Over the last few decades, many have observed and increasingly implemented a “less is more” approach when it comes to healthcare settings. Instead of putting patients in a massive medical center or community hospital, with their over-the-top overhead and incumbent costs, why not delegate certain procedures to a smaller, more streamlined facility designed to get patients in and out quickly and efficiently? Et voilà, the ASC!
It comes as no secret to our readers that ambulatory surgical centers are not only found but flourishing across the country. This is because, for those procedures that don’t involve inpatient stays or specialized circumstances, the ASC is almost always the better cost option. And saving money is guaranteed to be a winner with both payers and patients alike. So, how does the growing transference of patient cases to the ASC setting impact anesthesia groups? Let’s find out.
Quality of Life
Unlike the hectic and frenetic pace found in most hospitals, practicing at a surgery center means regular and reasonable hours. No on-calls, no 2 a.m. emergency appendectomies, no all-night labor cases, no weekend duty. You’re there at 6 a.m. and off by 3 p.m. This allows for a better work-life balance. Remember the immortal words of Mr. Miyagi: “Balance not just [for] karate; balance [is for] whole life.”
So, there are some clear lifestyle benefits enjoyed by those anesthesia practitioners who elect to work exclusively at an ASC. Of course, not every anesthesia group practices solely in this setting. Often, a group has a multi-track practice approach, where they must provide services in both hospital and ASC settings. But, to the extent an anesthesia provider’s schedule can incorporate days in an ASC, those days are probably less stressful. In fact, no less a source than AI has this to say on the subject:
Working in an ambulatory surgery center is perceived as less stressful and less demanding than working in a hospital environment. ASC patients are generally in good health, and the personalized care provided by ASC nurses contributes to the reduced stress.
Income Pressures
As we’ve pointed out on previous occasions, the U.S. is facing a shortage in anesthesia providers—a problem that is only likely to worsen in the years ahead. The American Association of Medical Colleges has estimated a shortage of 12,500 anesthesiologists by 2033, with 56 percent of current practitioners over the age of 55. The projected number of CRNAs also falls well short of future demands. Already, the current and projected paucity in anesthesia providers has created an upward pressure on salaries.
The problem is that, as provider salaries have increased, reimbursement for anesthesia services has progressively declined, at least as it concerns certain payers. Medicare, for example, has reduced payments to providers by over eight percent from 2019 to 2024, and some commercial payers have also created policies in recent years that have had the effect of cutting into anesthesia reimbursement.
According to one observer, “This combination of higher salaries and diminishing reimbursement has placed financial burdens on management companies and direct employment models, creating the request for subsidies to hospitals and ASCs to cover the fiscal gap of providing anesthesia coverage.” So, yes, it’s not only hospitals feeling the pressure to provide stipends to anesthesia groups; now, the ASCs are feeling the pinch.
It's Complicated
So, stipends are on the table, but how equipped are ASCs to ensure their anesthesia team is sufficiently compensated? Here are some thoughts provided by Tina Driggers, administrator of DSC Day Surgery Center in Winter Haven, Florida, which our readers might find illustrative of the issue:
The need for increasing compensation to the anesthesia departments to compete with the hospital subsidies is a necessity. It is unfortunate that our commercial insurance carriers have to bail out Medicare rates, but the system is broken. These [ASC] cases are performed at a massive savings to the insurance companies and part of these savings should be passed down to the Anesthesia departments who are working at surgery centers and doing the majority of the surgical volume to keep the system alive.
Similarly, Janet Carlson, vice president of ASC Operations at Commonwealth Pain & Spine in Louisville, Kentucky, noted:
The one consistent thing for ASCs is that we are all dealing with the same challenges to find Anesthesia support for safe patient care. The anesthesiologists and CRNAs do not need to be confronted with the recent risk of diminished reimbursement because of unscrupulous payer interference. If I could change one thing, it would be the ability to pay anesthesia a fair wage in my ASCs for their services. They are an integral part of our successes and outstanding patient outcomes. I cannot compete with the stipends that large health systems pay for anesthesia support. This is a direct result of the unfair reduced compensation for ASC services as compared to hospitals and hospital outpatient departments.
So, it’s not a slam dunk that your local surgery center will have the resources to subsidize your anesthesia providers to the level desired. Accordingly, anesthesia practices will need to keep a center’s ability to meet their team’s financial requirements in mind when it comes to their long-term planning, remembering that not all ASCs are created equally. A group’s decision to practice at a particular ASC will depend on several factors, including lifestyle fit and financial benefit. One thing is for certain: surgery centers are not going away. In fact, they are proliferating. It will be up to each anesthesia group to determine whether, and to what extent, they should devote resources to these settings.