July 1, 2014
Volume 78 Number 7
Collaboration Is Key in Bringing Quality Care ‘Home’
Alan E. Curle, M.D.
Committee on Governmental Affairs
No member of ASA could deny that a major focus of the organization and its leadership is advocacy for our patients and our specialty. One need only look at our strategic plan to appreciate the equal footing that this focus shares with education of our members and the development of new knowledge. And if you’re still not convinced, to paraphrase our current treasurer James Grant, M.D., then “follow the money,” as support from the organization for advocacy efforts is considerable. As effective as those efforts has been to date, anyone doing the work of advocacy would tell you that it is the cultivation of allies and their work with you that takes an organization to the next level of effectiveness. Who are our potential allies and how do we convince them to join our team? Please allow me to introduce each of them as I see them emerge in the work that you do each and every day, as advocacy really does begin at home.
“It is all about the patient,” said 2004 ASA President Roger Litwiller, M.D. in his presidential address to our House of Delegates not so many years ago. For advocacy, it clearly starts with the patient. So what are some strategies to improve your chances of bringing them on board? Engage them preoperatively, and I don’t mean simply on the day of surgery. A phone call on the day prior to surgery goes a long way toward starting the conversation and letting them know you care about their well-being. On the day of surgery, if at all possible, sit while speaking with them in your waiting area. As you patiently listen to their concerns and allay them, to the best of your ability, you are increasing the chances they will remember you and speak positively about their experience. As an aside, the impact of just this type of feedback on your reimbursement will only continue to rise in the future as an increasing percentage of your reimbursement will be linked to patient satisfaction. This positive feedback represents a potential win-win for you and your specialty when you see patient satisfaction scores increase and our visibility rise. Seeing your patients postoperatively presents another opportunity to ensure they understand the roll you have played, and continue to play, in their successful journey through surgery and then recovery. More than one group with whom I am familiar takes this opportunity to leave a business card with the patient that clearly identifies the physician anesthesiologist who cared for them and provides contact information should the patient have any questions in the future.
Speaking of preoperatively … an absolutely essential step in ensuring safe passage for our patients through the perioperative process is a thorough patient-specific optimization of co-morbidities. Physician anesthesiologists need to develop relationships with the primary care physicians who know their patients best. Once we have developed that rapport, our internal medicine and family practice colleagues will, when asked, be able to understand that it is not “clearance” we are seeking. Rather, when consulted, we need to know if in their opinion the patient is in the best condition possible prior to undergoing the additional stresses of surgery. This exchange gives us the opportunity to share with these colleagues what our specific concerns are and whether specialty consultation is warranted. It also gives us the opportunity to explain how we intend to mitigate the risks inherent to anesthesia. All of these conversations foster a collegiality that will pay dividends when those same primary care physicians are asked to join our delegation at the American Medical Association, for instance, in promoting anesthesiology as the practice of medicine or limiting encroachments by expansion of scope-of-practice efforts.
The next obvious focus of our attention should be our surgical colleagues. We have much to offer in the perioperative period beyond, and I paraphrase another of our recent past ASA presidents, James Cottrell, M.D. (2003), who talked of our role in “keeping the patient alive while the surgeon does things to them that would otherwise kill them.” From anesthesia techniques that blunt the stress response, to maintenance of normothermia and normoglycemia, to postoperative pain control that has the potential to shorten length of stay and hasten recovery, we have opportunities that increase our “value-added” to our surgical colleagues. Our active involvement in team-building and engagement in the O.R. through active participation in the “time out” and running the O.R. and procedure suites will also increase our visibility to our surgical colleagues This demonstration of what we bring to the table will be key as we see more and more procedures become a portion of “episodes of care” for which a single payment will be made to a team. In Washington, these same surgeons are represented in the Surgical Care Coalition, to which ASA belongs. We need those surgical allies to be on the same page with us when we discuss issues as diverse as drug supply shortages or scope-of-practice issues that impact our patients.
As for bundled payments, another party sitting at the table when those dollars are being divided is hospital representatives. Physician anesthesiologists must make themselves visible and available when asked to participate in policymaking and governance at our local institutions. Building those relationships will increase our credibility as well as the opportunities to tell our story to those who have the potential for considerable impact on our specialty and our access to patients. As health care continues to evolve, this bundling of payments for episodes of care will expand to include not just episodes of care but total care within accountable care organizations. Mike Schweitzer, M.D., M.B.A. and his Committee on Future Models of Anesthesia Practice defined the Perioperative Surgical Home as a “patient-centered, physician-led multidisciplinary, and team-based system of coordinated care for the surgical patient.” And this is the moment when physician anesthesiologists, as the leaders in that construct, bring all of those allies together to advocate for our patients.
In summary, the most effective advocacy engages and involves allies who are willing and able to tell the story of the value that we bring to the table when we are caring for them or with them. It begins in your daily practice at your home away from home, your hospital, and will evolve to working within the “Home.”
Alan E Curle, M.D. is Director, Center for Perioperative Medicine, UR Medicine/Strong Memorial Hospital; Medical Director of Perioperative Services, UR Medicine/Highland Hospital; Associate Professor of Clinical Anesthesiology, University of Rochester School of Medicine, Rochester, New York.
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