More ASCs are turning to anesthesia stipends as workforce shortages deepen and coverage gaps threaten daily operations.
Christina Menor, MD, president of the California Society of Anesthesiologists, joined Becker’s to discuss the sustainability of ASC anesthesia stipends and what alternatives centers may need to explore moving forward.
Editor’s note: This interview was edited lightly for clarity and length.
Question: More ASCs are providing stipends to anesthesia groups. How sustainable is that model, and what alternatives might ASCs explore?
Christina: This is the model that pretty much exists in almost every hospital. The reason it exists in hospitals is because of insurance payment for services. In hospitals, you have many uninsured or underinsured patients — Medi-Cal in California, Medicaid patients in other states, Medicare patients, and a significant number of uninsured individuals. The stipends are necessary to supplement inadequate insurance payments for services and coverage for hospital anesthesia.
In the ambulatory surgery center setting, this traditionally hasn’t been a problem because most ASCs don’t accept Medicaid insurers, usually don’t have lengthy cases, and often work with private insurers who pay adequate rates.
The reason some groups are requiring this now is to have adequate coverage. Say you have an anesthesiologist and one OR, and that OR has a surgeon. Most ASCs have traditionally always accommodated around surgeons’ schedules. That means you may have a surgeon who has a case at 7 a.m. and then another one at 9 a.m., and you’re done at 11. Then you have another surgeon who wants to finish their clinic and come at 3 p.m. to do a surgery.
That leaves the anesthesiologist with no cases — and no payment — from noon until three. What’s happening is there’s such a huge shortage that a group will pull that anesthesiologist to go somewhere else, and they may not come back at 3. So some centers guarantee coverage by paying a stipend, even if there’s a gap.
That’s one piece of it. The other piece is that more and more insurance companies — and CMS — are increasing the number and types of cases allowed in the ASC setting. For example, a year and a half ago we couldn’t do outpatient total shoulder replacements, and now we can. There are plans to remove any restriction on what can be done in the ASC setting by CMS.
So, there will be sicker patients and larger cases, but still gaps in scheduling. In order to guarantee coverage, centers will have to pay stipends. It’s not everywhere, and sometimes it’s structured like: “Here’s a guarantee for the day, but if you fill it with cases, the center doesn’t have to pay the stipend.” It’s an incentive to be efficient.
ASC’s have always been at the beck and call of surgeons, and that model is not likely sustainable if they don’t want to pay stipends.
