ASCs in many markets are facing major anesthesia provider shortages and declining reimbursements, affecting their ability to provide care.
"Anesthesia used to be a seemingly unlimited commodity," Jeff Dottl, principal at Ventura, Calif.-based Physicians Surgery Centers, told Becker's. "They were lucky to be invited to work at your surgery center. The tables have turned, and now if centers have anyone to cover anesthesia, it usually comes at a hefty price."
Many are feeling the effects of the shortage. Portland, Ore.-based Providence Portland Medical Center and Providence St. Vincent Medical Center had to delay several hundres surgeries this year due to a shortage of anesthesiologists. Billings (Mont.) Clinic was seeing a shortage of 35 or more full-time anesthesiologists late last year in the wake of the COVID-19 pandemic.
Some leaders worry this shift might slow the migration of procedures to the ASC setting. Anesthesia costs are on the rise, but payers have not adjusted their reimbursement rates to keep up and there are no stipends being given to ASCs to offset rising costs.
"The shift of inpatient to outpatient cases is a given, but this trend may be slowed by the abysmal Medicare reimbursement for anesthesia cases," Andrew Lovewell, CEO at Columbia (Mo.) Orthopaedic Group, told Becker's. "When salaries, wages and benefits are higher for an outpatient total joint than the anesthesia reimbursement, we have a problem. This is a double-edged sword as the case migration needs to happen to save Medicare money on the facility side, but they [Medicare] have to step up the anesthesia reimbursement if this is going to work."
Additionally, anesthesia providers were further affected by the No Surprises Act and its independent dispute resolution process — payers are using the process to "reduce their required reimbursement by refusing to go in network with the anesthesia providers," according to a VMG Health report. Because of this, VMG Health has received an increasingly high number of requested subsidy arrangements for ASCs.
The decline comes as the anesthesia workforce continues to shrink. More than 2,872 anesthesiologists left the workforce from 2021 to 2022, according to a report from Definitive Healthcare. Additionally, in 2021, the Association of American Medical Colleges predicted a shortage of 12,500 anesthesiologists by 2033.
Some leaders are optimistic — they believe ASCs could have an edge in recruiting anesthesia staff. Jack Dillon, CEO of Grand Rapids, Mich.-based Anesthesia Practice Consultants, told Becker's the predictable hours and steady work ASCs can provide could attract anesthesia providers.