As higher-acuity procedures continue to migrate to ASCs, anesthesia groups are being asked to support more complex care while navigating persistent workforce and financial pressures.
For Gary John Mullen, MD, CEO of Raleigh, N.C.-based Sovereign Anesthesiology Partners, the answer is not necessarily changing the anesthesia care-team model. Instead, it means tightening patient selection and clinical protocols, finding more efficient ways to deploy anesthesia providers and strengthening alignment between ASCs and their anesthesia partners.
Dr. Mullen spoke with Becker’s about why his organization has stuck with medical direction despite workforce shortages, how it is preparing for rising case complexity and the one factor he believes should drive every ASC’s anesthesia strategy.
Question: How is your center balancing teams composed of anesthesiologists, CRNAs and/or certified anesthesiologist assistants?
Dr. Gary John Mullen: We employ the Care-Team model in nearly every center we are in. When we have anesthetist shortages (rare), we have doctors perform the anesthetic. It’s my observation that the Care-Team model is still the de facto “Gold Standard” for delivery of the anesthetic in most urban and suburban areas.
Q: What does your anesthesia care team model look like (for example, anesthesiologist-only, medical direction, or CRNAs working independently), and has it changed in the last few years?
Dr. Mullen: We generally have one physician medically directing two to three anesthetists. Sometimes, if a room opens, we will add another physician to provide care in that room (solo). This has not changed in spite of the workforce shortages.
Q: As more complex cases move into ASCs, how is that changing your staffing and practice model?
Dr. Mullen: We have been planning for increased acuity (and site neutrality) for a few years. Increased acuity and complexity does not substantially change the staffing model; rather it changes how we select patients, and the algorithms we employ to provide safe care. We develop protocols to reduce risk; those protocols may become more stringent as acuity increases. On the flip side, we have helped ASCs develop methods to cause other (non anesthetist) providers to deliver minimal sedation for certain cases (e.g. cataracts), thereby freeing up more expensive physicians/anesthetists. This lowers the cost of care (to the ASC/Group partnership) and reduces patient delays.
Q: What’s one thing you’d tell another ASC leader who is rethinking their anesthesia strategy?
Dr. Mullen: ‘Alignment.’ Find an anesthesiology partner who is a like-minded collaborator. There is too much adversity between ASCs and their anesthesiology groups, and it is driven largely by financial pressures. An anesthesiology group who partners with an ASC by using clarity and transparency is paramount. The anesthesiology group should be pushing your ASC to be more efficient, rather than reacting after the fact. If your anesthesia group is not transparent in their mission, and their requirements (including financial modeling), then you should be asking ‘Why not?’
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
