Observations: The A’s of the Practicing Anesthesiologist

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February 1, 2014 Volume 78, Number 2
Observations: The A’s of the Practicing Anesthesiologist N. Martin Giesecke, M.D.

“What Got You Here Won’t Get You There” is the title of a 2007 publication of Marshall Goldsmith, Ph.D. Dr. Goldsmith is a world-renowned executive trainer and coach. Even though Dr. Goldsmith’s typical audience is composed of movers and shakers in the business world, his words ring true in medicine. As the measurement of anesthesiology performance and outcome continues to evolve, it is clear that what brought us where we are, as physicians and anesthesiologists, will not take us where we need to go, while remaining in the same profession – at least from a payment point of view.

As described by Drs. Fleisher and Cole in their article “PQRS: At the Intersection of Quality Improvement and Consumerism” (see page 16 in this NEWSLETTER, the practice of anesthesiology has already begun to be measured by Medicare. Originally, the three Medicare measures – patient temperature within 30 minutes of the end of surgery, appropriate timing of preoperative I.V. antibiotics, and central venous catheter insertion management – allowed anesthesiology practitioners (or groups) to receive a small incentive from Medicare. These three measures are just a few of the more than 300, applying to all medical specialties, that are reviewed by Medicare. The more important aspect is that as of 2015, the incentive that has been paid to participate (by meeting the measures) will actually become an amount of payment Medicare withholds from those who either don’t participate or who don’t meet the performance metrics. In 2015, that payment adjustment will be 1.5 percent. In 2016, for those whose reports fail to meet the metric, the Medicare value-based adjustment will be 2.0 percent.

The fact that Medicare chose thethree anesthesiology-related measures mentioned above is due to the collaboration of ASA® with the American Medical Association’s Physician Consortium for Performance Improvement (PCPI). The anesthesi-ology measures were developed by the ASA’s Committee on Performance and Outcomes Measurement (CPOM), then presented to and approved by the ASA’s House of Delegates, as described in the article by Drs. Fleisher and Cole. Eventually, they were passed on to Medicare via the AMA’s PCPI.

It would be easy, from an individual point of view, to be overwhelmed by all the measures for which we are held accountable each day. Administrators track on-time O.R. starts and room turnover times. The administrators want to know how to deal with the issues, so they look to see who or what is responsible. Are physicians (anesthesiologists and/or surgeons) the cause? Or are there nursing, or hospital process, issues involved? And who is actually compiling and keeping the data? It makes sense that anesthesi-ologists are involved, as another common adage is that “he who has the data rules.” And now we are measured by Medicare for the quality metrics already mentioned. But remember, there are more than 300 Medicare metrics, so the hospital administrators will also be measuring us based upon our allotted metrics, as hospital payments from Medicare are also value-based.

There are many arguments against these quality measures, and perhaps we will see some of those printed here in response to the article by Fleisher and Cole. However, the writing has been on the wall for more than six years – Medicare payments, and likely those of other payers, will become increasingly dependent on value-based medicine. Thus, our individual task as anesthesiologists is no longer “those rules don’t apply to me,” but rather “how do I best meet the current measures and how may I help shape the manner in which I am measured in the future?” And that is where CPOM comes in. We are fortunate that CPOM has been proactive in developing anesthesiology- related measures and that our leader-ship, both in Washington, D.C. and Park Ridge, Illinois, has taken those measures to the responsible parties. It is also important for each of us to understand that COPM remains vigilant in its preparation for those changes that are coming as a result of the continued evolution of value-based payment.

Companion to Anesthesiology

Something new with this issue of the ASA NEWSLETTER is a belated joint venture between Anesthesiology and the NEWSLETTER. When Anesthesiology decided that the January 2014 issue would highlight anesthesiology edu-cation, the journal solicited articles from anesthesia residents for the “Mind to Mind” section. The response was so great that they did not have space to run all the wonderful submissions. That is where the NEWSLETTER stepped in. Working with Drs. James Eisenach, Carol Cassella and Paul Firth, this edition of the NEWSLETTER will publish some of those additional submissions that would not fit in previous months’ Anesthesiology. Enjoy reading them, beginning on page 32. And let me know what you think. If this collaboration meets the needs of our membership, we will do more of it in the future.