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The Biggest Threats to Anesthesiology Are...

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Descripción

Upon completion of this presentation, participants will be able to:
1. Discuss the challenge of losing identity and apply strategies to establish a brand;
2. Review missed opportunities in adopting new technology and identify potential applications in future operating room models;
3. Understand barriers to change implementation and develop a team approach that redefines challenges as opportunities.

Transcripción

  1. 1. @@EMARIANOMD The Biggest Threats to Anesthesiology Are… Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System
  2. 2. @EMARIANOMD Financial Disclosures • None • Other disclosures: – FDA consultant on regional anesthesia – Clinical subcommittee, CMS MACRA episode-based cost measures for joint replacement – Technical expert panel, quality measures for pain management (now in QCDR) – Standards review panel, TJC hospital-based pain management – ACGME accreditation for regional anesthesiology and acute pain medicine fellowships
  3. 3. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  4. 4. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  5. 5. @EMARIANOMD Is Anesthesia Today “Too Safe”?
  6. 6. @EMARIANOMD It’s Just “Sleep,” Right?
  7. 7. @EMARIANOMD http://time.com/3006511/under-appreciated-professions-invisibles-zweig/
  8. 8. @EMARIANOMD http://time.com/3006511/under-appreciated-professions-invisibles-zweig/
  9. 9. @EMARIANOMD Large Group Practices Are Trending
  10. 10. @EMARIANOMD You Can Be One of 27,000
  11. 11. @EMARIANOMD
  12. 12. @EMARIANOMD Is “Burnout” Really Loss of Identity? https://www.beckershospitalreview.com/workforce/why-physician-burnout-jumped-to-54-over-3-years.html
  13. 13. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  14. 14. @EMARIANOMD Emerging Technology https://engineering.stanford.edu/magazine/article/can- algorithm-diagnose-pneumonia-better-radiologist
  15. 15. @EMARIANOMD Emerging Technology https://engineering.stanford.edu/magazine/article/can- algorithm-diagnose-pneumonia-better-radiologist
  16. 16. @EMARIANOMD Target-Controlled Infusion
  17. 17. @EMARIANOMD Target-Controlled Infusion Where Is It? Why Aren’t We Using It?
  18. 18. @EMARIANOMD https://www.washingtonpost.com/business/economy/new-machine-could-one-day-replace- anesthesiologists/2015/05/11/92e8a42c-f424-11e4-b2f3- af5479e6bbdd_story.html?utm_term=.cc307b242841
  19. 19. @EMARIANOMD https://www.newsweek.com/plug-pulled-robot-doctor-after-humans-complain-442036
  20. 20. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  21. 21. @EMARIANOMD
  22. 22. @EMARIANOMD 2017;42:368 http://www.edmariano.com/archives/1196 27%! J Arthroplasty 2016 100%
  23. 23. @EMARIANOMD Barriers to Change “Us” “Them”
  24. 24. @EMARIANOMD What Holds Anesthesiology Back? “Once a hot specialty, anesthesiology cools as insurers scale back” Anders G. Wall Street Journal. March 17, 1995. http://www.apnewsarchive.com/1995/Numb-and-Number-Once-a-Hot-Specialty- Anesthesiology-Cools-As-Insurers-Scale-Back/id-0ff8af6e9ab84b8a994aa4f123c6dc74
  25. 25. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42
  26. 26. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42
  27. 27. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42 Let’s look at this a different way…
  28. 28. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42 Not all anesthesiologists wanted to be anesthesiologists in the 90s (mid-career now)
  29. 29. @EMARIANOMD The Biggest Threats • Loss of identity → Establish a brand • Fear of technology • Resistance to change
  30. 30. @EMARIANOMD Anesthesiologists Need a Brand
  31. 31. @EMARIANOMD Personalized Medicine Anesthesiology is the most personalized form of medicine
  32. 32. @EMARIANOMD https://www.nytimes.com/2011/03/01/science/01conv.html
