As ASCs expand and evolve, anesthesiologists are reexamining their role in driving efficiency, ensuring patient safety, and navigating economic headwinds.
Here’s what five anesthesiologists across the country are saying about the shifting landscape of anesthesia care:
Yusuf Ahmad, MD. Anesthesiologist in Berkley, Calif.: Outpatient facilities need to mature in their way of thinking in order to be successful. The old model held anesthesia teams to be third-party, contracted services that were non-essential but necessary for the facility to operate. And this model held ground because the supply-demand curve was in favor of the facility with anesthesia groups competing with one another to gain ASC contracts. That supply-demand curve has shifted dramatically, especially given the dire shortage of clinicians and the no-holds-barred attitude hospitals have taken towards supportive stipends to keep and retain clinicians. Given this macroeconomic shift, as well as the declining reimbursements from commercial payers for anesthesia services, ASCs need to think differently. This new way of engaging anesthesia services resembles how ASCs have engaged surgeons: they must be seen and treated as essential, productive partners that contribute value. In turn, the anesthesia group has buy-in as partners and an economic incentive for remaining engaged with the center and driving efficiency. When the center becomes more efficient and outcomes improve, surgeons gain confidence and bring more cases, driving value up. This positive feedback loop enables a mutual win for all stakeholders. The ASCs that adopt this strategy the earliest will partner with the best and most talented groups while ASCs that remain on the old model will forever be stuck on a downward spiral of diminishing quality or get trapped into a losing battle of stipends with the larger health systems in attempting to attract talented anesthesia providers, only to lose them when the stipend bar moves. Ultimately, the best operating suites are the ones where anesthesia has a central role in medical directorship, quality control, and outcomes management. This is the case in the hospital, and most definitely will be the case in the most successful ASCs.
James Doebele, MD. Pediatric Anesthesiologist at Lakeland (Fla.) Regional Hospital and Watson Clinic: The biggest growth opportunity for anesthesia professionals or group practices is related to improving efficiency, safety, and the ability to provide care to sicker patients on an outpatient basis, and managing our operating rooms with an attitude of ‘taking ownership’ of the perioperative processes. To be leaders in making all these improvements, partner with surgeons and hospital administrators, and use our knowledge and skills to continually bring safe, quality care in an efficient manner.
The growth of [enhanced recovery after surgery] techniques, the increased use of regional anesthesia blocks and multimodal anesthesia, will help these processes.
Also, the increased volume of non-operating room anesthesia cases will challenge us to bring safe and efficient care with new technologies. Those of us who meet the challenges and seek to constantly adapt and improve will thrive.
Megan Friedman, DO. Anesthesiologist and Director of Pacific Coast Anesthesia Consultants (Los Angeles): I’m most excited about how AI-driven scheduling and real-time analytics are transforming anesthesia operations. We’ve adopted a platform that builds our schedule based on provider availability, skill set, and site-specific volume forecasts. It also tracks clock-ins via geolocation and pushes real-time overtime data to me each day.
That level of visibility has allowed us to proactively adjust staffing, reduce unnecessary coverage, and optimize room utilization. At one of our hospitals, we increased prime-time OR utilization to over 80% — all while improving schedule predictability and flexibility for our anesthesiologists.
That flexibility has directly improved anesthesiologist satisfaction, which has strengthened our ability to recruit and retain talent. In a national climate where rooms are closing due to staffing shortages, we’ve remained fully staffed across multiple hospitals.
It’s a perfect example of how the right technology can simultaneously improve efficiency, provider satisfaction and financial sustainability.
Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): Anesthesia shortages create production pressures for facilities trying to complete all scheduled cases. This pressure is a cause of clinician burnout. Anesthesia shortages also compromise quality by forcing surgeries into a few multi-purpose areas, rather than providing surgeons and proceduralists with specialty work areas where they can perform their tasks more effectively. I also worry that anesthesia shortages may lead to higher costs for patients and less access to care due to facility consolidation.
Udaya Padakandla, MD. Anesthesiologist at Baylor Scott & White Health in Dallas and Immediate Past President of the Texas Society of Anesthesiologists: The increasing volumes of surgeries in ASC’s forces [the] anesthesiology community to seek financial assistance from ASCs because of their ongoing poor CMS and private payer compensation. Since ASCs do not benefit from Outpatient Prospective Payment Services that ensure higher site-differential payments to [HOPD]s, ASCs face an uphill battle retaining anesthesiologists on their staff. This will necessitate higher throughput from anesthesiologists to keep up with the revenue generation and in the long run lead to increased burnout and difficulty in retaining physician and anesthesia provider talent.
