One never knows what lies out there a little farther down the road. It helps, however, to get the assembled assessment of experts in the particular field of inquiry. When it comes to emerging threats facing the practice of anesthesia, Becker’s ASC Review recently sought out the expertise of those in the specialty, getting their insights on possible future threats. From their interviews, we have pieced together a picture of what may be facing anesthesia groups in the days ahead.
Flagging Reimbursement
Mo Azam, MD, head of Innovation at U.S. Anesthesia Partners in Dallas, maintains that one of the biggest threats to anesthesia stability is similar to the rest of healthcare, which involves appropriate reimbursement. In this regard, “it is a well-worn refrain: unreimbursed clinical services or reimbursements that can be lower than the actual costs of providing care.” He further asserts that “Medicare is stuck where it was 30 years ago, on an inflation-adjusted basis.”
There does seem to be a general concern among many in the specialty that the overall financial stability of the average anesthesia group may be challenged in the next few years. There are many contributors to this notion, including the topic touched on just below.
Payer Tactics
Antonio Hernandez Conte, MD, Past-President of the California Society of Anesthesiologists has said that “the escalating aggressive behavior by health insurance carriers to place profits over patient care is a serious threat to access.” He asserts that the latest tactic is to financially penalize hospitals and ASCs that do not use physicians who participate on “in-network” panels. “This tactic is designed to force physicians to sign in-network contracts that are meant to lower physician reimbursement.”
Dr. Conte notes that “the resultant effect for anesthesia practices is that hospitals will be forced to provide additional revenue to anesthesiologists to make up for the deteriorating third-party payer reimbursement, which does not match market costs for anesthesia services.”
Provider Shortages
Many anesthesia groups and anesthesia departments have been feeling the pinch for some time now when it comes to adequate staffing. The need to recruit and retain anesthesiologists and anesthetists is becoming critical. Dr. Azam holds that “on the workforce side, the threat is the lack of clinical training sites, stagnant slots and funding for graduate medical education.”
Adam Chaucer, CRNA, owner of Trident Anesthesia in the Dallas-Fort Worth area, echoed Dr. Azam’s concerns. He noted the following:
Demand for anesthesia services is rising due to factors such as an aging population, increased surgical volume and growth in outpatient procedures. At the same time, workforce shortages are expected as many providers near retirement, potentially creating a shortfall of thousands within the next five to 10 years. This combination could widen staffing gaps, delay surgeries and reduce available services.
In that same vein, Garo Derparseghian, MD, an anesthesiologist in Montebello, California, believes that the greatest threat to anesthesia stability is the thought that you can use software to dictate anesthesia staffing needs, based on what cases are scheduled, in advance. “Anesthesia requires continuous staffing and standby readiness, not case-by-case deployment. Combined with a permanent shift toward workforce predictability, underestimating the cost of reliable coverage leads to burnout, turnover and rising subsidy pressure.”
Seeking Solutions
While the interviewees did not provide solutions to every problem outlined above, there were a few suggestions that addressed the recruiting/retaining problem in particular. For example, Dr. Azam’s practice has sought to ameliorate the provider shortage issue in their Dallas-area facilities through beefed-up training programs, as he notes below:
My practice has approached this dilemma by implementing innovative solutions to train residents, CRNAs and CAAs. These include bold new collaborations with academic institutions and the formation of several of our own residency programs.
Jacob Schaff, MD, Division Chief of Cardiac Anesthesiology at White Plains Hospital in New York, believes that “departments that build differentiated employment tracks will retain talent. Those that don’t will continue losing providers to contract work, regardless of how high their baseline compensation is.”
So, there is much work to be done to avoid the landmines that lie ahead. Some possible solutions have already been identified; it will be up to the greater anesthesia community and their representatives to find and implement others.