  33. 33. @EMARIANOMD Take a “Victory Lap” Daily
  34. 34. @EMARIANOMD Take a “Victory Lap” Daily X X = patient’s family or friend in waiting roomOR PACU
  35. 35. @EMARIANOMD Know When to Take Off the Mask
  36. 36. @EMARIANOMD Get Involved (Examples from VAPA) • Operating room (Chair) • Pain (Chair) • CPR (Chair) • Research and development (Chair) • Invasive procedures (Co-Chair) • Clinical product review (Co-Chair) • Professional standards board (Vice-Chair) • Peer-review (Vice-Chair) • Transfusion (Member) • Medication management (Member) • Infection prevention and control (Member) • Laser safety (Member)
  37. 37. @EMARIANOMD Physician Anesthesiologists Week Share Your Stories!
  38. 38. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology → Promote technology • Resistance to change
  39. 39. @EMARIANOMD Anesthesia Care Today MD DO CRNA CAA MD DO CRNA CAA
  40. 40. @EMARIANOMD “For better or for worse, we cannot resist technological advances. Our role is to manage those advances to best benefit patients, but also to avoid disappearing, like travel agents and bank tellers, who were displaced by the Internet. Taking ownership of the technology is paramount: we need to be the drivers of progress rather than those who resist it out of inertia.” Anesth Pain Med. 2014 Feb; 4(1): e16468
  41. 41. @EMARIANOMD Example: Blood Pressure Control
  42. 42. @EMARIANOMD Not a New Idea
  43. 43. @EMARIANOMD Not a New Idea Where Is It? Why Aren’t We Using It?
  44. 44. @EMARIANOMD Mobile Health Technology https://www.mesm.com/resources/realising-the-potential-of- wearable-technology-for-clinical-trials/
  45. 45. @EMARIANOMD We Still Need Pilots or her ˄
  46. 46. @EMARIANOMD Hypothetical OR of the Future OR 1 OR 2 OR 3 OR 4 Control Room
  47. 47. @EMARIANOMD Anesthesiologists of the Future? OR 1 OR 2 OR 3 OR 4 Control Room Who will they be? What skill level will be needed?
  48. 48. @EMARIANOMD Anesthesiologists of the Future?? OR 1 OR 2 OR 3 OR 4 Control Room
  49. 49. @EMARIANOMD Surgery Has Threats Too How many surgeons vs. technicians will we need in the future?
  50. 50. @EMARIANOMD “Drone” Surgery in the Future? No industry is immune to change
  51. 51. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change → Embrace change and look for opportunities
  52. 52. @EMARIANOMD So We’ll Need Leaders
  53. 53. @EMARIANOMD Bundled Payment http://www.kpmginfo.com/healthcare/PDF/bundled-payments-for-patients-providers.pdf Bundled Payment Care Improvement (BPCI) Initiative Began in 2013 (Voluntary)
  54. 54. @EMARIANOMD Bundled Payment “[A model of care] which link payments for the multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.” https://innovation.cms.gov/initiatives/bundled-payments/
  55. 55. @EMARIANOMD Kurtz S, et al. JBJS 2007 Apr;89(4):780 Example: Arthroplasty
  56. 56. @EMARIANOMD Bade, et al. J Orthop Sports Phys Ther 2010;40:559 Plenty of room for improvement! Big opportunities for pain medicine What if this was the bundle and not arthroplasty?
  57. 57. @EMARIANOMD The Opioid Epidemic https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0
  58. 58. @EMARIANOMD Opportunities for Anesthesiology Mariano, Walters, Kim, Kain. A&A 2015;120:1163 Walters, Mariano, Clark. Pain Med 2015;16:1666
  59. 59. @EMARIANOMD Lead Changes in Culture Mariano, et al. A&A 2017;125:1443 Mariano, et al. A&A 2015;120:1163 Ortho ERAS GI/GU ERAS Perioperative Pain Service Perioperative Surgical Home
  60. 60. @EMARIANOMD Find the Gaps that Need Filling Katz, et al. J Pain Res 2015;8:695 Huang, et al. Pain Manag 2016;6:435
  61. 61. @EMARIANOMD Develop Better Metrics https://qpp.cms.gov/ How do we measure quality of anesthesia? What do any of these have to do with anesthesia? If you’re not at the table…
  62. 62. @EMARIANOMD Protect Academic Medicine
  63. 63. @EMARIANOMD Questions?

