Providence Anesthesiology Associates

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Mark Casner
Mark Casner, CEO

 

Providence Anesthesiology Associates provides remarkable perioperative care, which is safe, reliable, value-driven, evidence-based and measurable of the highest quality. We are stemming the tide of opioid abuse and overdose, addressing rising healthcare costs, and improving the patient experience.”

“When faced with the choice between doing things right or doing the right thing, always choose the latter – never sacrifice your integrity.”

“We’ve fostered a culture and track record of unsurpassed safety, relentlessly measuring outcomes, addressing patient risk and implementing processes to drive the best possible outcomes.”

“At Providence Anesthesiology Associates, we pride ourselves on unparalleled safety and patient care.”

An Unwavering Commitment. Meeting the healthcare challenges of tomorrow, today.

The biggest challenges and achievements within healthcare cannot be solved by working in siloes. In order to tackle complex issues, Mark Casner, Providence Anesthesiology Associates’ CEO, is committed to breaking down barriers and collaborating with all team members to advance the practice, ultimately, benefiting their community of patients.

“Since our founding, we have demonstrated time and again, our unbending adherence to core values. Now numbering nearly ninety anesthesiologists and another sixty clinical support staff including Certified Registered Nurse Anesthetists (CRNAs), Physician Assistants (PAs), Nurse Practitioners (NPs), Nurses and Medical Assistants, we are supported by nearly one hundred administrative professionals, including our related billing company, Capital Anesthesia Billing Services (CABS).

With deep roots in the greater Charlotte market, over the years we have expanded our borders to include the entire state of North Carolina and more recently our endeavors in South Carolina. While we began exclusively serving our hospital partners, with our recent acquisition of Mobile Anesthesia of the Carolinas, our expansion into the outpatient arena has grown exponentially.”

“We take extreme measures to ensure the safest environment for our patients, and not just while they are under anesthesia. We provide dedicated patient care from the moment surgery is scheduled, all the way to discharge and beyond. Our planning begins long before we meet each patient, as we research individual health history and create an anesthetic plan that will afford the highest possible level of safety, maximize comfort and enable fast recovery. Following surgery, we provide post-operative care and pain management, keeping patients safe and comfortable through their hospital stay, as well as their return home, back to normal activity.”

Mark is a visionary with a strong moral compass. His values compliment that of Providence Anesthesiology Associates (PAA) and he leads through adaptability and collaboration. “Our practice is rooted in the belief that the independent physician practice drives the highest levels of productivity, creativity, professionalism and clinical excellence. It’s something every anesthesiologist at PAA is passionate about and is an inherent part of our culture.”

Mark is acutely in tune with the present and future healthcare landscape, making strategic decisions today, to prepare for tomorrow’s disruptions, challenges and opportunities.

Industry Challenges: Anesthesia.

One of the biggest trends in healthcare today is the shift to value-based care. For many providers the movement from fee-for-service to the pay-for-performance model is presenting a multitude of challenges, forcing many, within the industry to reevaluate their approach to the delivery of care. Anesthesia primarily remains a fee-for-service driven entity; it has traditionally been difficult to define metrics that show whether an anesthesiologist is doing a “good job versus a poor job.”

One could argue that as long as a patient does not suffer an adverse event during and/or from the anesthesia, the anesthesia provider has succeeded in providing his or her service and deserves full payment. It’s relatively easy, for example, to assess a surgeon’s performance of 10 knee replacements. If three become infected and the surgeon is being paid through pay-for-performance, he or she will (likely) only receive full payment for seven of the 10 knee replacements.

Organizations such as the Anesthesia Quality Institute are working with physician anesthesiologists and Centers for Medicare & Medicaid Services (CMS) to develop and obtain approval for quality measures that are relevant to anesthesia. As such measures are defined, we expect anesthesia contracts to move away from fee-for-service and to pay-for-performance.

Anesthesia providers will be impacted by the migration to value-based care in a non-monetary manner; since reimbursement for surgeons and facilities is increasingly tied to quality, there is greater pressure to ensure optimal outcomes.

The anesthesia provider is now, more than ever, involved in preoperative care to help optimize patient outcomes.

Such a growing reliance on care collaboration may require anesthesia providers to perform more services and interact more closely with patients, than in the past. Anesthesia providers should be prepared to address their expanding role and increasing responsibilities during contract negotiations.

Providence Anesthesiology Associates & Quality.

“We’ve implemented a patient-centered model to maximize both patient safety and satisfaction. Our care extends beyond the traditional intra-operative arena, as we believe truly comprehensive patient care includes the entire perioperative spectrum, not just the surgery. We connect with our patients from day one, beginning with their decision to have surgery and spanning all the way through recovery and to their return to normal activity.

At PAA, we pride ourselves on unparalleled safety and patient care. We’ve built a reputation on evidence-based anesthetic plans and a track record of positive outcomes, but it’s all rooted in our commitment to quality measurement, ensuring that our practice continues on the track of constant improvement.

We created our own quality system (PAAQS) as a comprehensive resource for internal improvement efforts. This system allows us to collect, analyze and report data across 42 quality metrics that we track for every patient. It’s a chance for us to learn from each individual’s experience.

