Trends in anesthesiology: Employing technology to reduce costs and manage information

August 22, 2011
by Olga Deshchenko, DOTmed News Reporter
This report originally appeared in the August 2011 issue of DOTmed Business News

After graduating medical school, my father joined the anesthesiology department of a small Ukrainian hospital and stayed there until immigrating to the United States in 1999.

My dad is no longer an anesthesiologist but he still works in a hospital, where curious colleagues often inquire about the differences in health care between the U.S. and his homeland.

“In Ukraine, medical practice is an art,” he always says. “In America, it’s a science.”

For years, I couldn’t figure out what he meant by this response. But it made more sense after he described how his department functioned.

Anesthesiologists relied on Soviet-era drug delivery systems, archaic enough to warrant display in a surgical museum. Ventilation was a manual practice. And patient monitoring devices were mere items on a wish list – throughout the procedure, the anesthesiologist or nurse had to regularly check the patient’s vitals.

New anesthesia devices were slow to reach hospitals in the southern tip of Ukraine, meaning doctors had to work with what was available and often, fall back on creative solutions.

Fortunately today, Ukrainian anesthesiologists have more access to innovative anesthesia devices for precise drug delivery and automatic patient monitoring.
Meanwhile, here in the U.S., the spotlight on quality improvement in health care is triggering a role shift in the profession. As a result, anesthesiologists are being held to a higher standard of accountability.
Dr. Robert Goldstein, chief medical officer and executive vice president of Somnia Anesthesia Services, a physician-owned anesthesia management company, likens anesthesiologists to airline pilots. For the most part, they have been anonymous to their patients. And just like airplane passengers trust pilots to safely bring them to their destination, patients expect anesthesiologists to safely manage them through a surgical procedure.

But today, Goldstein says, “People want to know who their anesthesiologists are,” and their performance greatly contributes to the facility’s reputation in the community.

At the same time, hospitals are looking to trim spending, a demand that doesn’t spare anesthesia departments. “A tremendous challenge anesthesiologists face is trying to balance our patients’ needs for safety by using more complex and costly machines in patient care with the increased cost of the care,” Dr. Charlotte Bell, chair of the American Society of Anesthesiologists’ Committee on Equipment and Facilities, told DOTmed News via e-mail.

Cost saving practices
Manufacturers are aware of the goal to reduce costs in anesthesia delivery and are equipping their devices with technologies to help anesthesiologists use fewer pharmaceuticals while maintaining the same level of patient care.

In a recent letter to the editor of Anesthesia News, a director of anesthesia at a medical center in South Carolina wrote that his facility slashed its spending on anesthetic agents by an average of $8,800 a month, which works out to $105,600 a year. The center was able to cut costs of its pharmaceuticals by taking advantage of a previously rarely used feature on its machines called low flow anesthesia.

When the feature is used, the software indicates when flows are too high, too low or just right for the particular patient undergoing a procedure. Since carrying out the study that helped determine its impact, the center’s anesthesiologists are regularly using the low flow feature, a practice that “has more than met our goal to reduce pharmaceutical costs without limiting our drug options,” the author wrote.

And while the financial savings delivered by low flow anesthesia are increasing its popularity, it’s not the only advantage of the functionality, according to David Karchner, director of marketing, perioperative care, with Dräger.
“Not only is low flow anesthesia better from a cost saving standpoint, it’s also better for the environment because there is less waste,” he says.
The contribution of anesthesia medications to environmental pollution is an ongoing concern in the surgical community, with nitrous oxide, a popular anesthetic, being a known greenhouse gas, although numeric data on its contributions to emissions is scarce. (The ASA has issued guidance on the subject.)
Image courtesy of Drager

Yet, a 2008 study published in the intensive care journal Signa Vitae noted that volatile anesthetics are a small contributor to environmental damage when compared to large-scale industries.

And according to the study, “during low flow or metabolic anesthesia, even taking into account eventual gas leakages from the circuits, the amount of total gases released in the environment is significantly reduced if compared with high flow anesthesia.”

Although low flow anesthesia enables anesthesiologists to efficiently reduce fresh gas flows, the accumulation of moisture in the breathing systems has been considered a drawback in its use. However, manufacturers have delivered innovations to deal with this issue.

For example, Dräger’s Apollo Anesthesia Workstation, which is equipped with a low flow anesthesia feature called Low Flow Wizard, also includes a warming element as part of its breathing system.

The warming element reduces the opportunity for condensation in the breathing system, according to Karchner.

