Dr. Kurt Knauth – President of Capitol Anesthesiology Association

Operating more efficiently creates better value for our clinical partners and our patients.

Dr.Kurt Knauth currently serves as President of the largest independent anesthesiology practice in the country. Dr. Knauth was born and raised in Texas, attended Texas A&M University for undergraduate studies and followed by medical school at The University of Texas at Houston. Dr. Knauth completed his internship and residency at Duke University Hospital where he served as Chief Resident. Following residency training, he stayed at Duke where he completed a fellowship in Cardiothoracic Anesthesiology, a subspecialty of anesthesiology focused on surgery of the heart and lungs. After completing fellowship, Dr. Knauth returned to Texas where he joined Capitol Anesthesiology Association (CAA) in Austin, Texas. His tenure at CAA has included multiple leadership roles including Chief of Cardiac Anesthesia, Board Member and, beginning in 2015, President.

Capitol Anesthesiology Association was started in 1973 by Dr. Dennis Bowyer and a small group of colleagues. What began as 3 anesthesiologists practicing together in 1973, has grown into the largest physician-owned anesthesiology group in the nation with 80+ physicians, 150+ nurse anesthetists, 20 registered nurses, and a comprehensive administrative and executive leadership team.

How has Capitol Anesthesiology Association grown and evolved since you have been a part of the organization?

I’ve seen CAA grow tremendously since 2002 when I joined the group, however, at its core CAA is still the independent, physician-owned practice that has always operated with one goal above all others: excellent patient care.

Our steady growth is the result of the same core principles that made CAA a success in the first place: high clinical standards, a willingness to integrate our practice and ourselves into the hospitals we serve, and an eagerness to evolve with technology and new surgical procedures.

Part of this evolution has involved creating a non-physician executive leadership team which provides strategic, managerial and financial expertise. We’ve embraced the digital revolution and use a 100% paperless medical record system. Peripheral nerve blocks that were once done with landmark guidance are now performed with real-time ultrasound guidance. We’ve embraced nurse anesthetists and continue to employ them throughout our practice. In fact, CRNAs have played an integral role at CAA since the very beginning and we have recognized the benefits to quality patient care that comes with team anesthesia.

Our goal is to continue evolving and growing, while always remembering our number one priority: take care of the patient.

What does your typical day look like and how do you make it productive?

My workday typically starts around 5:30am when I drive to the hospital. I think maximizing productivity requires a plan, and this time of the day is one of the few uninterrupted periods when I can give thought to the day’s surgical cases, as well as to other projects and ideas within CAA.

I usually arrive at one of our hospitals by 6am and begin seeing patients scheduled for surgery. I discuss the anesthetic plan with each patient as well as with the Certified Registered Nurse Anesthetists (CRNA) who will be involved with the patient’s anesthesia care, as well as any anesthesia RNs or technicians that will be involved.

Since its inception, CAA has embraced a team approach to anesthesia. The anesthesia care team model refers to MDs and CRNAs working together on a team, similar to a pilot and copilot.

In addition to CRNAs, we’ve taken the anesthesia care team model one step further by routinely involving specially trained Registered Nurses (RNs) and anesthesia technicians to assist with patient care. This multidimensional team enhances the patient’s experience and our productivity.

My days also typically involve meetings with surgeons, internists and hospital leaders in an effort to constantly improve our efficiency and be maximally integrated. By keeping open communication channels with non-anesthesia departments in the hospital, we’ve managed to find opportunities to add value far outside of the operating room, whether it’s assisting with procedures in the ICU or difficult IV placement on the medical wards.

How do you bring ideas to life?

I usually start by presenting a new idea to our executive team for feedback. I ask them to scrutinize the idea for potential pitfalls, as well as for ways to make the idea bigger and even better. The next step is to bring in the experts: our back office team. We’re lucky to have a top-shelf team of administrative professionals who excel at implementing new ideas and processes. I like to discuss the overall goal and any specific constraints with the implementation team, and then step back and just be available for questions. I find that people are more creative and motivated when they’re given a degree of autonomy and discretion.

