A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Earlier this year, I spoke to an audience of physician anesthesiologists about setting up a basic quality assurance (QA) program within their departments. At the end of the presentation, one physician anesthesiologist stated that his group “will not let anyone out of the operating room (OR) to do QA.” He further described how any activity not related to clinical work takes a back seat to the group’s mandate that the physician anesthesiologists must first “generate revenue in the ORs.”

While this mindset toward practice management and nonclinical time may have been acceptable in the past, this traditional strategy in 2015 puts the group at risk to fail or, at the very least, not define its own success. Increasing demands in which physician anesthesiologists demonstrate their value require practices re-examine their strategies and resources for managing and developing personnel. Anesthesiology practice management infrastructure needs have evolved and, as a result, forward-thinking anesthesiology practices recognize they must devote resources to what in the past may have been defined as nonclinical work.

What is infrastructure? For an anesthesiology practice, infrastructure essentially is the resources — people, technology, and processes — necessary for a practice to conduct its business. For many years, the purpose of practice infrastructure was to support individual physician anesthesiologists, primarily with billing/collecting, benefits coordination and privileging. While those needs still exist, regulatory changes, alternative payment models, and competition in the marketplace all have placed added pressure on physician anesthesiologists to support a new paradigm, specifically to create value on both the individual practitioner and group levels. Beyond the administration of anesthesia care, anesthesiology groups as an entity increasingly are being asked to define and demonstrate their value to health care organizations with respect to managing systems and processes that impact cost and outcomes. The need for anesthesiology practices to demonstrate value has evolved beyond the delivery of clinical care from its individual physicians. As a result, the definition of “necessary infrastructure” for a successful anesthesiology practice has grown beyond just providing what is necessary to support the individual practitioner.

“Doing the work,” and with high clinical quality, now is assumed for most anesthesiology practices. The additional challenge for physician anesthesiologists is to build a practice infrastructure that demonstrates how they add value in terms of cost, outcomes, and access — “how the work is done.” Multiple factors are driving this new paradigm for physician anesthesiologists:

1. Quality reporting mandates. Practices increasingly must demonstrate value by measuring and reporting patient and surgeon satisfaction, peer review, and clinical outcomes.

2. Changing payment models. The ongoing shift from “payment for procedures” to “payment for value” is evident – bundled payments, payments for episodes of care, and penalties for hospital readmissions are current challenges. Physician anesthesiologists are uniquely positioned to define their value and to lead development of protocols before, during and after surgery, and care models that lower organizational costs and improve patient outcomes. It is no longer enough, and perhaps strategically unwise, to focus only upon anesthesia care and leave care coordination to others in the organization.

3. Cost control. Legislators, regulators, and health care executives are focused on reducing costs. Who in your practice is addressing comments that physician anesthesiologists’ services are too costly and identifying the many ways your physician anesthesiologists contribute, directly and indirectly, to the organization’s operational and financial health?

Infrastructure: How to start

1. Culture change. The old dichotomy of clinical versus nonclinical time needs to be re-examined. Essential to changing this attitude is defining the need for change and clearly articulating a strategic vision for the group’s success. The practice’s physician anesthesiologists must believe value is created at the group level and resources must be devoted to group performance as well as to the care of individual patients. The anesthesia group of the future will need to rely on a variety of clinical and nonclinical specialists working together to deliver value to the health systems that they serve.

2. Designate champions — Give them time and/or money to do the job well. It is imperative that practices provide their physician leaders sufficient time and resources to work in specific areas of the organization. Many practices already have designated physician anesthesiologists to serve as QA directors, department chiefs, and/or in leadership roles on committees within the organization. Are there other key services that physician anesthesiologists could lead or provide and in turn deliver value to the organization? A few examples include sedation services, basic financial knowledge, and perioperative surgical care.

3. Support practice leaders to develop and learn new skills. A paradox of the current age is that physicians are by and large still seen as leaders, but they have generally not been taught basic skills, such as change management, negotiation, and effective communication, necessary to lead effectively. Fortunately, there is a burgeoning industry to deliver whatever skill training and experiential learning is required, and at a cost and in a format that allow almost any physician anesthesiologist to participate.

In summary, new value-based mandates related to payment, regulation, and scope of practice have put enormous pressure on anesthesiology practices to modify how they allocate resources. The critical role of anesthesiology practice infrastructure never has been more important. Successful practices likely will be those that identify the needs of patients and the organization, and build an infrastructure that supports, on a group level, “nonclinical” work that measures and delivers value. Regardless of your practice’s size and model, it is a good time to take a fresh look at how you support activities that add value and  ask yourself, “What’s in your ‘infrastructure?’”

Jay Mesrobian is an anesthesiologist and chair, ASA Committee on Practice Management.