Anesthesiologists and the World of ASCs: A Different Value Proposition

Stanford Plavin, MD
Technical Anesthesia Strategies and Solutions, Atlanta, GA

As the business of anesthesia continues to evolve and the disruptions to our profession and our identities morph, the role of the physician anesthesiologist in the ambulatory surgical center (ASC) realm is ripe with opportunity. ASCs and office-based surgery centers have a vast array of business ownership models and infrastructures that provide the anesthesiologist the chance to impact the delivery and profitability of these models on so many levels in addition to provision of our anesthesia services.

ASC environments present many different challenges for the “typical” anesthesiologist, leading us to the following list of ten top reasons (in reverse order of importance) why anesthesiologists don’t always succeed in this practice setting:

1. Everyone is replaceable...it's not like it is a hospital group!
2. But the in-network rates are too low. I don’t want to participate in the plans with which the ASC contracts.
3. Marketplace consolidation and entitlement...I am part of the hospital network.
4. Lack of self-awareness.
5. Goals are not aligned with facility and ownership of the center.
6. Inconsistencies among providers and skill sets.
7. Inflexibility and obstructionist nature of provider.
8. Lack of emotional investment in the center.
9. Not customer-centric and consumer driven.
10. It’s just outpatient and it’s easy… “I’m almost ready for retirement.”

The bridge between success and failure is Communication, which raises at least the following three questions:

• How does the anesthesia group identify the needs specific to each ASC or practice site?
• What can a group or provider do in order to tighten up the relationship?
• How do we learn to engage the facility and the ownership group?

We as providers always seem to feel that we are doing an excellent job but sometimes we lack the insight and data necessary to properly evaluate our performances. This is a potential death knell. Physicians by nature are traditionally challenged to be humble. Our personalities tend to see ourselves as loved and liked by all of those around us. Little do we know, this is typically not the case; and in the ASCs, which are smaller practice settings, our character flaws and technical shortcomings tend to be magnified.

How do we identify what our customers need? We must first identify our customers and unfortunately this seems to be changing on a regular basis. In the ASC realm, who are the decision makers and are they our customers? This varies as well depending upon the ownership and governance structure of the facility. There are tools available to us that we should strongly consider.

Surveys and executive summaries are not inexpensive if properly constructed— but they provide tremendous insight and analysis regarding the needs and wants of our various customers.

Carefully constructing the survey is of the utmost importance. Take the time and resources necessary to ensure that you will get the information needed to provide the answers that you want. It does the practice no good to spend a ton of money and energy to survey your customers if you aren’t going to take the time and energy to identify the “value proposition.”

Consider the following when putting together a target survey: evaluating the anesthesiologists and care team, communication, preparation/facilitation, services provided, business relationship and overall satisfaction which targets a number of key components.

Also, leave opportunities to identify unique characteristics and those items which are both positive and negative about your practice and practitioners. Please provide this survey to your own group of providers and discuss the findings as they relate to those of your customers.

Statistics and data analysis. After completing your assessment and survey, what is next? Take the time to carefully analyze the information and put together a summary of your data points. Identify and prioritize the areas of strength as differentiators and, more importantly, identify your areas of weakness and vulnerability.

Extracting the data and information and putting them into a context to be shared amongst your colleagues is of paramount importance. This can truly define your strategic plan moving forward.

If constructed correctly, surveys and summaries can help one identify the value proposition of their customers. You can see the criteria that most correlate to the overall satisfaction of your segmented customer base and compare that to what you as the group may have identified as of importance. The results will likely surprise you.

Investing in oneself and stepping outside of the comfort zones that we traditionally have as providers will enable us to identify opportunities for ourselves.

In the world of ASCs, the microscope is powerful and the lights are bright. We cast a big shadow; it is challenging to overcome poor outcomes and quality or to hide that one provider who just doesn’t fit the mold. Be part of the solution and the team; put together a strategy for your practice which can make you as indispensable as possible. Nothing is a panacea, but look for the perioperative solutions that can define your value proposition.

Our scope of services should begin before a patient even sets foot inside of a facility; take them through the full operative/ procedural course and provide a postoperative piece that can be tied to our service line.

I have identified the following P Factors, a nomenclature that puts the “P” into value proposition:

1. Patient: patient-centered care
2. Perioperative: seek to have an impact in all three components (pre/ intra/post)
3. Process: identify areas that we can impact and impart
4. Professionalism/Personality
5. Procurement: consider an ancillary component to add to your product line
6. Performance: affect outcomes, satisfaction, throughput
7. Profitability: a likely result of the previous factors

The factors required for success in the ASC environment are numerous and require constant evaluation and are ever-changing. No one P-factor alone is any guarantee of success or failure. The above is merely an introduction to those ideas and offerings that you need to consider embracing in order to define your own value proposition and the unique qualities that you can offer as a practice.

Stanford R. Plavin, MD has been actively involved in the ASC arena for 18 plus years as a practicing anesthesiologist serving as past president of the Georgia Society of Ambulatory Surgical Centers and currently an Ambulatory Surgery Center Association board member. He practices in Atlanta, GA as a co-founder of Ambulatory Anesthesia of Atlanta and can be reached at splavin@technicalanesthesia.com.