How efficient anesthesia staffing ensures quality and reins in costs

Spiraling costs, provider shortages, hospital closings and an aging population were already driving the U.S. healthcare system into crisis before the COVID-19 pandemic. To stay financially viable and continue providing patients access to high-quality healthcare, administrators must take a hard look at all facility resources and services, including anesthesia. This requires a willingness to evaluate costs, services and staffing, and to make decisions that maximize resources while ensuring quality and access to care.

The American Association of Nurse Anesthesiology believes Efficiency-driven Anesthesia Modeling is ideally suited to address key concerns of healthcare systems. By adopting a decision-making framework from the science of public policy, Efficiency-driven Anesthesia Modeling identifies the most appropriate anesthesia care delivery system for a location. This makes the most of a facility’s resources by positioning efficient anesthesia provider staffing as a central objective.

As research demonstrates, Certified Registered Nurse Anesthetists are integral to a high-value anesthesia care delivery approach where quality and safety are emphasized and costs are reduced. Efficiency-driven Anesthesia Modeling engages both CRNAs and physician anesthesiologists working at the full scope of their practice, education and licensure. It also supports flexibility to match local demand and financial capacity, even as it limits the duplication of services, improves effectiveness, increases access and reduces costs.

An anesthesia department’s efficiency assessment should begin by identifying a delivery model that is the most appropriate for the facility. Anesthesia delivery models to consider are:

This model is designed to promote professional cooperation and to create the most value for patients. It does not consider licensure like the Anesthesia Care Team (ACT) model, but instead focuses on maintaining quality, maximizing efficiencies and increasing patient and surgeon access. In the Consultative/Collaborative model, all anesthesia providers are clinically autonomous and encouraged to use their full skill set and licensure in caring for patients.

Also known as the ACT model, Medical Direction with TEFRA requirements requires heavy physician anesthesiologist involvement in key portions of every anesthetic procedure, as well as fulfillment of Medicare’s seven regulatory billing requirements under TEFRA. The ACT’s explicit hierarchical physician-led structure ultimately increases healthcare costs by mandating a maximum 1:4 ratio of physician anesthesiologist to CRNAs. There is no scientific evidence that the ACT model increases patient safety or quality of care, but there is strong evidence that the ACT model increases costs to the healthcare system.

Some care settings function best with a single anesthesia provider who either works solo or as part of a team made up of only CRNAs or only physician anesthesiologists. Historically, lower volume facilities in rural areas are more likely to use CRNA-only groups. Today, this single-provider model is being rapidly adopted at urban facilities in non-hospital-based settings such as ambulatory surgical centers and medical offices. Delivery models that utilize CRNAs, including the model where CRNAs practice alone, are the most cost-effective option.

CRNAs provide the majority of anesthesia services in rural America and have a greater presence in areas with vulnerable populations including Medicaid recipients, the uninsured and the unemployed. Increased use of CRNAs may create cost savings that can be redistributed to provide additional coverage for anesthesia services and other areas. Facilities serving disadvantaged populations, struggling to attract high-cost physician anesthesiologists or burdened by expensive financial subsidies could be well-served by utilizing Efficiency-driven Anesthesia Modeling, and CRNAs are ready to provide effective, more efficient and equitable anesthesia care.

The time has come to ask questions and listen to communities to select the best Efficiency-driven Anesthesia Model that suits the locale’s needs. Efficiency-driven Anesthesia Modeling is purposely responsive to a facility’s needs and based on evidence established in safe practice, cost effectiveness and improved accessibility.

For more information about the Efficiency-driven Anesthesia Model, see AnesthesiaFacts.com.

Dr. Dina Velocci, DNP, CRNA, APRN, is president of the American Association of Nurse Anesthesiology. Velocci has long been active in nurse anesthesiology, spanning 18 years as a CRNA and 14 years as a clinical and didactic instructor for nurse anesthetists, and success as a healthcare business leader.

Founded in 1931, the American Association of Nurse Anesthesiology (AANA) is a professional association representing 60,000 Certified Registered Nurse Anesthetists and student registered nurse anesthetists nationwide. CRNAs are prolific anesthesia professionals who safely administer anesthetics to patients. As advanced practice registered nurses, CRNAs are among the nation's most trusted professionals.