There is an evolving controversy brewing and picking up steam as to anesthesia relationships with ASCs. Here, the issues focus around when ASCs and their owners can profit from or be the providers of anesthesia.
The issue came to the forefront over the last decade as more ASCs began to bring anesthesia in-house or to a related company. Many were brought in-house to improve quality or services, eg., make sure providers stayed until the last patient was discharged, avoid anesthesia billing patients on an out-of-network basis, speed service delivery, or improve culture, etc. Others were brought in-house as a somewhat naked grab to make money. In many places a mix of motives may have driven the decision to control anesthesia. The American Society of Anesthesiologists roared back.
First, the ASA sent a letter to the Department of Justice encouraging the DOJ to investigate and condemn these relationships.
Second, an anesthesia group asked for an Office of Inspector General advisory opinion (12-06) and received one that broadly condemned the relationships asked about. This threw somewhat of a chill into the evolution of the relationships.
Third, there has apparently been an emergence of false claims cases related to anesthesia. Here, there have been rumor of a handful of investigations and discussions of a criminal investigation.
The amount of smoke related to such relationships means that at minimum ASCs should take another look at their anesthesia relationships and the facts and circumstances related to them. Were there quality or services reasons behind changes? How did they evolve? Was there coercion? Were there explicit discussions about trading dollars for the right to serve patients?
We will continue to watch this situation evolve.
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