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Challenge Facing Anesthesia Management Choices – “We are the They” (Part 1 of 4)

  • Opportunities arise daily where facilities can improve the management of anesthesia care.  The passage of the Affordable Care Act may appear to have resulted in “affordable care” for everyone, but for hospitals, surgery facilities or healthcare practices, it has created more challenges than many believed it would.  The game has changed from clear standards to blurred lines consisting of regulatory issues that make the possibility of being compliant more and more difficult.  When this happens, facilities look towards third party solutions to help make sense of it all.

    23 Mar
    23 Mar
  • There is a difference between providing anesthesia services and being an anesthesia management company.  As more and more facilities are being penalized for not taking proper precautions to prevent patient infections and other complications considered by the government to be unavoidable, hospitals are at risk for losing millions of dollars in Medicare reimbursements.  It is imperative for hospital executives to focus on ways to maximize revenue while continuing to improve quality of care in the ever changing and challenging world of healthcare.  Anesthesia services make up one of the biggest opportunities where a review can prove to have an untapped source of additional financial benefits for these facilities.

    10 Mar
    10 Mar
  • Patient satisfaction is a new competitive advantage for anesthesia services. The holiday season also brings a silent pressure to find the perfect gift for all of the people on your shopping list.  Whether it is the latest and greatest technology or, as in a scene from National Lampoon’s Christmas Vacation, the jelly of the month club, everyone is looking for, “the gift that keeps giving the whole year.”  For Steel City Anesthesia, the gifts we provide our facilities such as costs savings, efficient operating procedures and expert anesthesia services, are presents we deliver every day.  However, patient satisfaction is an integral part to quality management and is the perfect “gift” from any anesthesia partners.

    22 Dec
    22 Dec
  • Our CRNAs and anesthesiologists practice strict infection control to avoid pre and post-operative complications. Our anesthesia care model emphasizes and improves patient safety which increases positive patient outcomes. We send anesthesia providers who are familiar with your facility’s operating procedures.

    11 Nov
    11 Nov
  • Anesthesia outsourcing reduces your liability in the OR. Physician intra-operative monitoring is eliminated and anesthesia is the sole responsibility of our anesthetist. As your anesthesia provider, Steel City Anesthesia LLC becomes responsible for any issues that might arise.

    11 Nov
    11 Nov
  • The biggest factors that inflate anesthesia-related costs are insufficient OR room utilization and provider productivity. OR utilization is a measure of use of an operating room that is appropriately staffed with personnel to successfully deliver a surgical procedure to a patient. Improvements in OR efficiency can have a major impact on hospital staff, finances and OR management. Outsourced anesthesia is one way to increase the efficiency of staffing and care delivery.

    08 Nov
    08 Nov
  • New evidence confirms the quality and safety of Certified Registered Nurse Anesthetists and the anesthesia care they deliver! This is the conclusion reached by Jerry Cromwell, PhD and Brian Dulisse, PhD while researching the quality and safety of care provided by CRNAs in states that opted out of the physician supervision rule by Medicaid (“No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians”). The study concludes that there is no difference in the outcome experienced by the patient whether the anesthetic was administered by the physician anesthesiologist, the supervised Certified Registered Nurse Anesthetist, or the unsupervised CRNA. RTI International, where the study was conducted, confirmed what has been known for years by the community of nurse anesthetists; CRNA-only care is high quality and safe. As of right now, the Center’s for Medicare and Medicaid Services (CMS) restricts or in some cases prohibits reimbursements to hospitals and ambulatory surgery centers where there is no physician supervision of the CRNA. However, states began opting out of that rule in 2001. California is the most recent of the 15 states to have opted out. The RTI findings illustrate that physician supervision of Certified Registered Nurse Anesthetist is outdated and unnecessary. The study compared states where physician supervision is mandatory versus 14 states where it is not and found that the patient outcomes did not differ. As a result, the authors of the study are recommending that CMS repeal the “supervision rule.” Paul Santoro, CRNA, MS and president of the American Association of Nurse Anesthetist’s (AANA) states, “this study should encourage other states to think critically about their healthcare needs and how nurse anesthetists can expand access to anesthesia services.” In a recent article published in May by RTI, they found that the CRNA-only anesthesia care to be the most cost-effective anesthesia delivery model. This study obtained coverage in such notable media sources such as: The Wall Street Journal, Reuters, The Bureau of National Affairs, and Modern Healthcare. For further information on this topic visit the AANA website or contact Steel City Anesthesia.

