Anesthesiologist Involvement in an ASC: Q&A With Howard Balkenbusch of Associated Anesthesiologists of Fort Wayne
Howard (Skip) Balkenbusch, CEO of Associated Anesthesiologists of Fort Wayne, Ind., offers is thoughts on the hotly debated topic of anesthesiologists' involvement with ASCs.
Q: Should anesthesiologists own interests in an ASC?
Howard Balkenbusch: Of course. The fact that anesthesiologists do not generate referrals fails to consider their role in costs and efficiencies. Though this often counter-intuitive to the surgeon's thought pattern the anesthesiologists have the ability to significantly impact drug costs, surgeon satisfaction, OR schedule efficiency and patient recovery time (impacting staff/facility costs). The amount of ownership allocated would be more of an internal discussion but the goal is to optimize alignment towards specific performance incentives. The lack of aligned incentives is one of the most troublesome parts of our healthcare delivery system.
Q: Should anesthesiologists be employees of centers, independent contractors of centers or completely outsourced?
HB: I think anyone of the three options can work with the right people. In the surgery center setting some objectives that are critical may be valued differently in the hospital setting. The objective of safe anesthesia remains paramount. Anesthesiologists that have strong experience with critically ill patients may be more adept at handling the occasional patient crash in an ASC setting and therefore current critical care experience can be an asset to the ASC setting. Beyond being a fundamentally sound clinician, the anesthesiologist must also help create and sustain an environment that is perceived as desirable to surgeons. That is, they would preferably be affable and have the mindset of working in a fast-paced and efficient environment. Turnover times need to be minimal and, as most ASC's know, the ability to either wake the patient up or recover from a regional anesthetic in minimal time is helpful to both the center and the patient.
Q: So the question becomes how does an ASC best control these highly desirable attributes?
HB: The answer will likely vary depending on your anesthesia provider resources. Some 'groups' can readily provide this need, others cannot. Options to employ or exclusively contract simply depends on availability within the specific community. If employment is not the model then the 'anesthesia group' must be able to work flexibly with pricing issues- especially for those services that are 'pre-pay' or otherwise non-insured such as cosmetic surgery. A strategic approach to pricing will help assure the final 'product' is marketable. Smart groups will try and meet these needs, otherwise an ASC may need to look at the possibility of another group or anesthesiologist employment- again- assuming that the 'right' kind of anesthesiologists are available.
Q: What should be our primary focus when considering anesthesiologists and anesthesia services?
HB: Safe anesthesia care is always foremost. The other attributes for anesthesia services delivered in an ASC setting rely on anesthesiologists that contribute to the overall success of the center through cost containment, a smooth running operative schedule and promotion of surgeon and patient satisfaction. Every member of the team should be aligned to create a good experience for the patient. Anesthesiologist ownership certainly contributes to the alignment of a well-managed ASC.
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