Our physicians also utilize Real-Time Event Assessment (RTEA) to collect, analyze and discuss patient outcomes as they happen. RTEA alerts are sent electronically through a secure HIPAA (Health Insurance Portability and Accountability Act) compliant platform to the Medical Review Committee (MRC). Our MRC works diligently to create evidence-based protocols that promote patient safety and quality care.”

PAA reports quality metrics to several external resources as well:

The American Society of Anesthesiologists’ (ASA) Anesthesia Quality Institute (AQI) is standardizing the definition of quality indicators, working to aggregate quality data from member practices into several national registers.

The National Anesthesia Clinical Outcomes Registry (NACOR) is the country’s largest clinical data registry. Through our PAAQS system, we’ve reported more than 120,000 patient cases to NACOR. The AQI uses the NACOR registry to provide reports comparing PAA data to national benchmarks from the NACOR.

PAA consistently scores above the benchmark on the National Anesthesia Clinical Outcomes Registry (NACOR), which sets the standard for 15,000 anesthesiologists nationally.

“We developed LongLives Anesthesia Pathways to bring an evidence-based framework to every patient we serve. This system includes crisis checklists, which reduce missteps by 70% when used during an uncommon medical event; a collection of published, vetted guidelines and tools that provide very specific direction for a myriad of patient concerns; and a database of up-to-date patient care initiatives, providing a wealth of knowledge on various patient populations and disease states.”

PAA’s Enhanced Recovery After Surgery Program.

Introduced in 2016, PAA’s ERAS (Enhanced Recovery After Surgery) Program is designed to improve and accelerate patient recovery, improve patient outcomes and decrease costs in major, often high-risk surgeries. Through ERAS protocols, Providence Anesthesiology Associates is challenging the status quo and replacing traditional, dogmatic methods with evidence-based, best practices.

Collaboration is key to PAA’s success; by partnering with surgical colleagues and hospital administration, the anesthesia practice is equipped to lead and coordinate this multidisciplinary approach to improving care and outcomes for patients.

The benefits of PAA’s ERAS Program are evident.

In a recent review of outcomes, PAA noted that patients in the ERAS pathways are experiencing many benefits compared to patients treated with traditional care. Length of time in the hospital for ERAS patients compared to those who received traditional care is cut in half, allowing patients to return home up to several days earlier, cost of care is thousands of dollars less per patient, and there is a significant decrease in the use of narcotics, with many patients not needing any opioids.

“The effects of a successful ERAS program, such as this, cascade; this collaboration with our surgical partners has changed the way in which they practice perioperative medicine – they are more aware of patient pain scores and their opioid consumption.”

The data shows that less than half of PAA patients require opioid pain medication measurable due to the use of a multimodal analgesia regimen using non-opioid medications.

Since patients require less opioid pain medication while they are in the hospital, approximately 40% of them did NOT require an opioid prescription on discharge.

Of these patients who are discharged with an opioid prescription, 20% opted not to have that prescription filled, all milestones in the right direction to fighting not only a national crisis but a crisis in their own backyard.

The Patient Experience.

Patient-centered care is associated with better outcomes, improved patient satisfaction, and even has the potential to lower healthcare related costs. PAA is committed to connecting with their patients across the entire spectrum of care, starting with their decision to have surgery and ending with their return to normal activity.

With their hospital partner(s), PAA has developed and implemented the “We Care” handoff, which recognizes that patient engagement and a patient-centered approach to care are critical to safety and satisfaction.

“We continue to actively develop our Enhanced Recovery After Surgery (ERAS) program, which is aimed at improving the patient experience and clinical outcomes through standardized patient care. In addition, we created Talk to My Doc to offer patients education and encouragement to become more proactive in their care, and we promote shared decision-making, including smoking cessation counseling and anemia management.”

PAA developed and implemented patient surveys as a means of gathering critical patient satisfaction feedback straight from the source. Once a patient’s care is complete, every patient receives an automated interactive voice response survey. This yields a response rate greater than 10%, which translates to completed surveys from tens of thousands of patients every year. This information provides PAA with statistically significant results that can be studied for trends and opportunities for improvement.

Listening to our Peers. PAA’s 360-Degree Evaluation Program.

PAA’s 360-Degree Evaluation allows physician anesthesiologists to (anonymously) gain insight into individual strengths and weaknesses, directly from their peers. Every anesthesiologist within the practice is evaluated by fellow CRNAs, PACU Staff and Surgeons, through a standardized survey. Feedback allows for further insight to PAA physician communication, clinical and technical proficiency, ability to navigate stressful situations with decisiveness, as well as bedside manner and patient compassion.

“This initiative allows our physicians to improve their interpersonal relationships and clinical efficiency. The 360-Degree Evaluation program has continued to better our practice with the analysis of multi-sourced surveys — the key to our physicians, and practice relations with surgical peers & our hospital partners.”

About Providence Anesthesiology Associates.

Founded in 1991, Providence Anesthesiology Associates (PAA) is an independent practice of nearly 90 anesthesiologists. Based in Charlotte, North Carolina, we provide unparalleled anesthesia and perioperative care at a growing list of hospitals and healthcare facilities across the Carolinas, serving more than 120,000 patients annually.