Traditionally, anesthesiologists have focused their efforts solely on the intraoperative phase of surgery. But the PSH brings them out of the OR and into leadership roles aimed at marrying the needs of the hospital with the needs of its patients and its surgeons.
The emergence of this new model is auspicious for hospital administrators. Not only can the implementation of the PSH model improve integration across the Acute Care Continuum, it can boost market share too.
A New Approach
The PSH model charges anesthesiologists with managing patients' surgical care from the decision to operate until 30 days after the patient is discharged from the facility.
Anesthesiologists coordinate the entire care team — primary care providers, emergency physicians, surgeons, hospitalists, intensivists, and physical therapists — to create a seamless spectrum of care.
For example, at Vituity, we’ve developed a Total Joint Replacement program in which our anesthesiologists work in conjunction with the surgeon, nursing staff, and physical therapy staff to get patients properly prepared before they come to the hospital. They tailor the patients’ preoperative, intraoperative, and postoperative anesthesia care. They maximize pain control and minimize the side effects of pain control modalities so that patients can become active and early participants in their rehabilitation.
The program has led to a tremendous improvement in outcomes and patient satisfaction. Additionally, it's energized entire care teams. Participants are excited about the possibilities of this approach. Everybody benefits: the surgeons, the patients, and the hospital itself.
Benefits Across the Board
Surgeons tend to respond positively to anesthesiologists’ leadership when it comes to coordinating care because anesthesiologists are already intimately familiar with the OR process. And that means they are intimately familiar with the surgeon’s needs in the OR. So surgeons feel like they’re dealing with hospital representatives — but on a peer-to-peer basis.
In addition, patients both notice and appreciate when care is coordinated throughout the length of their stay. They find it reassuring.
Preoperative attention helps to better prepare them for surgery. And best practices — in particular, tailored anesthetics — enable them to wake up and ultimately return home more quickly.
At the Silicon Valley Joint Replacement Center at Good Samaritan Hospital in San Jose, Calif., where CEP America staffs the ED and anesthesia departments, average length of stay is well below the 3.2-day state average. The PSH in place there has been so successful that more than half of patients are discharged directly home.
Bottom line: satisfied physicians and patients lead to more surgical referrals. And more surgical referrals mean more market share.
In addition to boosting market share, the PSH model boosts revenue in other ways too. After all, in 2011, the most recent year for which data is available, surgical admissions generated nearly half of hospital revenue, according to the Department of Health & Human Services’ Agency for Healthcare Research and Quality.
In the meantime, the quality of care that hospitals provide is increasingly under a microscope by federal regulators — and commercial payers are following suit. Depending on how well a facility “scores,” the result can mean more dollars—or fewer.
Because the PSH model’s coordinated care paradigm decreases the length of patient stays through better outcomes, the hospital can take more patients. Engaging with the patient proactively ahead of surgery reduces the number of last-minute cancellations. And when quality of care improves and readmissions fall, value-based reimbursements tend to rise.
Finding a PSH
Implementing a PSH model is a significant undertaking. It requires identifying a champion within the hospital system who can bring together key stakeholders and encourage them to agree on adopting this new model. Sharing the benefits above with your medical staff is a great first step to foster buy-in.
Because the PSH model is relatively new, few hospitals are using it in a robust manner. Not only does Vituity have PSH model capabilities in place, our anesthesiologists are physician-owners of the practice who are driven to get results. And of course, anesthesiologists are facility-based physicians. The result is that CEP anesthesiologists are both figuratively and literally invested in the success of their hospitals.
Your hospital’s success, in other words, is our success.