ASCs are rapidly becoming the setting of choice for a growing share of surgical procedures, but as patient acuity rises and payment models shift, the anesthesia workforce is grappling with mounting pressures.
Five anesthesia leaders joined Becker’s to discuss the biggest challenges and opportunities in anesthesia.
Question: What are the biggest challenges and opportunities for anesthesia in outpatient care?
Editor’s note: These responses were edited lightly for clarity and length.
Patrick Giam, MD. President-Elect of the American Society of Anesthesiologists:
Outpatient centers are facing pressure on the bottom line due to staffing and resource constraints, as well as declining reimbursement. The majority of anesthesia care (including sedation) is provided as outpatient services. This poses significant challenges as our population ages. We are asked to care for sicker patients safely while maintaining, or even improving, efficiency. Many ASCs must financially contribute to anesthesia departments because the reimbursement for our services does not fully cover the cost of providing the service. The number of practicing anesthesiologists, anesthesiologist assistants, and nurse anesthetists is not sufficient to meet current demands, let alone anticipated future needs.
Andrew Hicks, CRNA. Advanced Practice Providers for Cardiothoracic Division of the Ohio State University College of Medicine (Columbus): One of the biggest challenges in outpatient anesthesia today is finding quality anesthesia staffing and maintaining consistent surgical volume. A key contributor to the staffing issue is the limited flexibility in compensation models. Many CRNAs prefer 1099 compensation for its autonomy and financial benefits, yet are often forced to work through third-party staffing agencies to access these arrangements. A practical solution would be for outpatient surgical centers and large healthcare systems to offer both 1099 and W-2 compensation options directly. This would not only attract a broader pool of qualified anesthesia providers but also reduce reliance on external agencies, improving consistency and quality of care.
Maher Kodsy, MD. President of Elyria (Ohio) Anesthesia Services: Our anesthesia group staffs three hospitals and one freestanding ASC — 80% of procedures performed at the hospitals are same day surgeries.
- Our corporation faces the same challenges like any other facilities, staffing shortages, increased overhead and unrealistic expectations. We were able to identify many opportunities to help us navigate through the current staffing crisis
- Optimization of surgery schedule and room utilization. We don’t leave any holes in the schedule to get the work done within the working hours to avoid incurring unnecessary overhead.
- We were able to get the administrators, surgeons and anesthesia to be on the same page to run an efficient operation. Everyone is aware of the challenges and is willing to work collaboratively to achieve a smooth daily sailing.
- Development of an efficient, yet very accommodating model through a thorough preoperative screening to avoid same day cancellation. This by itself increased the provider’s and patient satisfaction scores significantly. Obviously, that helped us tremendously since we’re not losing any unproductive time.
Christina Menor, MD. President Elect at California Society of Anesthesiologists:
1. Workforce pressures and financial constraints
One of the most pressing challenges facing anesthesia in the ASC space is maintaining an adequate workforce amid declining payments from Medicare and other insurers. Some centers are already having to provide stipends to anesthesia groups when they cannot guarantee a full day of cases. This trend will likely continue — and possibly accelerate — given the shortage of anesthesiologists and the growing number of ambulatory and office-based anesthetizing locations.
2. Site of service payment shifts
A significant policy change on the horizon is CMS’ move toward site neutrality in payment for ambulatory-approved codes. If facility fees become site neutral, it is unclear whether hospital fees will decrease, ASC fees will increase, or both. Whichever direction these changes take will influence where cases are performed, potentially driving higher-acuity, more complex procedures into the ASC setting.
3. A paradigm shift for anesthesiology leadership
We now have an opportunity to rethink how anesthesiology services are delivered in ASCs. Anesthesiologists — by virtue of our involvement in all aspects of perioperative care and workflow — are uniquely positioned to serve as ASC medical directors, often better suited to the role than surgeons. Partnering closely with our surgical colleagues, we can lead innovations that enhance efficiency, safety, and patient outcomes.
Key areas for improvement:
Critical domains where anesthesiology leadership can make an impact include:
- EHR implementation and record management – Moving beyond paper and fax-based workflows toward integrated, digital systems.
- Preoperative assessment processes – Streamlining information flow to reduce delays and optimize patient readiness.
- Supply chain and staffing management – Ensuring resource availability and efficient team deployment.
- Revenue Cycle Management – Transitioning from manual, paper-based billing processes to connected, automated RCM tools to improve financial efficiency.
Leveraging technology for efficiency:
While some ambulatory sites have adopted EHR systems and improved preoperative record flow, many still rely heavily on faxing and paper anesthesia records. Revenue cycle processes are frequently tied to physical transport of billing sheets and manual data entry — creating significant inefficiencies. Greater adoption of integrated technology solutions offers a clear path toward improved throughput, reduced waste and better financial performance.
Eugene Viscusi, MD. Professor of Anesthesiology and Perioperative Medicine at Thomas Jefferson University: Margins continue to be the focus of most ambulatory centers hence efficiency and throughput are critical. This can only be accomplished with a team approach from the reception desk to the patient leaving the center. Everyone must share their vision and goals. The biggest challenge is the continued movement of formerly inpatients that are now same day procedures. Patient selection is a critical part of this trend if you are to be successful and move patients through the system in a timely and safe manner. Postoperative pain management is a key part of managing these bigger procedures such as total knee replacement. The big opportunity for anesthesiologists is to be the leaders in ambulatory surgery designing the best approaches to efficiency, and highly effective postoperative pain management.
