professionals and providers.

In March, the CMS released the first set of guidelines for the ACO program. The skepticism and negative feedback was palpable. Healthcare providers, professionals, and organizations all questioned the feasibility of the plan. Among their complaints was the number of quality measures were far too many; the requirement to use electronic health records (HER) wasn’t realistic; financial terms weren’t attractive; and smaller physician groups would be at a financial disadvantage.

Under the new proposed changes, the number of quality measures was lowered from 65 to 33, the EHR percentage requirement was nixed and the risks associated with savings for cost-effectiveness were eliminated. Additionally, an advance-payment model for physician-owned ACOs will be offered, thereby lowering the financial burden many of the smaller facilities could face.

When the original ACO model was unveiled earlier this year, Somnia Anesthesia published a resource document that defined an Accountable Anesthesia Organization (AAO) model designed to align Somnia’s core business elements of increasing quality and reducing cost with the purpose and goals of the ACO model.

Hugh Morgan, Somnia’s director of quality assurance and a key contributor in creating the AAO model, was pleased with the latest changes to the ACO final ruling.

“No question that the initial ACO proposal was rather lengthy, complex and cumbersome at best,” says Morgan. “And although the final rule is still an almost 700 page document, the new guidelines are much less burdensome and restrictive for those who are considering voluntary participation in the initial ACO program. Even the final reportable quality metrics that were pared down from 65 to 33 are now in direct alignment with all of the currently reportable quality measures that exist in other regulatory programs.

“On the cost-savings side of the equation, it was clear that the original proposal had the potential for significant downside risk so the final rule has implemented various participation ‘tracks’ in which cautious ACOs can opt to participate in the shared savings, but not the shared losses in their particular ACO region. The overarching goal and likely result of the final ruling is to clearly entice more healthcare providers to view ACO participation as a good thing whereby the requirements are much clearer and straightforward and the risk upside is greater than the risk downside.”

Somnia Anesthesia

Blog Editor

Anesthesia Information Technology Systems Have Growing Demand

Somnia Anesthesia Services — Fri, 28 Oct 2011 20:07:00 GMT

Anesthesia Information Management Systems (AIMS) are high on anesthesia providers' wish list.

A recent survey conducted by Surgical Information Systems, a software systems company, revealed 71 percent of the respondents currently use or are planning to implement or evaluate an AIMS within the next year.

Shift to Outcomes-Based System

The shift from a volumes-based reimbursement system to one based on outcomes demands greater quality of care and efficiency. The survey reflects that shift in focus with the 212 respondents ranking quality of care and decreasing reimbursements as their top motivator for investing in information technology.

With the increased emphasis on improved quality of care, providers invest in AIMS for greater efficiency in the operating room through electronic records, analytics capabilities, improved communication and support for mobile devices for better coverage throughout the hospital.

The respondents also hope that enhanced data collection on metrics, such as anesthesia and surgical times and outcomes, will improve their purchasing power with suppliers and reduce unnecessary waste of supplies, drugs, and blood.

The ultimate goal in the use of AIMS is cost-effective, high quality of care for the delivery of anesthesia services.

Somnia Anesthesia

Blog Editor