Descripción

Upon completion of this presentation, participants will be able to:
1. Discuss the challenge of losing identity and apply strategies to establish a brand;
2. Review missed opportunities in adopting new technology and identify potential applications in future operating room models;
3. Understand barriers to change implementation and develop a team approach that redefines challenges as opportunities.

Transcripción

  1. 1. @@EMARIANOMD The Biggest Threats to Anesthesiology Are… Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System
  2. 2. @EMARIANOMD Financial Disclosures • None • Other disclosures: – FDA consultant on regional anesthesia – Clinical subcommittee, CMS MACRA episode-based cost measures for joint replacement – Technical expert panel, quality measures for pain management (now in QCDR) – Standards review panel, TJC hospital-based pain management – ACGME accreditation for regional anesthesiology and acute pain medicine fellowships
  3. 3. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  4. 4. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  5. 5. @EMARIANOMD Is Anesthesia Today “Too Safe”?
  6. 6. @EMARIANOMD It’s Just “Sleep,” Right?
  7. 7. @EMARIANOMD http://time.com/3006511/under-appreciated-professions-invisibles-zweig/
  8. 8. @EMARIANOMD http://time.com/3006511/under-appreciated-professions-invisibles-zweig/
  9. 9. @EMARIANOMD Large Group Practices Are Trending
  10. 10. @EMARIANOMD You Can Be One of 27,000
  11. 11. @EMARIANOMD
  12. 12. @EMARIANOMD Is “Burnout” Really Loss of Identity? https://www.beckershospitalreview.com/workforce/why-physician-burnout-jumped-to-54-over-3-years.html
  13. 13. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  14. 14. @EMARIANOMD Emerging Technology https://engineering.stanford.edu/magazine/article/can- algorithm-diagnose-pneumonia-better-radiologist
  15. 15. @EMARIANOMD Emerging Technology https://engineering.stanford.edu/magazine/article/can- algorithm-diagnose-pneumonia-better-radiologist
  16. 16. @EMARIANOMD Target-Controlled Infusion
  17. 17. @EMARIANOMD Target-Controlled Infusion Where Is It? Why Aren’t We Using It?
  18. 18. @EMARIANOMD https://www.washingtonpost.com/business/economy/new-machine-could-one-day-replace- anesthesiologists/2015/05/11/92e8a42c-f424-11e4-b2f3- af5479e6bbdd_story.html?utm_term=.cc307b242841
  19. 19. @EMARIANOMD https://www.newsweek.com/plug-pulled-robot-doctor-after-humans-complain-442036
  20. 20. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change
  21. 21. @EMARIANOMD
  22. 22. @EMARIANOMD 2017;42:368 http://www.edmariano.com/archives/1196 27%! J Arthroplasty 2016 100%
  23. 23. @EMARIANOMD Barriers to Change “Us” “Them”
  24. 24. @EMARIANOMD What Holds Anesthesiology Back? “Once a hot specialty, anesthesiology cools as insurers scale back” Anders G. Wall Street Journal. March 17, 1995. http://www.apnewsarchive.com/1995/Numb-and-Number-Once-a-Hot-Specialty- Anesthesiology-Cools-As-Insurers-Scale-Back/id-0ff8af6e9ab84b8a994aa4f123c6dc74
  25. 25. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42
  26. 26. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42
  27. 27. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42 Let’s look at this a different way…
  28. 28. @EMARIANOMD Rock-Klotz, Miller. ASA Monitor 2018;82:42 Not all anesthesiologists wanted to be anesthesiologists in the 90s (mid-career now)
  29. 29. @EMARIANOMD The Biggest Threats • Loss of identity → Establish a brand • Fear of technology • Resistance to change
  30. 30. @EMARIANOMD Anesthesiologists Need a Brand
  31. 31. @EMARIANOMD Personalized Medicine Anesthesiology is the most personalized form of medicine
  32. 32. @EMARIANOMD https://www.nytimes.com/2011/03/01/science/01conv.html
  33. 33. @EMARIANOMD Take a “Victory Lap” Daily