One of our bigger undertakings several years ago was implementing a system that allowed patients to go home with a peripheral nerve catheter (PNC), but still receive close follow up. A PNC is a way of delivering local anesthesia to a specific region of the body for several days through a disposable infusion pump (e.g. after knee replacement surgery). Patients with PNCs often require less narcotic pain medication and have lower pain scores after surgery because of decreased sensation to the surgical site while the PNC is in place. Implementing this program required a multidisciplinary team of physicians, anesthesia nurses, post-operative recovery room nursing staff. We call patients at home each day their PNC is in place, and remain in contact with them for several days after their PNC is removed.

What’s one trend that really excites you?

Surgery does not occur in a vacuum – patients have primary care doctors and specialists who manage chronic diseases and the degree of coordination between patient’s internist/specialists and surgery team has historically been low. There’s been a recent national push for better coordination of care between all healthcare providers approaching the time of surgery. The American Society of Anesthesiologists has developed a concept called the Perioperative Surgical Home which aims to improve the teamwork between clinicians.While this is is an exciting trend, it’s not something new to CAA.

For years we’ve invested a lot of time outside of the operating room screening patients and preparing them for surgery. Over 15 years ago we implemented a Pre-anesthesia Testing (PAT) clinic which allows us to dedicate resources to screening and optimization in an effort to improve post-surgical recovery. It’s exciting to see some of our early ideas validated on a national scale.

Protocol-based post-operative pain management is another exciting trend that is slowly taking hold. We’re seeing more protocols geared towards pain management and Enhanced Recovery After Surgery (ERAS) which ensure that all patients undergoing a particular surgical procedure are treated with a variety of pain management methods (antiinflammatory medications, narcotics, regional nerve blocks and more). This protocolized approach has streamlined our approach to some of the most common surgeries and, as a result, lowered post-operative pain scores and reduced hospital length of stays.

What software and web services do you use? What do you love about them?

Operating more efficiently creates better value for our clinical partners and our patients. We’ve integrated several web services into our practice that make our operation more efficient and help us to provide better value.

We currently use Medaxion as an electronic medical record (EMR). Medaxion is cloud-based EMR specifically for anesthesiology practices. We transitioned from all paper-based medical records to 100% electronic records in less than 1 year. For a large group of over 250 clinicians practicing at over 30 sites, this transition wasn’t without challenges, but we’re already reaping the benefits of real-time big data at our fingertips. We’re able to quickly identify opportunities to improve patient comfort, safety and outcomes.

SurveyVitals is another web-based service that we recently began using to administer post-operative patient satisfaction surveys. Each patient receives a link to a survey via text or email several days after their procedure. Having real-time access to the survey data helps us identify ways to improve patient experiences as well as improve our care delivery.

What is one strategy that has helped grow your business?

Excellent patient care has always been our top priority, and above all else is the one thing that has really allowed us to become successful. Of course there are numerous strategic decisions and partnerships that have contributed to our success, but our reputation as a value-adding partner in the perioperative space is really a result of consistent high quality patient care since 1973.

What is one habit of yours that makes you more productive as an entrepreneur?

I wake up early and make a plan for the day. Not all days go according to the plan, but having an outline of goals gives me a place to start and allows me to be more productive.

What is the one book that you recommend our community should read and why?

“Mountains Beyond Mountains” by Tracy Kidder is a biography about Dr. Paul Farmer, a Harvard Medical School infectious disease expert who has spent over half of his life treating patients with tuberculosis in Haiti. Not only is it a masterfully written story, but the insight to Dr. Farmer’s never-ending pursuit of excellence, even in times of incredible adversity or overwhelming odds, is inspiring. My field and practice of medicine is very different from Dr. Farmer’s, but his dedication to patient care and continual improvement
is something I admire.