The growing demand for surgical services and an ongoing shift of procedures from inpatient settings to ambulatory surgery centers is pushing anesthesia providers towards new forms of care delivery and innovation.
Shifting care models
Nationwide, ASCs are transitioning towards care models that rely more heavily on certified registered nurse anesthetists.
A white paper from Medicus Healthcare Solutions found that 75% of CRNAs reported practicing without physician oversight as of 2023. Additionally, CRNAs now account for over 80% of anesthesia providers in rural counties and administer more than 50 million anesthetics annually in the U.S., according to the report.
“Most of the ASCs in my area are also becoming CRNA-only,” Jesse Johnson, CRNA at Springdale, Ark.-based Chief Anesthesia Services, told Becker’s. “This helps keep costs down for anesthesia services.”
In for-profit, physician-owned ASCs, common in Mr. Johnson’s region, limited support staff and straightforward cases make CRNA-only models a logical fit.
The proliferation of CRNA-heavy care team ratios is likely to continue as operating costs in healthcare continue to rise, Gavin Baker, CRNA, CEO of New Orleans-based Krewe Anesthesia, told Becker’s.
“As the dollars get stretched, where does the ratio end up? There’s obviously pros and cons of doing it both ways, in terms of lower and higher ratios, but I think that’s what each different facility has to decide based on the economics, the acuity of the patients, surgeons’ preferences, facilities’ preferences and many other factors,” he said.
Emerging technologies and innovations in perioperative care
As more surgical cases shift towards the outpatient setting, anesthesia providers are becoming increasingly familiar with pain management tools and methods that support quicker recoveries.
“Especially in ASCs… they don’t want prolonged recovery. They don’t want post-op nausea. So [enhanced recovery after surgery protocols], opioid-sparing protocols and increased reliance on peripheral nerve blocks, neuraxial blocks to where you can spare those narcotics and you can get patients in and out and with less pain and complications associated with narcotics,” Mr. Baker said.
As ASCs continue to grow and expand, developments in this area of anesthesia care are likely to continue evolving.
“I think that the type of anesthesia and the techniques that we use in ASCs, are definitely something that will continue to spread as ASCs proliferate, which I don’t see reversing anytime soon,” he added.
Stipends and surgeon fees
As reimbursement rates continue to decline amid rising operational costs, some contracted anesthesia groups are requesting daily stipends—minimum payments to offset revenue shortfalls and maintain provider compensation. But not all centers are in a financial position to cover these costs.
Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker’s in October he is introducing a new approach to anesthesia stipends. His center plans to have surgeons pay a fee if they don’t meet the minimum number of cases required for their assigned block of operating time.
“Let’s say a surgeon’s block requires a minimum of eight cases, but they only end up doing six cases,” he told Becker’s. “The anesthesia group will send a bill to the surgeon for $300 for each case that they were short, resulting in a bill of $600 in this scenario. So the financial hit will fall on the surgeon, not the center.”
While Mr. Feldman anticipates some resistance, he believes the model will incentivize surgeons to fully utilize block time and keep ORs productive, without requiring the ASC to pay anesthesia stipends of $2,000 to $3,000 per day.
