Becker's ASC Review

10 Thought Leadership How opioid-free anesthesia can boost cases, reduce costs at ASCs: Q&A with Dr. Chhaya Patel By Alan Condon T ime is money for ASCs, but patient care must always be the No. 1 priority. e use of opioid-free an- esthesia can provide quality pain control while reducing postoperative complica- tions for patients and allow for improved productivity for outpatient surgery centers, according to a study published in Urology in Pediatrics. Chhaya Patel, MD, director of Satellite Boulevard Surgery Center in Duluth, Ga., spoke to Becker's ASC Review about the benefits of opioid-free anesthesia for patients and surgery centers. Note: Responses were lightly edited for style and clarity. Question: What is the significance of opioid-free anesthesia at an ambulatory surgery center? Dr. Chhaya Patel: The national opioid epidemic has shed light on the role of opioid administration for surgery and its contribution to opioid abuse. It has been recognized that opioid use during surgery is a risk factor for future opioid misuse. Emerging data on the short- and long-term side effects of opioid ad- ministration for surgery has highlight- ed the importance of an opioid-free anesthetic regimen as an alternative to traditional practice. Opioid-free anes- thesia is a multimodal technique that allows for a good quality of anesthesia and analgesia while obviating the need for opioids. There is good evidence that opioid-free anesthesia allows for quality pain control while reducing postoperative nausea and vomiting, allowing timely discharges and reduc- ing opioid-related adverse events. As good stewards to our patients and to curb this opioid epidemic, we felt it was important to assess the opioids admin- istered to our patients. Q: How can opioid-free anesthe- sia lead to greater productivity at surgery centers? CP: By using an opioid-free anesthesia, we were able to implement a fast-track technique in which we were able to bypass phase 1 of recovery, thereby saving money and improving efficiency. In a busy ASC, in which we perform 20 of these cases a day, this decrease in time leads to meaningful savings and an opportunity for increased cases each day. Opioid-free anesthesia at ASCs demonstrates increased efficiency, cost containment and an opportunity for greater productivity. It also led to increased satisfaction for the surgeons and families. Q: What are the challenges to implementing opioid-free anesthe- sia at an ASC? CP: Implementing a new protocol requires extensive education of the staff as well as periodic review of the impact on patient care and delivery of healthcare. We used the plan-do-study- act cycle as the systemic approach to implement this protocol and to review the quality of our patient care. The nurses and surgery center staff became comfortable as they noted the patients were comfortable, opioid requirement was negligible and family satisfaction score was at an all-time high. n Is CMS reversal on rates and inpatient- only list a sign of things to come? By Marcus Robertson A fter announcing a plan to eliminate the inpatient-only list, last year CMS eventually reversed its stance — keeping the list, adding more procedures to it, and frustrating ASC leaders nationwide. Andrew Lovewell, administrator at the Surgi- cal Center at Columbia (Mo.) Orthopaedic Group and CEO of the Lodge at Keene Street, told "Becker's ASC Review Podcast" that he has the feeling it could be the start of a trend. Question: What trends are you following most closely right now? Andrew Lovewell: The most interesting trends I am following — they're probably similar for many other ASC administrators — but for me [a big one is] the ASC and hospital outpatient department rates and the inpatient-only list. When we talk about the ASC and HOPD rates and the inpatient-only list, I honestly got a pretty big unsettling feeling that what CMS finalized in the 2022 final rule is just a starting point. It's kind of funny because CMS just recently had a plan to eliminate the inpatient-only list altogether. And that was extremely celebrated among ASC administrators, but now we fast forward and their plan to eliminate it is all of a sudden gone. In fact, they're putting procedures back on the inpatient- only list without any rationale whatsoever. So I guess for me, there's maybe a fear that we have an approach of being non-progres- sive and [not] trending toward what consum- ers are actually demanding today. n

• Cover