Anesthesia staffing and coverage have become a growing pain point for ASCs across the country.
Amid provider shortages and reimbursement pressures, ASC leaders are adopting creative approaches to ensure anesthesia coverage while preserving financial sustainability.
Here are six strategies ASC leaders are employing:
1. Insourcing anesthesia coverage
For many ASCs, bringing anesthesia services in-house is proving to be both a strategic and cost-saving move.
Alex Andrade, COO of Medical Associates in Dubuque, Iowa, told Becker’s that insourcing began as a defensive strategy but has evolved into an opportunity for operational efficiency.
“Our goal is to leverage our anesthesia team to drive operating efficiencies and increase throughput as part of one end-to-end process,” he said.
Other leaders agree. Angela Durham, vice president of ancillary services at Franklin, Tenn.-based US Heart and Vascular, said that owning and operating an anesthesia business provides coverage stability and cost containment.
“This model allows anesthesia providers to join the ASC family as a permanent member of the care team,” she said, adding that it eliminates third-party markups and unpredictable subsidy costs.
Krishna Jain, MD, CMO at Chicago-based APEx Health Network, also advocated for directly employing anesthesiologists and CRNAs, even if it’s an added expense.
“This is the only way to guarantee coverage,” he said.
2. Providing equity to anesthesia partners
Aligning incentives through shared ownership is another tactic gaining traction.
Ron Bullen, executive director at ProHealth Care Moreland Surgery Center in Waukesha, Wis., recommended providing equity to anesthesia groups.
“Nothing aligns strategic commitments better than a share of ownership,” he said. “Your anesthesia group is critical to operational efficiency success, growth and cost containment. Nothing produces better results than skin in the game.”
3. CRNA utilization
In the face of provider shortages, maximizing the use of certified registered nurse anesthetists is a pragmatic step.
James Flaherty, MD, professor of cardiology at Chicago-based Northwestern Medicine, encouraged using CRNAs “as much as possible” in the ASC setting.
“They are typically well-trained and clinically astute,” he said, highlighting their ability to safely handle a wide range of anesthesia responsibilities.
4. Exclusive contracts
While insourcing and CRNA utilization may work for some, others still rely on external groups.
Michael Gale, administrative director at Sentara Health’s Obici ASC in Suffolk, Va., uses an exclusive contract with a single anesthesia provider.
“They have personnel shortages of CRNAs from time to time but generally manage it well,” he said.
However, the costs are high, and the limited competition in his state makes it difficult to find alternatives.
“There are no easy solutions,” he said. “Reimbursement continues to be very low for anesthesia services. And as long as that is true, ASCs and acute care facilities will continue to be asked to subsidize the ever-increasing labor expense of CRNAs and anesthesiologists employed by anesthesia groups.”
5. Creative scheduling
Efficiency in scheduling and workforce utilization is a must when every anesthesia provider counts.
Brett Maxfield, CRNA, director of New York City-based Madison Avenue Surgery Center, pointed to provider shortages and cost pressures as a serious concern.
“The only real solutions I see are creative scheduling to maximize use of each anesthesia provider, and allowing each provider to practice to the full capacity of their licensure,” he said. “Allowing each type of anesthesia provider, whether it is a physician anesthesiologist, nurse anesthesiologist or dental anesthesiologist to practice to the top of their licensure could potentially free up additional providers whose talents are being under utilized in a supervisory role.”
In response to the shortage, Gary Haynes, MD, PhD, chair of anesthesiology at Tulane University School of Medicine in New Orleans, and his team have adopted flexible call schedules across multiple hospitals.
“We’ve played with our call schedules and gone to — instead of one night or one night on call the next day off — we’d go into a night float system for a week at a time, which helped mitigate our current situation,” he said at Becker’s 30th Annual Business and Operations of ASCs Meeting in October. “We talk a lot about physician wellness and I think it’s easier for physicians to be on call and do it a week at a time, giving them more free time during the day and then a week off afterwards for mental and physical reasons.”
6. Industry collaboration
Some believe the answer lies in collective action across the ASC industry.
“ASCs need to bond together for fair anesthesia charges, negotiating the ‘no call, holidays or weekends’ as a direct benefit working at an ASC, to lower the salaries and help with financial stability of the centers,” Kathy Meccia, RN, administrator of Fremont, Ind.-based Lake George Surgery Center, told Becker’s.
There is also ample room for collaboration between ASCs and physician offices on patient safety, operational efficiency and care quality, Scott Mayer, CEO of Rosemont, Ill.-based Ambulatory Anesthesia Care, told Becker’s.
“The ASC is a mainstay and a must for the healthcare industry,” he said. “[Especially with] how it’s been able to do so many surgeries on a more cost-effective basis, and also with a higher [level of] quality. In many cases, they are getting more and more higher acuity procedures and sicker patients into their surgery centers, and those smaller procedures and those healthier patients have to go somewhere to be seen.”
The post The anesthesia strategies saving ASCs appeared first on Becker’s ASC.
