Understanding Outsourced Anesthesia

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Written by Stephanie Wasek

Monday, 21 April 2008

Q: What are the major challenges ASCs are facing with regard to employing anesthesiologists?
Dr. Koch: ASC employment of anesthesia providers has several challenges. First, being able to gauge clinical quality and cost in front of local, regional and national supply and demand realities is an acquired skill. Although value is possible, the adage that you get what you pay for makes it very difficult to discern a good value from a provider with shortcomings. Second, successful employment means much more than just recruitment. It includes scheduling, conflict resolution, benefits coordination, goal-setting, performance reviews and, when applicable, development and administration of an incentive program as well ongoing position re-pricing.

Q: What factors are driving these issues?
Dr. Koch: The demand for anesthesiologists outstrips the current supply; pricing, value and ongoing sophisticated human resource management become more challenging given this backdrop.

Q: What is the solution outsourced anesthesia brings to the table?
Dr. Koch: Outsourced anesthesia lets the ASC focus on its core competency: providing a safe and secure environment for outpatient surgical patients in the most financially prudent manner. Establishing and managing an anesthesia department, even one that involves only one full- or part-time provider, requires much more than just competency in recruitment and human resource matters. It also includes adroitly navigating the complexities of payor contracting, revenue management and being able to coordinate staff absences.

For centers whose payor mix and volume do not sustain its anesthesia department, an anesthesia management company can help cut and manage losses without sacrificing quality. On the other end of the spectrum, the right anesthesia management company can provide input to ASCs seeking integrated anesthesia services. That is, discussing methods to maintain clinical excellence, improve profitability and comply with state and federal provisions and prohibitions. Even for centers with integrated anesthesia departments, most still outsource recruiting and revenue management, fees for which often eclipse the all-inclusive fees charged by anesthesia management companies.

Q: How is this different from contracting with a local group or hiring anesthesiologists?
Dr. Koch: Compared to contracting with a local group, engaging an anesthesia management company, particularly those owned and operated solely by anesthesiologists, provides an unambiguous layer of accountability responsibility. The ASC can also access expertise and insight on a variety of clinical, administrative and financial matters and a more robust menu of strategic and operational options and planning Close personal relationships between surgeons and relationships established through working together in the hospital or ASC make it difficult to address sensitive matters on a local level. Also, the local group may have financial requirements predicated on its indigenous structure. For instance, an ASC?s volume and anesthesia revenue may need to support, or not serve to dilute, the partner-compensation for the local group. On the other hand, an anesthesia management company often indexes off of experience, skill-set and other factors that often create a more permissive financial requirement.

Q: What are the benefits of outsourced anesthesia?
Dr. Koch: An anesthesia management company hires and manages local talent and provides the full complement of back-office support while creating overall accountability and responsibility that may be less obvious when compared to retention of a local group. A physician-owned and -operated company is more likely to primarily gauge success by clinical endpoints while those owned by non-physicians may be apt to define success in more economic terms. If the anesthesia management company being used offers a cost-effective on-site consultation, generally for one to three days, it can help the ASC develop an action plan with a range of associated costs before making more expansive changes.

Dr. Koch ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is the CEO of Somnia and a board-certified anesthesiologist.