The increasingly complex business of anesthesia: 4 areas to keep an eye on

From rapid M&A activity, to changes in reimbursement, to the evolving role of the anesthesiologist in a healthcare facility, the anesthesia industry has seen sweeping changes over the last few years.

At the Becker's ASC 22nd Annual Meeting – The Business and Operations of ASCs in Chicago from Oct. 22 to 24, a panel of anesthesia industry experts discussed the business of anesthesia and how it is evolving to keep pace with the brave new world of value-based care. The panel included Jeff Peters, MBA, president of Surgical Directions; Michael Hicks, MD, CEO of EmCare; Nishant Shah, MD, anesthesiologist at Midwest Anesthesiology Partners, PRAA Division; Jeffrey Weiss, DO, president of TeamHealth Anesthesia; and Rafael Cartagena, MD, president North American Partners in Anesthesia – East Division. The session was moderated by Scott Becker, JD, CPA, publisher of Becker's Healthcare.

Anesthesia M&A
The rate of anesthesia group M&A has been pronounced and according to Dr. Cartagena, this recent flurry of activity is a result of smaller anesthesia groups looking to develop infrastructure and establish scale to remain meaningful in the new healthcare environment. "Smaller organizations join with a larger organization to gain access to resources," he said.

Dr. Weiss corroborated this, pointing out that the scale issue is a major driver of M&A. "That is why an Amsurg is trying to buy TeamHealth and why it bought Sheridan last year," he said. "The individual and small groups get to a point where they just cannot prove value because of their smaller size." Dr. Hicks predicted that there will be more widespread vertical and horizontal consolidation.

Bundled payments & anesthesia
Mr. Peters noted that a lot of Surgical Directions' clients have implemented bundled payments. "Fifty percent of bundled payment cost is the cost after patient discharge and the really good providers have been able to improve discharge services and have avoided sending their patients to rehab by providing better postop pain control," he said.
According to Dr. Weiss, the bundled payment environment is really driving anesthesiologists to figure out how to provide more value, end-to-end, to partners, including hospitals and ASCs. The push toward bundled payments has driven interesting clinical changes such as the evolution of perioperative surgical home, a new care delivery model that focuses on the entire episode of care.

Anesthesiologists' evolving role
The whole role of the anesthesiologist in ASCs and hospitals is evolving, noted Mr. Peters. Anesthesiologists are co-managing the operations on the business end with administrators in many cases. "Anesthesiologists are helping administrators move into an era of value-based payments," he said. "Most ASCs and hospitals are looking at anesthesiology to drive value."

According to Dr. Shah, his practice has made itself indispensable to the facilities where they provide care. The practice provides pediatric anesthesia, regional anesthesia, critical care and more. "We have taken over every one of those little avenues," he said. "So they don't need to ask anyone else for anesthesia services. We try to stay a step ahead."

Pressure on reimbursement
Anesthesiologists do whatever necessary to help a facility succeed and make sure the case goes well, said Dr. Cartagena. By focusing on the patient, anesthesia groups can help stem the effects of declining reimbursements.

"There is a lot of turmoil in the business of anesthesia, but we need to remember, always put the patient first," said Dr. Hicks


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