Anesthesia providers are in the process of transitioning to value-based care reimbursement systems and pushing for inclusion in innovative models supported by CMS, according to a Jan. 24 report from law firm Whiteford in JDSupra.
Here are eight things to know from the report:
1. Anesthesia practices and providers have seen massive reimbursement cuts from the traditional fee-for-service model. Value-based care alternative payment models aim to reduce unnecessary procedures, lower costs and improve care quality, according to the report.
2. The report identifies three main types of alternative payment models:
– Bundled payments and incentives
Providers share a single payment covering the entire care process, from preoperative to postoperative stages. This encourages financial alignment with patient outcomes, reduces unnecessary services, promotes evidence-based practices and fosters collaboration for better care.
– Accountable care organizations
ACOs involve voluntary collaboration among healthcare providers to deliver cost-effective, high-quality care. While primarily focused on primary care, anesthesiologists have a limited role in ACOs. Financial rewards are provided for meeting cost and quality benchmarks.
– Penalty-based models
These models impose penalties for high readmission rates, aiming to enhance care coordination, improve outcomes, increase accountability and lower costs by preventing avoidable readmissions.
3. American Society of Anesthesiologists supports value-based care and highlights the crucial role of anesthesiologists in perioperative care and patient safety. The ASA also promotes guidelines and models, like the perioperative surgical home, to improve care coordination and outcomes while reducing costs.
4. The perioperative surgical home model, developed by the ASA, focuses on comprehensive care, including preoperative assessments, intraoperative management and postoperative care.
5. The ASA advocates for anesthesiologists' inclusion in alternative payment models such as CMS's Transforming Episode Accountability Model (TEAM). While CMS has not yet included anesthesiologists in the TEAM model, opportunities exist with commercial insurers and private entities.
6. In value-based care models, anesthesiologists play a vital role in perioperative and postoperative care. They perform risk assessments, optimize patient health and create personalized care plans. Strategies include managing chronic conditions, addressing nutritional issues and using opioid-sparing techniques within a multidisciplinary approach.
7. Anesthesiologists are also central to postoperative care through Enhanced Recovery After Surgery (ERAS) pathways. These integrate evidence-based practices to improve outcomes, shorten recovery times and reduce hospital stays by managing pain and symptoms effectively.
8. Alternative payment models rely on robust data analysis and provider coordination. Smaller institutions may face challenges, but anesthesiologists' expertise makes them key contributors to value-based care initiatives in both CMS programs and private payer arrangements.