As anesthesia shortages and rising costs push ASCs to rethink how they staff operating rooms, many leaders are weighing a fundamental choice: bring anesthesia in-house or outsource it to a third-party group.
Brian Cohen, MD, administrative chief of Miami Anesthesia Services, said the bigger mistake may be treating that choice as the solution itself. He recently joined Becker’s to discuss the importance of diligence and consistency in aligning anesthesia teams with ASC operations.
Editor’s note: This interview was edited lightly for clarity and length.
Question: What is the biggest mistake an ASC leader can make when it comes to anesthesia procurement and management?
Dr. Brian Cohen: The biggest mistake is treating anesthesia as a procurement decision rather than an operational one. Leaders are being forced to experiment right now and throwing darts to see which one fits their center. Therefore, missteps and mistakes are inevitable. The red flag is assuming that once you’ve selected a model, the work is finished. Anesthesia is not a plug-and-play specialty. Cost and quality come from high-touch, daily attention to assignments, block utilization, processes and relationships.
There are two general trends right now with optionality to land somewhere in the middle: bring anesthesia in-house or hire an anesthesia company to provide services at your center.
If you employ the anesthesiologists and CRNAs directly, understand what you’re taking on. You are committed to those salaries, which means you lose the ability to scale costs down on lighter days, weeks or months. You also inherit payer contracting and credentialing. Strong commercial contracts are what make the employment math work, and ASC companies do not always own them. Even under employment, I would recommend partnering with an anesthesia-specific management group for daily operational oversight and direction. Owning the staff is not the same as running the service.
If you contract with an anesthesia company, the proven component of success is transparency in both directions. You need to hand over accurate historical data, and they need to hand back honest projections, not a pro forma built to win the deal. That only happens when you have access to aligned clinical and operational leaders, not just the suits in the business office 200 miles away. Every stakeholder has to be rowing in the same direction for the financial, clinical and operational results to hold up over time. It is OKto throw darts but the end goal is to land on a sustainable model that survives the current challenges while positioning for a more stable future.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
