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Lies_ Damn Lies and


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									1132 Banbury Lane
                                                                                    Winter 2008             Volume 1 Issue 2
Brentwood, TN 37027
Phone (615) 730-5755
Fax    (615) 349-8861
                                 Lies, Damn Lies and...
Inside This Issue                O.R. Data? Sad but true, in our travels
                                 through numerous OR’s, the validity of data
                                 often crumbles under scrutiny. Staffed time
                                 utilization, on time starts, turnover time, even
       How do your
 2     surgeons perceive
                                 the total number of operative cases are
                                 commonly over or underestimated. Like
       your operating            statistics, incorrectly applied OR data can

       room and                  cause substantial harm to the management
                                 team making decisions based upon the
       anesthesia services?      results. The only thing worse than no data, is
                                 bad data.                                           commonly accepted definitions for each
                                                                                     operational metric. It is typical to find major
       So, you want                                                                  discrepancies between national norms and
 2     to employ your
                                 In health care today, dashboards and
                                 benchmarking are common tools for                   the input data and/or the calculations. As
                                 evaluation of performance and identification        OR stakeholders begin to understand the
       anesthesiologists?        of improvement opportunities. If your com-          precise definitions and requirements, they
                                 parisons are not apples to apples, then you         can develop clean, reliable data for key
                                 will tend to spend a lot of time, money and         metrics. Thus the foundation is set for accurate
                                 effort “barking up the wrong trees”. Our            identification, prioritization and implementation
       Your Anesthesia
 3     Providers... Superstars
                                 fundamental goal in looking at any OR data
                                 set is to compare the data to industry
                                                                                     of meaningful OR process improvement.

                                                                                     Take the time to understand and sanitize
       or Benchwarmers?          norms, and to ensure validity of the data.
                                                                                     your operating room data and it will no
       Part II                   Commonly performed by data analysts with            longer represent “damn lies”. In fact, used
                                 operating room expertise, a first pass will         properly, it will allow the truth to be seen,
                                 define the currently used primary input             facilitating meaningful benchmarking and a
       Anesthesia                variables and the subsequent calculations.          clear light to shine on current and ongoing
 4     subsidies are a           These calculations will be compared to              opportunities in your OR.

       big problem
       for hospitals.
       But exactly how big?          “Like statistics, incorrectly applied OR data
                                  can cause substantial harm to the management
                                   team making decisions based upon the results.
                                  The only thing worse than no data, is bad data. ”

How do your surgeons                                                                          Are you paying all or part
perceive your operating                                                                       of your anesthesia subsidy
room and anesthesia                                                                           due to poor billing
services?                                                                                     performance by your
    Find out with the HPS Peri-Operative Data Suite’s                                         anesthesia group?
    two surgeon-specific surveys that address these
                                                                                              Most hospital executives do not have the
    focused components of satisfaction. Both surveys are:
                                                                                 anesthesia revenue cycle expertise necessary to assess the ef-
      • Distributed via e-mail
                                                                                 ficacy of the collections process. With The HPS Anesthesia
      • Convenient and easy to complete
                                                                                 Billing Tool, a separate component of the Peri-Operative Data
      • Designed to proactively identify key drivers of
                                                                                 Suite, executives can now track revenue cycle metrics to proac-
        surgical volume.
                                                                                 tively monitor revenue cycle opportunities.
    And, hospital executives can easily access online reports with
    a user friendly dashboard and benchmarking data available for
    all measures.

As a firm immersed in operating room and anesthesia improvement, Healthcare Performance Strategies
(HPS) has long seen facilities with no easy mechanism to answer these important questions. But
now, with the HPS Peri-Operative Data Suite, hospital executives can have targeted, actionable data
right at their fingertips.

       For more information on the HPS Peri-Operative Data Suite, please contact
       HealthCare Performance Strategies at info@hpsllc.com or at (615) 730-5755.

     Is paying your                                    So, you want to employ your anesthesiologists?
     anesthesia subsidy                               S    ubsidies paid by hospitals to anesthesia
                                                           groups continue to escalate, both in real
                                                                                                          Employing anesthesia providers is fraught with
                                                                                                          potential pitfalls if the hospital has not carefully

     putting you under?                               dollars, and as a percentage of group revenue.
                                                      In some cases the hospital stipend comprises
                                                                                                          planned for all contingencies and received the
                                                                                                          advice of seasoned professionals. In order to
                                                      over 50% of total group revenue, essentially        maintain engaged providers, the compensation
     Let Healthcare                                   making the group de facto employees - totally       package must contain incentives that align
     Performance Strategies                           dependent upon the hospital for fair market         with the hospital’s mission and vision regarding
     revive your bottom line!                         compensation. As this phenomenon spreads,           surgical care. The interplay between CRNA’s
                                                      many hospitals and systems are considering          and the general nursing staff can present new
     Healthcare Performance Strategies is
     an anesthesia service consulting firm            employment as an alternative that allows more       issues due to the high compensation CRNA’s
     specializing in:                                 control over the group in exchange for the          enjoy. The recruitment and retention of
       • Anesthesia Subsidy Reduction                 significant anesthesia investment. Through the      providers is critical and highly specialized.
       • Subsidy/Contract Negotiations                compensation package, the hospital can more         However, the area most often overlooked
       • Anesthesia Incentive
                                                      effectively align the incentives of the providers   is the successful execution of the transition
         Compensation Programs
       • Performance Metrics                          with its own, exert greater influence on            plan and effective daily management of the
       • Anesthesia Revenue Cycle Optimization        provider scheduling, and generally promote a        department.
       • Payer Contracting                            more team-focused environment instead of
       • Interim Anesthesia Group Management          suffering through tense annual subsidy nego-        Many facets of managing an anesthesia practice,
                                                      tiations.                                           from its impact on OR efficiency to the anes-
     Why choose Healthcare
     Performance Strategies?                                                                              thesia revenue cycle, are highly specialized.
       • We address all components of                 Once considered anathema to anesthesiologists,      Due to all these factors, it is critical that the
         your anesthesia subsidy.                     the concept of employment is beginning              hospital consult subject matter experts in the
       • Our engagement teams are led by              to become a more palatable option than              area of group formation, start-up and employ-
         experienced, insightful anesthesiologists.
                                                      renegotiating hospital subsidy arrangements         ment models. Properly planned and executed,
       • Your anesthesia performance is
         monitored by structured data analysis.       each year. This confluence of hospital desire       the transition to an employed anesthesia
       • By reducing your anesthesia                  for control and greater physician acceptance        model can align the incentives of the providers
         subsidy, we increase your profitability.     of employment have opened the door to em-           and hospital, increase efficiency and lead to a
                                                      ployed models for anesthesia.                       stable and symbiotic relationship.

