In this episode:
1) A surprise visit from our producer, David Henderson, with some updates about the Time Out show!
2) Dr. Z discusses how data, though often overlooked & undervalued, can play a vital role in empowering and modernizing your anesthesia practice.
Why is data important? What data is important? I think once you can answer that question and appreciate the value of data, you'll be able to communicate much more effectively with hospital administration and with certification bodies. You'll be able to interact in a more functional way with the people around you once you understand the value of data.
I think historically we’ve been trained, as anesthesiologists, to focus on patient outcomes. And traditionally, culturally, we focus success and we define our quality as, "How well do our patients do?" For example, we achieve CPR and we gave the right amount of blood, and the patient survives this horrific trauma case, and that's how we typically, emotionally define success in how we practice is, "I saved the patient's life and everyone's the better for it," and that's the end of my day.
Unfortunately, that kind of framing and focus on just your patient's outcome leaves a lot of value on the table. And from an administrative perspective, it undercuts & undersells our potential value. We need good outcomes, there's no doubt about that. We need to save the patient, that is always the primary objective.
The reality, though, is that if you look at complications, they're incredibly rare— to the tune of one to three per thousand (I’m talking about major complications per thousands of cases). Anesthesia is just very safe. So, when I say "We're leaving value on the table," I'm saying it's important to pat ourselves on the back that we have these good outcomes, that we did a good job in the OR. But that's not what counts, so to speak, anymore. It's the priority, yes, but it's a conundrum. If all you're doing is going to work and loading the boxes and doing a fantastic job of loading those boxes, the administration just starts to expect that. That's the standard, boxes are going to get loaded. But what can happen, then, when the focus instead becomes, "How do we do that better? How do we load the boxes better? How are we more cost-conscious? How are we more efficient? How do we measure our outcomes beyond just survivability or morbidities? What does that look like?" Suddenly, you end up in the administrator's world asking,
That's what I mean by leaving value on the table. If you're just focused on the patient outcome, then you overlook all of the other pain points that the entire administration staff is focused on doing everyday.
And I think too often we have an unhelpful view of the administrative staff in saying, "They don't know what we do, and there's a disconnect." Sometimes that's true. In my experience, most of the time it's not that. Rather, the reality is we don't understand what they do, and we don't understand the challenges they have, the responsibilities that they have, or what they're being held accountable for. That can lead to a dysfunctional relationship in one sense, but if you flip that on its head, it also leaves a wonderful opportunity for anesthesiologists to partner with those hospital administrators in a way that makes their lives easier. So while it's always a priority to do the best for the patients and help get good outcomes, you can partner with that hospital administrator by understanding the value of data and enabling them to understand how the process works.
A lot of reports come to mind that can help that relationship. The data that you possess as the anesthesia provider can show administration what their first case on-time start rate is, how many minutes they're being delayed, and which surgeon’s cases are responsible for those delays. If you can give them any insight on a case-by-case basis so that they can aggregate those across a certain timeframe, then they can start to hone in on how to improve processes. And that's their job. The hospital is saying, "We have an inefficiency where we can't start our cases on time. What is it that we need to change? What behavior do we need to change? What process do we need to change?"
That's their task. And so if we narrow our focus only to, "I need patients to survive their anesthetic," we're leaving a huge value on the table: How do we partner with that hospital administrator to understand which cases are delayed? And you need to be careful here. It's not an opinion-based question. They're not asking you for an editorial. or for your emotional conclusions that may sound like, "Well, cases are delayed, because of this or that…" That's not what they're asking for. They're asking for data.
A data-driven response is, “Let me show you, in each case, what the scheduled start time was, what the actual start time was, and the reason for that cases specific delay.” And it could be one or multiple reasons. Then over time, we will let the data speak for itself. That's just one example of where data is important. There are dozens of different data points that are of value to different players in a very complex ecosystem, and efficiency & on-time start is just one of them. The other reports that come to mind highlight the fact that we, as anesthesiologists, don't appreciate the richness and the value of the data we're sitting on. Because again, we don't have this perspective of, "Why is data important?" We just want to have good outcomes and then go home. But once you start to realize the value of the data, you find that something as simple as start and stop times, when mapped through a process, can have enormous implications from both an income and an expense standpoint, which becomes incredibly valuable to the administrators who are responsible for delivering that sort of value at any given time.
Taking it a bit further, those data points can be visualized on a heat map that shows every 30 minutes over a 24-hour period across the month. Suddenly, you have all sorts of answers to all sorts of questions:
When you can actually get objective data, and it comes directly from the anesthesia chart, you can drill into exactly what your human resource is, to say, "Well, if I'm contracted to run seven ORs up until 3 o'clock, and then at 3 o'clock it drops down to six or seven ORs:
That's where your efficiency comes into play. We frequently see facilities that are overpaying for the amount of services and bandwidth that they're actually using. They end up opening up new ORs that start at 7:30 that don't go for the full seven or eight hours out of the day, because that's what the surgeon wants.
So the hospital is trying to manage the surgeon's desires to be the first to cut and then go to clinic, along with their HR balance with, "Well, we have to pay these people full-time, and so do we open up more rooms? Or are we correctly using the rooms that we have already paid for?" A question like that is very complicated.
It just so happens, coincidentally for us, that anesthesia is sitting on this mountain of data on their forms. If we can leverage that information in the right way, then we can suddenly start to provide things like location utilization heat maps, so that hospital administrators know exactly the type of resource that they are needing to use every day. Unfortunately, the anesthesiologist, doesn’t frequently consider the value of the data that they're sitting on. They are appropriately concerned with their primary focus, which is patient safety, I get that. But what I'm saying is, if you can, in addition to the patient safety, take a look at your anesthesia form, you'll recognize that we're sitting on a treasure trove of data, we just don't typically leverage it correctly.
Instead, hospital administrators label us as just a black box. A black box, by the way, full of opinions on how things could or should be better. But that's not how decisions should be made, and it's not how they're typically made. There's much more bang for your buck if you make data-driven decisions, so it's incumbent upon us to show that data or to adopt technologies that allow us to leverage the data we're already collecting in a way that's mutually beneficial. And when I say mutually, I mean yes, it certainly helps the hospital administrator. However, if you think you're just doing the hospital administrator's job, consider that data has plenty of value for your billing team, and you will benefit as an anesthesiologist with better data management. Consider the quality reports that you send to CMS and the MACRA bonus that you very clearly could participate in. Think about streamlining your billing teams efficiencies. They have entire staff that are dedicated just to manually entering in the data that you already entered into your form. Why is there that duplication? What ways can we use technology to interface with existing electronic health records to improve our billing—not only inefficiencies, but outcomes as well?
We can increase the number of claims that we generate simply by eliminating erroneous paper-based processes. We can get cleaner claims and reduce our rejection rates then get our money sooner. We can increase the quality of the actual service provided on any given claims.
So while patient safety will always remain our primary goal, it can't be the only goal. We have to think beyond that. We’re sitting on data that is just so unique to any other medical specialty because we touch every step of the perioperative process, including the patient experience through the pre-op, intra-op and post-op. We need to begin to leverage that data in ways that makes sense to the hospital and to our own practices.