More health systems are directly employing anesthesiologists & CRNAs — Anesthesia PROfessionals President Bob Gauvin explains why


Bob Gauvin, CRNA, is president and owner of Dartmouth, Mass.-based Anesthesia PROfessionals, which provides practice management and anesthesia staffing services to facilities including surgery centers, ophthalmic centers and endoscopy centers.

Here, Mr. Gauvin shares his insights on anesthesia group partnerships, out-of-network billing and more.

Note: Responses have been lightly edited for style and clarity.

Question: Why do some healthcare organizations partner with anesthesia service providers rather than directly employing anesthesiologists or certified registered nurse anesthetists? What are some advantages and risks associated with these partnerships?

Bob Gauvin: Healthcare organizations are always looking for efficiencies when they work with service providers, but anesthesia is complex and they don't always understand the business side of it. For example, healthcare organizations may attempt to bill for anesthesia services thinking it is similar to other Medicare Part B providers, but later discover significant differences leading to inadequate results. And while larger anesthesia service providers bring a great deal of experience to the table and often have better reimbursement agreements with third-party payers, the potential for mergers and acquisitions to disrupt their anesthesia-service agreements creates an unpredictable situation.

We're now seeing many larger hospital systems moving back to directly employing CRNAs and anesthesiologists because of their ability to control the anesthesia practice model more effectively. By doing this, they can better utilize both provider types to their strategic advantage, such as using CRNAs to the full scope of their education and training. Economics and evidence are replacing costly practice models and politics.

Q: How is public and legislative concern about "surprise" out-of-network billing affecting anesthesia groups?

BG: Public outcry and proposed legislation surrounding out-of-network billing have drawn the attention of anesthesia groups, spurring some to double down on their efforts to come to agreement with third-party payers. Clearly, it is in the best interest of anesthesia groups to be in network — it's good business practice and good for patients. Though most payers are cooperative in the negotiation process, in some instances, they either refuse to contract or offer unreasonable payment terms. It is in these situations, specific rules from the legislature and insurance commissioners across the country need to help reform the industry to ensure high-quality and accessible care delivery for patients and providers.

Q: Have you seen any change in the number of anesthesia group partnerships or acquisitions occurring in the past year? Why do you think that is?

BG: We have seen a stabilization generally, but it appears that the next wave is ready to occur. In Massachusetts, for example, many long-standing private group practices are struggling to provide adequate staffing and meet the needs of their hospital partners. Some CEOs and CFOs are looking to control costs by limiting stipends paid to anesthesia groups for services, and we are also seeing a move to employing anesthesia providers by the larger healthcare organizations. Again, there are inherent benefits and challenges to this structure, but one of the most significant incentives is transparency of all business activities. Frankly, hospitals and health systems are still learning the business of anesthesia, removing the middleman, dictating the practice model that best suits their needs (ratio of physician anesthesiologists to CRNAs) and providing the most efficient service possible.

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