    23 Sep
    23 Sep
  • In today’s economic downturn why should bailouts be the norm? We have all seen the infamous AIG bailout scenario and the debacle that it caused. The current healthcare cost debate is prime news on most news networks, and a simple Google search brings a multitude of articles debating the issue. Why is it necessary then for facilities to subsidize (bailout) it’s anesthesia groups? This hotly contested debate is centered around reimbursements to the anesthesia groups providing services. As governmental restrictions reduce the amount collected by medical providers and the number of providers decreases, creative solutions must be utilized to continue to provide quality healthcare. One solution that is currently being used by some 75% of anesthesia groups is to  bill and be reimbursed for the care rendered, but in addition require the facility in which they render these services to pay an additional stipend. This provides for the profitability of the anesthesia group, but at an added expense of the facility. This stipend based healthcare model is probably the simplest means for anesthesia groups to maintain viability in today’s marketplace. However, the recent changes to the Physician Supervision Requirement from CMS and many states ” opting out” has allowed another  model to be utilized to reduce costs for facilities.  It is much more cost effective and simple… bill for service. In this model, no stipend is required from the facility. This  simpler model may not be the right fit for every facility, but can be for a multitude of settings.  Every facility should at least take a look at it, as an option to possibly reduce costs without cutting care. Contact us if you require more information on this type of model or please comment through the blog.

    23 Aug
    23 Aug
  • Did you realize that 20% of Americans still smoke? That is an amazing number considering that cigarette smoke has some 6000 identifiable constituents! Some of the constituents include: ammonia, arsenic, benzene, formaldehyde, toluene, and vinyl chloride. I don’t know about you, but that sounds appetizing! But what does this mean for the anesthetist working in the clinical setting? For starters, smoking increases the likeliness of an irritable airway and a greater potential for hypoxia. There are a few steps you can take to try and mitigate the effects smoking can bring to the table. A thorough pulmonary examination is a great start. Listen to the lungs and ask if there is a history of wheezing, coughing, and expectoration. Observe their passive breathing and note if there is clubbing of the nails. Are they short of breath just sitting in the pre-op area? This can be an indication of pulmonary disease and prompt the need for further evaluation. As a side note, if they have pulmonary disease it is very likely that they cardio-vascular disease as well. While doing your H&P, don’t hesitate to focus on this area as well. Next, take a look at the medications they are on. If they use inhalers, ask them about the last time they used them and how frequently they use them. This is another good indicator for potential problems during the procedure. Have them use their inhaler before the procedure. It never hurts to have the airways as open as possible prior to a procedure. Chuck Biddle, CRNA, has a great list of considerations for the smoker that include, abstinence for 24 hours if possible, bronchodilators, nicotine patch if possible, pre-oxygenate, and there may be a need for increased analgesia during the procedure. Also be aware that their FRC (functional residual capacity) may be diminished. This may lead to a state of hypoxia sooner than normally expected in a non-smoker. Be prepared! And finally, as anesthesia providers we have a unique opportunity to educate our patients about the deleterious effects of smoking. For a brief period of time the patient is a captive audience, don’t hesitate to seize this opportunity for education.

    16 Aug
    16 Aug
  • A recent article brought about some very important and simple symptoms that patients can use to evaluate their susceptibility to sleep apnea. In an article by Dr. Orly Avitzur  M.D., she describes the need for medical evaluation of loud snoring.  She stated up to 1 in 10 women and 1 in 4 men might have undiagnosed sleep apnea and the first symptom to look at is loud snoring . She further states that less than 15% know they have sleep apnea and most physicians don’t routinely inquire about it during office visits. Other symptoms that warrant further professional evaluation include, but are not limited to: High blood pressure Frequent morning headaches Day time drowsiness Frequent wake-ups Frequent morning sore throats Wake-ups with choking or gasping for breath Wake-ups in a sweat Overweight Loud snoring Sleep apnea increases a persons chance of high blood pressure , stroke and type 2 diabetes, but the most terrifying statistic Dr. Avitzur stated is there is an increased risk of death that is associated with having sleep apnea. Anesthesia providers especially need to be aware of any of the symptoms listed above prior to administration of any anesthetic, so please inform them before any surgery. Additional protocols may be implemented in the pre and post-op areas and drug regimes may be modified if the symptoms are present in a patient. Avoid anesthesia complications with sleep apnea by speaking with your physician. Check out this article on sleep apnea and same-day surgery for more information. As sleep apnea affects such a high number of people, we would appreciate any personal experiences with sleep apnea you could share on this blog.

    12 Aug
    12 Aug
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