Saving the OR starts with addressing new anesthesia provider dynamics

Hospitals are facing a looming anesthesia provider shortage as a consequence of converging demographic, organizational, care delivery and compensation-related factors. How hospitals respond to this crisis is crucial to keeping operating rooms open and profitable.

During a November webinar hosted by Becker's Healthcare and sponsored by Surgical Directions, Jeff Peters, founder and chair of Surgical Directions, and Jason Klopotowski, MD, department chair of anesthesiology at Baptist Health-Fort Smith (Ark.), and physician consultant with Surgical Directions, discussed ongoing trends and approaches to maintaining anesthesiology services.

Four key takeaways:

  1. Four major disruptions are causing the current crisis in anesthesia. These are supply-side issues, demand-side issues, changes in reimbursement and changes in marketplace regulations. The rate at which medical schools are graduating residents and certified registered nurse anesthetists is not keeping up with rising demand for surgical services given an aging population, an explosive growth of ambulatory surgical centers and a rise in non-operating room anesthesia procedures. Added pressures come from decreases in reimbursement and from differing regulations by state in terms of who among anesthesiologists, CRNAs and certified anesthesiology assistants can deliver these services.

    "It's leaving hospital system administrators confused as to what is the best, safest and most cost-effective way to deliver anesthesia. Nobody's quite sure how to right-size that to a model that fits best for their case acuity, their patient safety and their revenue cycle," Dr. Klopotowski said.

  2. Since reimbursement no longer fully covers anesthesia salaries, subsidies are playing a key role. With reimbursement from government and private payers both decreasing, hospitals are making up some of the difference through subsidies. Currently about 80 percent of private and employer-based anesthesia practices are receiving some kind of subsidy. In this climate, delivering safe patient care is no longer enough, and hospitals are looking to anesthesiologists to also provide leadership and integration into the broader needs of the healthcare system.

  3. Anesthesia care team models are changing. MD-only anesthesiology care models are giving way to hybrid configurations, such as medical direction and medical supervision models, which incorporate different ratios of MDs, CRNAs and certified anesthesiology assistants, with reimbursement split accordingly. "The East Coast is much more active in deploying anesthesia care team models than the West Coast, but we see that trend moving west," Dr. Klopotowski said. "Overall, the ratio of nurse anesthetists to anesthesiologists is rising."

  4. Hospital OR leaders are considering multiple options to alleviate staffing shortages. Designing staffing models that reduce OR downtime, decrease staff overtime and/or use contracted providers are additional approaches to tackle the staffing crisis from a human resources perspective. Weighing the advantages and disadvantages of contracting versus employing anesthesiology provider groups is an important consideration. "While clearly one of the advantages of employing is alignment of providers and the opportunity to insert new management, providers' fear of no longer having a voice is a disadvantage," Mr. Peters said.

Anesthesia is in crisis because of an unstable anesthesia marketplace, decreasing reimbursement, rising expectations and staffing challenges. In this environment, hospital OR leaders will need to apply new solutions to the problems of resource utilization and efficiency.

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