‘Either we pay or we close a room’: Anesthesia challenges hit small ASCs harder

Declining reimbursements and a growing anesthesia provider shortage are putting significant strain on ASCs, especially those smaller in size that lack the resources to compete for providers.

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Kristi Manutai, RN, regional administrator for Redding, Calif.-based North State Surgery Center, joined Becker’s to discuss the difficulties in securing anesthesia coverage, particularly for smaller ASCs. 

“With anesthesia, it all comes down to what you’re willing to pay,” she said. “Small ASCs like ours are competing against large entities that can afford to pay providers much higher rates. Hospitals get reimbursed at three times the rate an ASC does, but anesthesiologists still expect to be paid the same. That puts a huge strain on our finances.”

For many ASCs, this financial burden is a direct threat to their survival.

“Either we pay or we close a room,” she said. “And if it gets bad enough, a surgery center could have to close altogether if it doesn’t have the financial backing to bring providers in.”

Located in rural Northern California, North State Surgery Center faces an additional hurdle: provider recruitment. The region’s remoteness makes it difficult to attract and retain anesthesia professionals.

The practice either brings providers in from outside the area — incurring substantial travel costs — or it has to convince them to relocate, which is another major challenge, Ms. Manutai said.

Because of this, ASCs like hers must be resourceful in their approach to staffing.

“It takes a lot of negotiating and contract discussions,” she said. “Everyone is looking for the highest dollar.”

She has noticed a trend in which anesthesia providers are seeking extra shifts beyond their full-time roles. Leveraging this, her ASC is working with larger anesthesia groups from nearby metropolitan areas rather than relying on local providers who charge “significant amounts,” she told Becker’s.

“If you can connect with a group that has enough providers willing to pick up additional shifts, you can create a more stable block schedule,” she said.

Despite the uphill battle, Ms. Manutai remains focused on managing what she can, but the upshot often affects her staff and other ASC functions.

“At the end of the day, the only things we can control are staffing and equipment costs,” she said. “That often means asking employees to do more with fewer resources, which creates a vicious cycle of burnout and retention issues. I wish I had the answers, but we just have to take it day by day — it’s incredibly challenging.”

As the anesthesia shortage continues to put pressure on smaller ASCs, administrators like Ms. Manutai are forced to make difficult decisions, balancing financial sustainability with patient care. 

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