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forward slash beckerspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are recording live at the
twenty second annual Spine Orthopedic and Pain Management
Conference.
I'm currently joined by doctor Doctor. Leanne Carlisle,
who is the medical director of UMA anesthesia
at University Health Systems. So Doctor. Carlisle, thank
you for being here. Let's start off by
having you introduce yourself and tell us a
little bit more about your role in organization.
Absolutely. Yes. And good morning to you, Grace.
My name is doctor Lee Carlisle. I am
the medical director of UMA Anesthesia Services.
UMA is University Medical Associates, which is a
nonprofit
multispecialty
group practice
that provides health care services to University Health.
Now University Health
is the
public health and hospital system for Bexar County.
And how good are you
with Texas geography? Do you know where Bexar
County is? I do not. I've only been
to Texas once. Okay. So Bexar County actually
houses San Antonio.
And San Antonio, if you didn't know, is
one of the seven it's the seventh largest
city in The United States.
So
lots of people in the county,
lots of opportunity for patient care. So that's
where I work and live.
Wonderful.
Well, thank you for joining me. And,
I'd love to start off with what trends
or shifts that you're currently seeing in the
industry,
that you specifically think are important for leaders
to be paying attention to.
Absolutely.
So
I've been in the field
of anesthesia,
primarily
in ambulatory
surgery centers,
that one of the major shifts that I've
seen in a change of patient population,
patients are much sicker
in being cared for in an ambulatory outpatient
setting.
Variety of reasons for that.
Certainly,
the insurance companies have a vested interest in
finding a low cost center, which ambulatory surgery
centers are. The challenge of that all we
always is to make sure that we assess
the patient adequately
and provide the same level of care we
would within the hospital.
In San Antonio, like I mentioned,
patient population is growing by leaps and bounds.
So
increased
patient volumes is what we're seeing.
And, again,
being
the challenges that come with that
staffing
throughput,
resources,
Those are some of the challenges that we
see with the increasing patient population.
And the other one is a the third
one is one that's near and dear to
my heart that I pay great attention to
is the challenges
within the world of anesthesia,
the anesthesia shortages.
This has been growing for the last several
years and is projected to last
years into the future. Becker's does a wonderful
job of highlighting
the challenges in anesthesia,
and certainly, I see it on the front
line.
Absolutely.
And let's touch on staffing and workforce challenges
too as these continue to be a concern
across health care. So how's your organization navigating
these pressures, and what strategies have you seen
work well?
Back in
February
2023,
the Bexar County Hospital District Board of Managers
tasked Ed Banas, who is the president and
CEO of University Health,
to address
these ongoing
anesthesia shortages.
What he came up with was a really
innovative plan
of a delegated
delegation
of privileges
for CRNAs.
This has
flipped our staffing model, our team model that
we practice at the surgery center,
and has allowed the CRNAs to practice to
the fullest extent of their license.
We implemented this in
June,
so June
2024,
and it has been
a wonderful experience for me
to work within a team of
highly trained CRNAs.
We've realized
increased patient throughput
when you compare at our institution.
The patient population that we cared for in
the last two quarters of twenty twenty three
compared to the last two quarters of twenty
twenty four, we saw a 13%
increase in patients that we cared for. And
I attribute this
to the
experienced
team,
to the process
that allows me to act as a consulting
physician on the team.
I am no longer doing direct patient care.
My responsibility
as the medical director of the surgery centers
under University Health is to focus on strategic
goals
for the facilities
as well as prescreening
all patients before they show up for the
date of surgery.
This has decreased
our same day cancellation
rate. So when the patients do make it
on the schedule, they stick and we get
to care for them.
So a multifold
benefit
of this
staffing model,
delegation of CRNAs, delegation of privileges,
the cost savings for the institution
is also something
We used to practice medical direction
at the surgery center, which required
two MDs
and six CRNAs.
We now have one MD,
myself, at the surgery center where I'm based
out of
and seven CRNAs.
So we have a reduction in salary costs.
So
a great combination
of
factors
have increased the efficiency
and maximized the revenue per institution.
And as outpatient care continues to grow, how
do you see the role of orthopedics,
and ASCs evolving within the broader healthcare ecosystem?
I think it's a really exciting time, again,
to see these cases being outsourced from the
hospitals
into the ASCs.
The challenge
always is to
make sure that they are able to go
home at the end of the day.
Regional anesthesia
or a multimodal
approach
for pain care management
postoperatively
is an absolute necessity.
This is also something that I'm really excited
about at the institution where I am.
The MARC, which is where the surgery center
where I am, and downtown,
the other ambulatory surgery center of U H,
the Robert b Green Ambulatory Surgery Center, have
a robust regional anesthesia service.
We started this
in February
2025.
This is all run by the CRNAs
who are completely adept in regional anesthesia
and have created a great working network
with the orthopedic surgeons,
as well as other physicians who are interested
in post op pain blocks, but primarily ortho,
to provide their patients with
aftercare
that enables them to go home at the
end of the day.
What we've seen since February
is
patients who arrive in the Recovery Room
and less than ten percent are receiving pain
medications there.
The impact
on PACU stays,
the post anesthesia
care unit,
has been tremendous.
It shortens the amount of time that patients
are recovering.
It doesn't
create
a stop
for OR cases coming out of the Operating
Rooms. But quite the contrary, it frees up
PACU
space to allow more patients to flow through
our facility.
So less than ten percent are receiving pain
meds.
The average block lasts
two to three days.
So the reliance on narcotics is dramatic.
It has changed how we manage
pain.
We don't use narcotics
like we used to. And in fact, CMS
introduced
a no pain act
that is reimbursing
for
modalities
that help to reduce the reliance on narcotics.
These are for Medicare patients.
So, for example, they're reimbursing for EXPAREL,
reimbursing for the cost of the vial, as
well as a 6%
bonus added to that
to try to focus on
multimodal
approaches
instead of our traditional reliance on narcotics.
Patient satisfaction, as you can imagine,
is wonderful.
Imagine having an ankle reconstruction
and going home and never needing any pain
medication,
and your block lasts for
three, four days,
again, the CRNA regional anesthesia program that we've
developed there
has been a wonderful source of revenue
for
The EXPAREL
reimbursement,
where it pays for the vial
as well as a 6%
increase
of revenue
of that cost.
The patients are happy. The surgeons are very
happy. They don't get calls in the middle
of the night for pain meds. And when
they show up back in clinic for their
post op visit,
they usually,
I can't say always, they usually hear good
news.
Well, doctor Carlisle, thank you so much for
sharing these thoughts today. Is there anything else
you'd like to share that we didn't touch
on?
I would like to. Like I mentioned before,
I'm from San Antonio
and,
live and work there.
The team that I work with is primary
primarily retired CRNAs.
We talked about this
innovative staffing model,
delegation of privileges
within
the medical staff for CRNAs to practice to
the fullest extent of their license. This requires
that the CRNA
understands and is comfortable in working autonomously.
Military CRNAs
are the ones who are comfortable practicing
autonomously
as well as other experienced CRNAs.
Another fun fact about San Antonio, it's known
as Military City USA.
We have a large military presence.
We have a large population of retired military.
So my current team is probably
90%
retired military CRNAs,
highly skilled.
They also promote a team culture.
I think a strong team culture on an
anesthesia team is vital.
Looking out for each other,
not just focusing on your own OR and
your own cases,
but looking out for your teammates
so we can create a very stable staffing
model for university health
currently and for years to come.
Wonderful. Well, thank you so much for joining
me today on the Becker's Healthcare Podcast. Again,
we're recording live at the twenty second annual
Spine Orthopedic and Pain Management Conference.