How to Boost Your Hospital’s Surgical Services Integration Efforts

Shale Imeson

Shale Imeson , MD

Anesthesia Medical Director, Lodi Memorial Hospital

Published October 16, 2017

Surgical tools in the operating room
The operating room (OR) is often the biggest source of revenue within a hospital. But it’s also costly to run — with approximately 60 to 70 percent of a hospital’s expenses associated with surgical and procedural care — and it can be prone to inefficiency.

With shrinking net income margins and the continued shift toward value-based payments, the need to improve efficiency has never been greater. One way to do this is to integrate surgical services with other acute care specialties to improve quality and lower costs.

In today’s post, you’ll hear from Shale Imeson, MD, Anesthesia Medical Director at Lodi Memorial Hospital in California. Dr. Imeson discusses how anesthesiologists are natural partners for leading the effort to build a thriving, efficient, and integrated surgical services program.

Perspectives: What barriers prevent many surgical services programs from being as profitable as they could be?

Imeson: Traditionally, surgery, anesthesiology, and other hospital-based specialties have operated in their own silos, not establishing common goals and working together toward those goals. Without collaboration between departments, preoperative care is uncoordinated, leading to surgical delays or cancellations and duplicative or unnecessary services. Poor communication also causes surgical start time delays, long turnaround times between surgeries, and underutilized ORs. This all negatively impacts profitability.

Perspectives: What role can anesthesiologists play in surgical integration?

Imeson: As hospital-based physicians, anesthesiologists are well positioned to lead the development of protocols and processes that streamline operating room throughput. Some of the things anesthesiologists can support include assessing patients’ readiness for surgery, developing a plan for pain management, and leading more efficient discharge and rehabilitation planning.

Perspectives: Why is surgical services integration so important today?

Imeson: Reimbursement models are being redesigned to stress accountability for care quality and healthcare costs. Hospitals participating in the Centers for Medicare and Medicaid’s total joint replacement–bundled payment program, for example, are responsible for the total cost of care for each patient undergoing a total hip or knee replacement. To be successful and improve care for patients in this program, hospitals, physicians, and other providers must work together to improve care coordination and manage costs.

Perspectives: How has Lodi Memorial adapted to succeed in CMS’s Comprehensive Care for Total Joint Replacement (CJR) program?

Imeson: The anesthesiologists at our hospital have worked to establish a close collaboration with the orthopedic surgeons, perioperative nurses, and physical therapists to develop a standardized program for total joint replacement. We have a wonderful nursing champion for the program who sees each patient through the perioperative process and ensures everyone who touches the patient follows the process.

Under CJR, we’ve established consistent techniques for anesthesia and analgesia. These techniques allow patients to start physical therapy as soon as possible after surgery and help our physical therapists predict when patients will be ready for their first post-op ambulation. The effort has improved efficiency, decreased length of stay, and boosted outcomes. In addition, we’ve lowered costs and improved patient satisfaction.

Perspectives: How do you ensure the surgeons and other players are engaged and on the same page with integration efforts?

Imeson: We are establishing a multidisciplinary operations committee with anesthesiologists, surgeons, and the perioperative nurse director. Representatives from other departments, such as radiology and physical therapy, join us as needed. The group will meet monthly to iron out problems and issues, and implement new programs and processes.

Obviously, surgeon buy-in is imperative to surgical integration efforts. Surgeons must be involved in the design of the program from the beginning and understand that the changes will not add complexity to their jobs and will improve patient care. Physicians also love data. Regular reporting of results helps keep surgeons engaged and involved, which leads to continued improvement

Perspectives: What resources are available at Vituity to support anesthesiology leadership?

Imeson: Our anesthesiology group joined Vituity about 1 1/2 years ago. Since joining, we’ve had access to Vituity’s clinical and administrative programs and expertise. One of those tools is the operations committee. They’re providing training on how to make the ops committee successful, who to invite, and how to run it efficiently. With the support of Vituity’s practice management consultants, the ops committee will be able to successfully tackle issues, especially issues related to efficiency.

Perspectives: Tell us about Vituity’s new surgical hospitalist program and how that supports surgical services integration?

Imeson: These physicians will play an important role in managing the medical care of surgical patients coming in through the emergency department who could be better managed by doctors who specialize in internal medicine. These specialists understand inpatient medicine and will help optimize the surgical experience, making sure patients are getting the care they need around the clock. Our surgical hospitalists add a new dimension to our multidisciplinary team and will strengthen our surgical services integration.

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