From declining reimbursements to rising stipends and burnout, providers are sounding alarms about how anesthesia provider shortages can impact care delivery.
Here’s what five anesthesiologists have recently told Becker’s about the challenges ahead:
Yusuf Ahmad, MD. Anesthesiologist in Berkley, Calif.: Outpatient facilities need to mature in their way of thinking in order to be successful. The old model held anesthesia teams to be third-party, contracted services that were non-essential but necessary for the facility to operate. And this model held ground because the supply-demand curve was in favor of the facility with anesthesia groups competing with one another to gain ASC contracts. That supply-demand curve has shifted dramatically, especially given the dire shortage of clinicians and the no-holds-barred attitude hospitals have taken towards supportive stipends to keep and retain clinicians. Given this macroeconomic shift, as well as the declining reimbursements from commercial payers for anesthesia services, ASCs need to think differently. This new way of engaging anesthesia services resembles how ASCs have engaged surgeons: they must be seen and treated as essential, productive partners that contribute value. In turn, the anesthesia group has buy-in as partners and an economic incentive for remaining engaged with the center and driving efficiency. When the center becomes more efficient and outcomes improve, surgeons gain confidence and bring more cases, driving value up. This positive feedback loop enables a mutual win for all stakeholders. The ASCs that adopt this strategy the earliest will partner with the best and most talented groups while ASCs that remain on the old model will forever be stuck on a downward spiral of diminishing quality or get trapped into a losing battle of stipends with the larger health systems in attempting to attract talented anesthesia providers, only to lose them when the stipend bar moves. Ultimately, the best operating suites are the ones where anesthesia has a central role in medical directorship, quality control, and outcomes management. This is the case in the hospital, and most definitely will be the case in the most successful ASCs.
Mo Azam, MD. Head of Innovation at US Anesthesia Partners (Orlando, Fla.): Clinician headcount and case volumes have been tightly matched for many years. The burnout, turnover and recruiting cycle have hit all sectors of the healthcare workforce. Health system margins are strained because of workforce costs and declining reimbursements, and anesthesia practices are encountering even more magnified effects, because of much more severe cuts in reimbursement and much higher wage inflation. In the desperate effort to retain or grow procedural volume, which is high-margin for facilities, health systems willingly sacrificed efficiency. The core issue is certainly NOT a labor shortage in anesthesia services. It’s structural inefficiency of procedural care. Most facilities run at less than 65% utilization. So they have to pay for clinical teams, who are not productive for nearly one-third of the day. Facilities paying stipends have created an arms race between each other, and are doing so to keep grossly inefficient systems in place and compete with each other to attract cases. The long term effect will be some winners and many losers. Those losers will be facilities that can not compete — rural, those that are already strained financials, and some ASCs. As well as many anesthesia practices that can not successfully negotiate for fair reimbursement in this context. The winners will figure out how to work together with shared alignment.
Patrick Giam, MD. President-Elect of the American Society of Anesthesiologists: Outpatient centers are facing pressure on the bottom line due to staffing and resource constraints, as well as declining reimbursement. The majority of anesthesia care (including sedation) is provided as outpatient services. This poses significant challenges as our population ages. We are asked to care for sicker patients safely while maintaining, or even improving, efficiency. Many ASCs must financially contribute to anesthesia departments because the reimbursement for our services does not fully cover the cost of providing the service. The number of practicing anesthesiologists, anesthesiologist assistants, and nurse anesthetists is not sufficient to meet current demands, let alone anticipated future needs.
Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): Anesthesia shortages create production pressures for facilities trying to complete all scheduled cases. This pressure is a cause of clinician burnout. Anesthesia shortages also compromise quality by forcing surgeries into a few multi-purpose areas, rather than providing surgeons and proceduralists with specialty work areas where they can perform their tasks more effectively. I also worry that anesthesia shortages may lead to higher costs for patients and less access to care due to facility consolidation.
Christina Menor, MD. President Elect at California Society of Anesthesiologists: One of the most pressing challenges facing anesthesia in the ASC space is maintaining an adequate workforce amid declining payments from Medicare and other insurers. Some centers are already having to provide stipends to anesthesia groups when they cannot guarantee a full day of cases. This trend will likely continue — and possibly accelerate — given the shortage of anesthesiologists and the growing number of ambulatory and office-based anesthetizing locations.
