In this Business Profile, Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.

Marc Koch SomniaTell me a little about your organization.

For 20 years, Somnia has been a leading anesthesia practice management company and trusted perioperative partner in more than 500 operating rooms nationwide. Our clients rely on us to manage every aspect of anesthesia services, from provider recruiting, credentialing, contracting, and scheduling to revenue management, quality improvement, technical support, and compliance.

Our company is committed to delivering clinical excellence, enhancing operating room performance, and ensuring both surgeons and patients are highly satisfied. Unlike a publically-owned company, we don't have to worry about return on investment or appeasing shareholders because we are a private physician-owned and operated organization. As a result, we can be very nimble and help our clients adapt to the changing healthcare space.

In the past, hospitals that partnered with us wanted to enhance coverage, improve quality, or mitigate cost issues. While these goals still hold true, we are also working with hospitals to think strategically about how to expand or deepen service lines, develop new services, and/or elevate an organization's competitive position in terms of cost and quality.

Can you talk about some common challenges you're seeing today with respect to anesthesia services?

Right now, there are a substantial number of people entering the healthcare marketplace seeking care. Even though demand is rising, the supply of physicians, advanced practice nurses and other medical professionals is flattening, or even decreasing in some areas. This uncoupling of the supply and demand curves is creating a dramatic caregiver shortage.

Consequently, clinicians in every specialty, including anesthesia, are being pushed to practice at the top of their license. Moreover, some clinicians are having to move beyond their usual tasks. For example, while anesthesiologists and certified registered nurse anesthetists (CRNAs) have historically delivered anesthesia, we're now seeing other clinicians, such as RNs and physician assistants, stepping in to fill the void left by shortages. In this context, there are many discussions about the best ways to assemble a qualified team and how to approach the education of nursing, medical staff, and ancillary services in the broadest sense possible. The challenge will be preparing staff to navigate new responsibilities while maintaining quality and patient safety.

Another issue is that hospitals frequently use anesthesia as a loss leader. While it might make sense from a financial standpoint to have one department subsidize the costs of another, this can lead to problems with how the anesthesia department is viewed, especially with regard to staff allocation and resource investment. If an organization does not have a strong handle on how best to manage anesthesia services, it could inadvertently put patients at risk.

Quality reporting is another hurdle organizations face. While such reporting can serve as checks and balances in this new healthcare environment, there are many entities providing quality metrics, and numerous places to cite them. A hospital can quickly get bogged down in data and neglect to focus on those items that truly reflect performance. As such, it's critical to be able to draw on experts with deep experience as hospitals figure out how, what, and when to measure and report. More importantly, each facility must partner with an organization that has the knowledge and expertise to leverage data to implement quality and performance improvements.

Finally, service line growth is another important issue in the marketplace, as healthcare organizations determine how to enhance their position from a clinical, operational, financial, marketing, and communications perspective. Hospitals are looking for savvy business partners that understand the complexities and can help solve cost, quality, management, and coverage concerns. Although some hospitals continue to manage the anesthesia department on their own, they are missing the depth and breadth of experience that organizations like ours can offer, particularly regarding how to efficiently navigate the byzantine payment process.

How can Somnia assist in these areas?

We provide a comprehensive solution that aims to deliver transformative changes as opposed to incremental improvement. Organizations experiencing the challenges I mentioned before-cost containment, quality management, coverage, education, and service line development-turn to us as a proven entity that can manage the entire perioperative experience.

Our services include defining a facility's niche, assessing its needs, and providing a thorough assessment and plan as well as the resources to execute and maintain that plan. Depending on the client, we may completely assume responsibility for anesthesia services or work with an existing anesthesiology group or chief anesthetist. We also may provide supplementary CRNAs or other nursing/ancillary support to assist with service delivery, such as in a pre-operative clinic.

What should hospitals look for when identifying a best fit for these types of services?

Organizations should be seeking more than just an anesthesia supplier but a partner that shares the organization's goals for improving quality, maintaining costs, and realizing value. The relationship should go beyond the logistics of delivering anesthesia to grow the service line and better manage the entire perioperative environment. Any potential partner should be able to demonstrate success and be transparent about how they spend the budget.

What kinds of best practices do you see with your clients who are delivering top-notch anesthesia services?

Forward-thinking organizations have the discipline to examine the entire perioperative experience and strive to achieve better clinical and financial outcomes throughout. In other words, they look at an individual profit and loss statement for each care interval-from when it is first determined that a patient needs service until he or she returns home and recovers-and modulate these stages strategically for a dramatic combined impact.

These organizations are careful to look at the whole picture and not just the costs involved. For example, those hospitals that want to elevate OR efficiency might choose to pay more for anesthesia, if the resulting ability to reduce case cancellations, improve throughput, and limit length-of-stay deliver financial performance that eliminates or significantly erodes a subsidy to the anesthesia department.

Where can readers learn more about Somnia's solutions?

There are a number of resources on our website, at, that demonstrate our broad commitment to educating not just clinicians, nurses, and patients, but also important perioperative constituencies, like hospital administrators. I'd recommend our white papers Bending the Healthcare Cost Curve Toward Improved Anesthesia Value and How Anesthesia Helps Hospitals Maximize Value-Based Purchasing Program Performance.

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Somnia LogoContent for this Business Profile is supplied by Somnia. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.

Publication Date: Thursday, October 01, 2015