As anesthesia reimbursement rates decline and workforce shortages mount, ASCs are exploring alternative anesthesia delivery models to ensure cost efficiency and consistent coverage.
From CRNA-only care to insourcing and surgeon fees, here are three new structures ASCs are using:
CRNA-only models on the rise
Across the country, ASCs are transitioning to certified registered nurse anesthetist-only models, especially in states where CRNAs have full practice authority.
“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 physician-owned, for-profit ASCs, common in Mr. Johnson’s region, limited support staff and straightforward cases make CRNA-only models a logical fit.
Jeff Tieder, MSN, CRNA, and a clinical assistant professor at the University of Tennessee at Chattanooga, sees this as part of a broader trend. CRNA-only environments, he said, are well-positioned to meet ASCs’ needs for “streamlined workflows, cost-effective care and rapid patient turnover without compromising safety.”
“These demands are driving a transition toward CRNA-led and CRNA-only models, which align more closely with the clinical and financial objective of these facilities,” he said. “The growing pressure to contain costs while maintaining safety is elevating the visibility and necessity of CRNAs. With the physician anesthesia shortage looming and reimbursement models shifting, CRNAs will continue to be at the forefront of innovative and sustainable anesthesia delivery.”
Stipends and surgeon fees
With falling reimbursements threatening profitability, 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.
Bringing anesthesia in-house
Some ASCs are taking another approach: bringing anesthesia services under their own roof.
Alex Andrade, COO of Medical Associates in Dubuque, Iowa, told Becker’s that what began as a defensive strategy has turned into a strategic opportunity to enhance throughput and efficiency.
“Our goal is to leverage our anesthesia team to drive operating efficiencies and increase throughput as part of one end-to-end process,” he said.
Other leaders agree. Angela Durham, vice president of ancillary services at Franklin, Tenn.-based US Heart and Vascular, said that she sees ownership of anesthesia services as a way to avoid third-party markups and gain greater control over coverage and costs.
“This model allows anesthesia providers to join the ASC family as a permanent member of the care team,” she said, adding that it eliminates third-party markups and unpredictable subsidy costs.