  34. 34. @EMARIANOMD Take a “Victory Lap” Daily X X = patient’s family or friend in waiting roomOR PACU
  35. 35. @EMARIANOMD Know When to Take Off the Mask
  36. 36. @EMARIANOMD Get Involved (Examples from VAPA) • Operating room (Chair) • Pain (Chair) • CPR (Chair) • Research and development (Chair) • Invasive procedures (Co-Chair) • Clinical product review (Co-Chair) • Professional standards board (Vice-Chair) • Peer-review (Vice-Chair) • Transfusion (Member) • Medication management (Member) • Infection prevention and control (Member) • Laser safety (Member)
  37. 37. @EMARIANOMD Physician Anesthesiologists Week Share Your Stories!
  38. 38. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology → Promote technology • Resistance to change
  39. 39. @EMARIANOMD Anesthesia Care Today MD DO CRNA CAA MD DO CRNA CAA
  40. 40. @EMARIANOMD “For better or for worse, we cannot resist technological advances. Our role is to manage those advances to best benefit patients, but also to avoid disappearing, like travel agents and bank tellers, who were displaced by the Internet. Taking ownership of the technology is paramount: we need to be the drivers of progress rather than those who resist it out of inertia.” Anesth Pain Med. 2014 Feb; 4(1): e16468
  41. 41. @EMARIANOMD Example: Blood Pressure Control
  42. 42. @EMARIANOMD Not a New Idea
  43. 43. @EMARIANOMD Not a New Idea Where Is It? Why Aren’t We Using It?
  44. 44. @EMARIANOMD Mobile Health Technology https://www.mesm.com/resources/realising-the-potential-of- wearable-technology-for-clinical-trials/
  45. 45. @EMARIANOMD We Still Need Pilots or her ˄
  46. 46. @EMARIANOMD Hypothetical OR of the Future OR 1 OR 2 OR 3 OR 4 Control Room
  47. 47. @EMARIANOMD Anesthesiologists of the Future? OR 1 OR 2 OR 3 OR 4 Control Room Who will they be? What skill level will be needed?
  48. 48. @EMARIANOMD Anesthesiologists of the Future?? OR 1 OR 2 OR 3 OR 4 Control Room
  49. 49. @EMARIANOMD Surgery Has Threats Too How many surgeons vs. technicians will we need in the future?
  50. 50. @EMARIANOMD “Drone” Surgery in the Future? No industry is immune to change
  51. 51. @EMARIANOMD The Biggest Threats • Loss of identity • Fear of technology • Resistance to change → Embrace change and look for opportunities
  52. 52. @EMARIANOMD So We’ll Need Leaders
  53. 53. @EMARIANOMD Bundled Payment http://www.kpmginfo.com/healthcare/PDF/bundled-payments-for-patients-providers.pdf Bundled Payment Care Improvement (BPCI) Initiative Began in 2013 (Voluntary)
  54. 54. @EMARIANOMD Bundled Payment “[A model of care] which link payments for the multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.” https://innovation.cms.gov/initiatives/bundled-payments/
  55. 55. @EMARIANOMD Kurtz S, et al. JBJS 2007 Apr;89(4):780 Example: Arthroplasty
  56. 56. @EMARIANOMD Bade, et al. J Orthop Sports Phys Ther 2010;40:559 Plenty of room for improvement! Big opportunities for pain medicine What if this was the bundle and not arthroplasty?
  57. 57. @EMARIANOMD The Opioid Epidemic https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0
  58. 58. @EMARIANOMD Opportunities for Anesthesiology Mariano, Walters, Kim, Kain. A&A 2015;120:1163 Walters, Mariano, Clark. Pain Med 2015;16:1666
  59. 59. @EMARIANOMD Lead Changes in Culture Mariano, et al. A&A 2017;125:1443 Mariano, et al. A&A 2015;120:1163 Ortho ERAS GI/GU ERAS Perioperative Pain Service Perioperative Surgical Home
  60. 60. @EMARIANOMD Find the Gaps that Need Filling Katz, et al. J Pain Res 2015;8:695 Huang, et al. Pain Manag 2016;6:435
  61. 61. @EMARIANOMD Develop Better Metrics https://qpp.cms.gov/ How do we measure quality of anesthesia? What do any of these have to do with anesthesia? If you’re not at the table…
  62. 62. @EMARIANOMD Protect Academic Medicine
  63. 63. @EMARIANOMD Questions?

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