As surgical care continues migrating to the outpatient setting and the demand for anesthesia rises amid ongoing staffing shortages, a number of economic, regulatory and clinical issues have surfaced as key factors in the industry’s future.
Limited flexibility in staffing models
Anesthesia staffing models vary greatly between different states and facilities, but the rapidly shifting industry has become inundated with a range of staffing models that may present challenges to ASCs and other facilities.
“A key contributor to the staffing issue is the limited flexibility in compensation models. Many CRNAs prefer 1099 compensation for its autonomy and financial benefits, yet are often forced to work through third-party staffing agencies to access these arrangements,” Andrew Hicks, a CRNA with Advanced Practice Providers for the Cardiothoracic Division of the Ohio State University College of Medicine, told Becker’s.
The utilization of CRNAs has become increasingly prolific in the outpatient space. 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.
Aligning with the demand for more flexible staffing models could improve the pool of qualified candidates for open positions while keeping costs down, Mr. Hicks said.
“A practical solution would be for outpatient surgical centers and large healthcare systems to offer both 1099 and W-2 compensation options directly. This would not only attract a broader pool of qualified anesthesia providers but also reduce reliance on external agencies, improving consistency and quality of care,” he said.
Scheduling issues
Optimizing operating room schedules has become vital in the anesthesia space as ASCs and hospitals alike attempt to meet surgical demand with a more strained workforce.
Gavin Baker, CRNA, CEO of New Orleans-based Krewe Anesthesia, told Becker’s that facilities must place anesthesia scheduling at the center of their operations in order to ensure the utmost efficiency and quality of care.
“Everybody, especially the surgeons, want to do as many cases as they can. Some surgeons want two to three rooms that they can bounce back and forth,” Mr. Baker said. “If you can be efficient with that, that’s great, but a lot of times that ends up costing decreased utilization in regards to anesthesia time. If you do the calculation and it makes sense to increase procedure count, you have to realize that may be an inefficient use of anesthesia, [even though] it is an efficient use of the surgeon’s time to give them multiple rooms.”
His practice works with facilities to align their financial needs with their anesthesia time utilization — a practice that involves thinking outside the box and finding a certain balance between the needs of the facility, providers and patients.
“There’s give-and-take there, because you’re going to have time where the anesthesia is now actually billing minutes when the surgeon is being more efficient. Sometimes that leads to less efficient anesthesia,” he said. “And as long as that give-and-take is upfront and calculated then, that’s fine. But I think sometimes they forget that just because the surgeon’s time is more efficient, doing it that way with multiple rooms, it may not necessarily be the case with anesthesia.”
Site of service payment shifts
Site neutral payments between HOPDs and ASCs has become a heavily discussed potential policy shift in healthcare, creating a level of uncertainty as to exactly how this policy may play out in the industry. “If facility fees become site neutral, it is unclear whether hospital fees will decrease, ASC fees will increase, or both,” Christina Menor, MD, president-elect of the California Society of Anesthesiologists, told Becker’s. “Whichever direction these changes take will influence where cases are performed, potentially driving higher-acuity, more complex procedures into the ASC setting.”
