Becker's ASC Review

33 Executive Briefing: Sponsored by: I t's official: Healthcare is changing — and rapidly. Consolidation is everywhere. Payers are becoming providers. Providers are becoming payers. Patients are becoming consumers. How widespread is the disruption? According to PwC, healthcare deal volume increased 14 percent last year, with nearly 1,200 transactions alone occurring in 2018. 1 Even more, there's little indication the M&A flurry will let up anytime soon. "Deal activity is likely to continue given capital availability, potential for disruption from cross-industry alliances, and continuing long-term trends such as regulatory uncertainty, reimbursement pressure, and increased focus on the consumer," PwC research shows. "However, deals are becoming more expensive, with multiples increasing for the seventh consecutive quarter." And hospital leaders are taking notice. The American College of Healthcare Executives (ACHE) recently asked more than 1,400 community hospital CEOs to list the top issues they're confronting. 2 The survey results suggested that while patients continue to be a top priority, hospitals and health systems increasingly are balancing patient needs with the realities of running a business in a fast-changing, competitive environment. "The overriding concern of hospital executives is to assure safe and high-quality care," said Deborah J. Bowen, ACHE president and CEO, in a press release. "The survey results indicate that leaders are working to overcome challenges of balancing limited reimbursements against the rising costs of attracting and retaining talented staff to provide that care, among other things." This new era of healthcare also is marked by previously unimaginable clinical advances, particularly in surgery. Assisted by advanced imagining and diagnostics, robotics and AI, minimally invasive techniques are expected to usher in a new dawn over the coming years. Considering this, the general surgery market is expected to top $21 billion by 2024, a 50 percent increase from 10 years prior, with North America alone expected to account for more than a quarter of all surgical volume within five years, according to the research group GlobalData. 3 ACHE survey: Top 10 issues facing hospital executives in 2018 1. Financial challenges 2. Government mandates 3. Patient safety and quality 4. Personnel shortages 5. Behavioral health/addiction issues 6. Patient satisfaction 7. Access to care 8. Physician-hospital relations 9. Technology 10. Population health management IONM: A patient safety net With this uptick in procedures, unforeseen neurological complications can — and will — arise during high-risk surgery. Without the right safety measures like intraoperative neurophysiological monitoring (IONM) in place, however, patient outcomes may suffer. An effective safety net that protects a patient's neuromuscular system during surgery, IONM provides instant and reliable feedback about a patient's nervous system without the need for a wake-up test during complex procedures involving the spine, brain and vascular system. IONM also enhances staff engagement during procedures. Surgical neurophysiologists are present in the operating room and maintain constant, real-time communication with board-certified reading physicians. They also are trained in electrical safety and follow all sterile field precautions in the operating room, including safety training and handling of sharps and bodily fluids. These clinicians are integrated within a hospital's surgical team, working seamlessly with all staff and physicians. But not all IONM providers are created equally. So, when choosing a solution, it's important to consider the following factors: • Certification and credentials of IONM clinicians and supervising physicians: IONM clinicians should possess CNIM (Certification Neurophysiologic Intraoperative Monitoring) certification or be working toward the credential. Earning CNIM certification involves passing a comprehensive neurophysiological monitoring exam offered by ABRET, a national credentialing board that develops and advances quality clinical standards for those in neurodiagnostic fields. Clinicians are eligible to sit for the CNIM exam after performing 150 cases where they have been the primary surgical neurophysiologist. • Accreditation: An IONM solution should be accredited by a nationally recognized organization. • Quality assurance: In many cases, using multiple IONM partners can result in quality assurance inconsistencies. Are providers following best practice guidelines? Can all surgical specialties be covered? Are billing procedures consistent? Are all oversight physicians board-certified? Routine evaluation is an important aspect of any quality assurance program. • Staff vetting: An IONM solution is only as good as its clinicians and supervising physicians. That's why providers should conduct a comprehensive interview process that includes phone screens, in-person interviews, DISC assessments, background checks and drug screens. All SNPs must abide by the credentialing requirements of the hospital, including flu shots, PPD, TDAP and other required immunizations. How one southern health system created capacity without adding a single bed The importance of choosing the right IONM provider — and what to consider By Karthik Seshan, CEO, Neuro Alert

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