GE Healthcare, another major player in the anesthesia market, offers a different feature on its digital Aisys Carestation anesthesia system that has the potential to reduce costs and improve quality.

The functionality, called Et Control, is an optional gas delivery mode that enables clinicians to set target EtO2 and EtAA values. Once the anesthesiologist sets the values, Et Control automatically adjusts gas delivery and flow throughout the procedure.

According to Risto Rossi, GE’s global anesthesia segment leader, Et Control reduces the potential of over- or under-delivery of the drug and hypoxia. “It also provides a potential to reduce anesthetic costs because it’s using a minimal flow anesthesia technique,” Rossi says.

However, at this point, only customers outside the U.S. can take advantage of the Et Control functionality. GE hopes to bring the automated anesthesia delivery feature to the States in the future, according to Rossi.

In addition to making better use of the available technologies, providers can save money by reconsidering their staffing models. Staffing costs make up as much as three-quarters of a department’s expenses, according to Somnia Anesthesia.

An all MD-model is often the most expensive, so exploring other options, such as a mix of physicians and certified registered nurse anesthetists or CRNAs alone, can result in savings for the hospital. (Currently, 16 states allow CRNAs to practice independently.)

But shaking up the structure of an anesthesia department can be tricky. According to Somnia’s Goldstein, it’s critical to understand the culture of a facility and the comfort levels of the clinical and administrative stakeholders before a decision to change the employee ratio is made.

Still,, restructuring a department can make a significant difference. In one case, Somnia Anesthesia helped a hospital eliminate its annual anesthesia subsidy of $1.8 million; a readjustment of the facility’s staffing model played an important role in securing the savings.

Managing information
In addition to managing costs, anesthesia providers also have to consider the best ways to handle their data. “We’ve never had a way to collect so much information, manage it, catalog it and pull it out for analysis,” ASA’s Bell said.

Anesthesia information management systems (AIMS) are currently the leading candidate to assist clinicians with this task. Research shows AIMS can help control and reduce anesthesia drug costs, streamline billing practices and contribute to improving patient care and safety.

And yet, the current AIMS adoption rate is low. Manufacturers estimate the technology’s market penetration to be somewhere between 10 and 30 percent.

According to Bell, less than 10 percent of hospitals and surgical centers are currently using the computerizing information management systems. “Right now, the use of these systems is relatively low as it is often cost-prohibitive for medical centers to purchase and maintain,” she said.

On a global scale, GE’s Rossi says the company is seeing an uptick in AIMS adoption, particularly in regions of Europe and Asia.

And Dräger’s Karchner says that U.S. adoption of information management systems will increase in the near future. The company projects that nearly 80 to 85 percent of anesthesia providers will be using AIMS in the next seven years.

At this point, academic centers are leading the way in AIMS adoption. According to a 2007 study in Anesthesia & Analgesia, 44 percent of the country’s academic centers already have or are planning to implement an anesthesia information management system.

Additional tech interests
While AIMS are slow to make their way into operating rooms, anesthesia machines with sophisticated ventilators and systems that are compatible with electronic medical records continue to be in high demand, according to James F. Ruggiero, director of biomedical clinical services with Mercury Medical.

Ultimately, providers are looking for devices that can help them efficiently analyze relevant data for quality improvement purposes and easily integrate with other systems in the OR.

In addition, anesthesiologists are interested in drug delivery devices that enable the delivery of a drug to a specific end point, like a level of consciousness, blood pressure or a specific medication dose, according to ASA’s Bell. “Research is ongoing in trying to define and understand biological systems that remain elusive and imprecise, such as consciousness,” she said. “This type of research will improve our ability to monitor this end point directly.”

And according to GE’s Rossi, the anesthesia market in the developing world is poised to grow as buying power increases. “In developed countries, the market will most likely focus on ensuring that the information [anesthesiologists] already have in their systems is put to better use,” he says.

DOTmed Registered Anesthesia Companies

Names in boldface are Premium Listings.
G. John Oggel, Green Cross Medical/ GOMED, CA
Clinton Courson, Quest Medical Supply, Inc., FL
DOTmed 100
Ken Kirby, Aneserv Medical, Inc., GA
DOTmed Certified
Alda Clemmey, Saffire Medical, MA
DOTmed Certified
DOTmed 100
Abe Sokol, Absolute Medical Equipment, NY
DOTmed Certified
DOTmed 100
Henry Steinitz, Medical Arts Support Corp, NY
Philip Mothena, Simple Solutions, Inc., VA

Jose Morillo, J Morillo Sistemas Biomedicos, Venezuela