   From                                               Your Anesthesia Providers...
    the                                              Superstars or Benchwarmers?
   Editor                                                        Part II
         By Robert Stiefel, MD                                                        By Brian A Dietrich

Y                                                I
          ou can’t manage what you don’t              n our last newsletter, we defined                   position in the operating room, collabo-
          measure. That mantra has long               the major categories of anes-                       rating with surgical and facility staff to
          been gospel in the business                 thesia group deliverables, prom-                    develop a functional governance and
world. To prove that performance meas-           ising more detail in future issues.                      decision making framework.
urement is increasingly prevalent in health-     Our first area of focus will be on
care, look no further than the recent            customer service. From a caseload                        Properly tracked, surgeons’ perception
“pay-for-performance” initiatives. However, in   and market share perspective, surgeons are         of anesthesia service levels form a meaningful
our specialized world of anesthesia and          the key anesthesia customers. But what             and objective mechanism through which an
operating rooms, data regarding business         specifically makes an anesthesia group             anesthesia group may be judged. They may
drivers is often unreliable, unavailable,        valuable to surgeons?                              also form a component of incentive based
or derived from larger, hospital wide                                                               compensation. As a simple example, a
information.                                     First, recognize that surgeons weigh several       medium sized group in the Midwest has 5% of
                                                 key variables in determining their preferred       provider compensation at risk in their subsidy
This newsletter is devoted largely to data                                                          model. Of their at risk pool, 25% is earned by
                                                 operating room venue. Anesthesia services
products which are designed to offer                                                                achieving over 75th percentile in satisfaction
                                                 occupy a critical role in that decision tree and
insight into our unique niche. As the main                                                          with anesthesia services. Other arrangements
                                                 are vital to surgeon perception of the operating
determinant of hospital revenue and                                                                 have tiered incentives based upon threshold
                                                 room environment. It is important to separately
profits, the operating room requires                                                                percentile performance, or based upon year
                                                 assess anesthesia satisfaction from satisfaction
specific products and analyses targeted to                                                          over year improvement.
                                                 with the rest of the operating room.
operational and performance drivers. In
the available space, this newsletter can                                                            Whether used as a part of incentive compen-
                                                 In order to identify specific strengths and
only offer an overview of targeted products                                                         sation or not, shining a light on satisfaction with
                                                 weaknesses, targeted evaluations of anesthesia
and approaches. However, please use the                                                             anesthesia services allows you to identify if your
                                                 satisfaction will optimally focus separately on
concepts as a springboard for dialogue in                                                           providers are “superstars or benchwarmers”.
                                                 clinical care and group service/responsiveness.
your organizations as to what metrics may                                                           For more information on methods of tracking
                                                 As a component of service, anesthesia
be tracked to monitor key processes in                                                              this vital data, contact us at info@hpsllc.com.
                                                 providers should also assume a leadership
your operating room.

I welcome any thoughts or feedback from
readers regarding particularly useful
                                                          Major Service Categories for Anesthesia Providers
existing OR/anesthesia data products or
potential products which you feel would
offer meaningful clinical or operational
                                                                            Impact on                 Support
                                                                            Operating               for Facility                  Customer
          Please contact me at                         Quality                                                                     Service
                                                                              Room                   Initiatives
         RStiefel@HPSLLC.com.                                              Performance              and Growth

                                                                  “Anesthesia services occupy a
                                                              critical role in that decision tree and
                                                             are vital to surgeon perception of the
                                                                operating room environment.”

                                          Anesthesia subsidies are a big problem
    Inside This Issue                      for hospitals. But exactly how big?
                                                          (By Number of Facility Anesthetizing Locations)
     1   Lies, Damn Lies and…..

         How do your surgeons
     2   perceive your operating room
         and anesthesia services?                                                                        Subsidy/Location

         So, you want to employ
     2   your anesthesiologists?

         Your Anesthesia Providers...
     3   Superstars or Benchwarmers?       Data from the recently completed HealthCare Performance Strategies survey of
         Part II                        Anesthesia Subsidies shows a substantial payment requirement for facilities of all sizes.
                                                       For a copy of the final report (available January 2009),
                                                         contact Brian Dietrich at BDietrich@HPSLLC.com.

            1132 Banbury Lane
            Brentwood, TN 37027


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