American Society of Regional Anesthesia and Pain Medicine May 2017 - 7
Figure 1: Opportunities for value added care within the context of bundled perioperative care.
Decreased perioperative morbidity and
mortality
Augmented patient experience
Augmented surgeon satisfaction
Enhanced disease monitoring
Optimized multimodal analgesia utilization
Leverage of the opioid epidemic via
enhanced risk stratification
Decreased average length of hospital stay
Decreased readmission post-discharge
Diversion of postdischarge care from
inpatient facilities
Decreased same day surgery cancellation
rates
Prevention of non-evidence based
perioperative testing and intervention
Decreased utilization of emergency care
resources
Clinical implementation of point of care
ultrasound
Enhanced patient education
Perioperative lifestyle modification &
preventative care
Quality improvement & research
contribution
Leadership & management of perioperative
clinical pathways
Optimization of seamless care coordination
with perioperative practitioners
Optimization of health information
technology infrastructure
Leadership & management of
interdisciplinary care teams
Optimized operative throughput and
reduced surgical times
virtually all patients were out of bed on the day of surgery. This
translated to a 9.5% decrease in average length of stay.18 An original
investigation by Dummitt et al5 demonstrated that in comparison to
nonparticipating hospitals, significant Medicare payment declines
are observed for lower extremity joint replacement episodes in
BPCI participating hospitals. Notably, these savings are achieved
without negotiation of important quality metrics, including unplanned
readmissions, postdischarge emergency department visits, and
perioperative mortality. Iorio et al1 are similarly able to exhibit
positive fiscal experiences for TJA procedures in a BPCI model.
Here, cost savings are primarily attained via decreasing the average
length of hospital stay and diversion of postdischarge care from
inpatient facilities. A study by Bozic et al19 revealed that the cost for
TJA procedures is highly contingent on postdischarge care, noting
that it contributes to upwards of one third of total episode payments.
Enabling tailored intervention, Siracuse and Chamberlain20 validated
that a risk stratification scale can effectively identify elevated risk
patients scheduled for TJA.
As forthcoming payment models are dynamically redefined,
it is sensible for anesthesiologists to explore expanding roles
that augment both the scope and quality of patient interaction
during the surgical course.21 The Figure presents several diverse
opportunities for anesthesiologists to contribute value added
(defined as either enhanced quality or decreased cost3,4,15)
care within the context of bundled care compensation. Notably,
many of the prospects outlined in the Figure transcend the
immediate operative period and embrace a philosophy of shared
accountability for ultimate patient centric outcomes throughout
the perioperative continuum. This integration of complete and
interdisciplinary care that primarily focuses on the patient-
starting from the decision to pursue surgery until full patient
recovery-is exemplified by the discipline of perioperative
medicine.4 Within the realm of perioperative medicine, emerging
paradigms such as enhanced recovery after surgery (ERAS)22 and
the perioperative surgical home (PSH)23 aim to unify providers
for the collective goal of improved patient care provided in a
fiscally responsible manner.8 The essential foundations of a PSH
include patient centeredness, comprehensiveness, coordination,
accessibility, and commitment to quality and safety.24-26 Similarly,
the key components of ERAS include collaborative decision
making, lifestyle modification before surgery, standardized in
hospital perioperative care, achieving full recovery, and using
clinical data for quality improvement.4
In close partnership with other disciplines, the Department of
Anesthesiology and Perioperative Care at University of California,
Irvine (UCI) implemented an innovative PSH program for TJA
procedures in 2012.27 Encouraging results included a decreased
incidence of major complications, lowered blood transfusions rates,
shortened lengths of hospital stay, and reduced postdischarge
readmission rates.27 A subsequent report from UCI indicated
that program success was maintained with outcomes further
improved.28 The PSH model has also been implemented in a number
of other organizations, including University of Alabama,29 Kaiser
Permanante,30 and DC Children's.31
Specific multimodal and opioid sparing strategies that can be
implemented throughout the perioperative course to optimize
analgesia after TJA procedures are elucidated.28,32 Amidst a major
public health crisis33 (often delineated as "the opioid epidemic"),
this presents a particularly keen opportunity for value added care
after TJA procedures. Raphael et al34 also demonstrated that direct
hospital fiscal burden was substantially below benchmark levels
American Society of Regional Anesthesia and Pain Medicine
2017
73
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine May 2017
No label
American Society of Regional Anesthesia and Pain Medicine May 2017 - No label
American Society of Regional Anesthesia and Pain Medicine May 2017 - 2
American Society of Regional Anesthesia and Pain Medicine May 2017 - 3
American Society of Regional Anesthesia and Pain Medicine May 2017 - 4
American Society of Regional Anesthesia and Pain Medicine May 2017 - 5
American Society of Regional Anesthesia and Pain Medicine May 2017 - 6
American Society of Regional Anesthesia and Pain Medicine May 2017 - 7
American Society of Regional Anesthesia and Pain Medicine May 2017 - 8
American Society of Regional Anesthesia and Pain Medicine May 2017 - 9
American Society of Regional Anesthesia and Pain Medicine May 2017 - 10
American Society of Regional Anesthesia and Pain Medicine May 2017 - 11
American Society of Regional Anesthesia and Pain Medicine May 2017 - 12
American Society of Regional Anesthesia and Pain Medicine May 2017 - 13
American Society of Regional Anesthesia and Pain Medicine May 2017 - 14
American Society of Regional Anesthesia and Pain Medicine May 2017 - 15
American Society of Regional Anesthesia and Pain Medicine May 2017 - 16
American Society of Regional Anesthesia and Pain Medicine May 2017 - 17
American Society of Regional Anesthesia and Pain Medicine May 2017 - 18
American Society of Regional Anesthesia and Pain Medicine May 2017 - 19
American Society of Regional Anesthesia and Pain Medicine May 2017 - 20
American Society of Regional Anesthesia and Pain Medicine May 2017 - 21
American Society of Regional Anesthesia and Pain Medicine May 2017 - 22
American Society of Regional Anesthesia and Pain Medicine May 2017 - 23
American Society of Regional Anesthesia and Pain Medicine May 2017 - 24
American Society of Regional Anesthesia and Pain Medicine May 2017 - 25
American Society of Regional Anesthesia and Pain Medicine May 2017 - 26
American Society of Regional Anesthesia and Pain Medicine May 2017 - 27
American Society of Regional Anesthesia and Pain Medicine May 2017 - 28
American Society of Regional Anesthesia and Pain Medicine May 2017 - 29
American Society of Regional Anesthesia and Pain Medicine May 2017 - 30
American Society of Regional Anesthesia and Pain Medicine May 2017 - 31
American Society of Regional Anesthesia and Pain Medicine May 2017 - 32
American Society of Regional Anesthesia and Pain Medicine May 2017 - 33
American Society of Regional Anesthesia and Pain Medicine May 2017 - 34
American Society of Regional Anesthesia and Pain Medicine May 2017 - 35
American Society of Regional Anesthesia and Pain Medicine May 2017 - 36
American Society of Regional Anesthesia and Pain Medicine May 2017 - 37
American Society of Regional Anesthesia and Pain Medicine May 2017 - 38
American Society of Regional Anesthesia and Pain Medicine May 2017 - 39
http://www.brightcopy.net/allen/asra/18-04
http://www.brightcopy.net/allen/asra/18-3
http://www.brightcopy.net/allen/asra/18-2
http://www.brightcopy.net/allen/asra/18-1
http://www.brightcopy.net/allen/asra/17-4
http://www.brightcopy.net/allen/asra/17-3
http://www.brightcopy.net/allen/asra/17-2
http://www.brightcopy.net/allen/asra/17-1
http://www.brightcopy.net/allen/asra/16-4
http://www.brightcopy.net/allen/asra/16-3
http://www.brightcopy.net/allen/asra/16-2
http://www.brightcopy.net/allen/asra/16-1
http://www.brightcopy.net/allen/asra/15-4
http://www.brightcopy.net/allen/asra/15-3
https://www.nxtbook.com/allen/asra/15-2
https://www.nxtbook.com/allen/asra/15-1
https://www.nxtbookmedia.com