With more procedures moving to the ASC setting, anesthesia leaders see opportunities to improve recovery and efficiency — but warn that safety readiness and broken reimbursement models could slow momentum. On July 15, CMS approved more than 200 additional procedures for the ASC setting, intensifying the need for anesthesia teams to prepare.
Five anesthesia leaders recently shared their perspectives with Becker’s.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What are the most important things for anesthesia providers to keep in mind as procedures continue to migrate to the ASC setting?
Laura Willard, MD. Anesthesiologist, Beth Israel Deaconess Medical Center Department of Anesthesia (Boston): Anesthesia providers must have a clear plan to stabilize patients in the event of a code or other sentinel event, and be able to transfer them quickly to the appropriate level of care.
Steve Dorman, MD. CCO, CCI Anesthesia (Pensacola, Fla.): It is important to prioritize short recovery times and minimize side effects by using short-acting IV agents such as propofol instead of inhalation agents when appropriate. Providers should also decrease the use of opioids and increase the use of regional blocks, while aggressively preventing postoperative nausea and vomiting. These strategies apply not only in the ASC setting but also in non-OR anesthesia environments.
Steve London, MD. Medical Director and Anesthesiologist, Aloha Surgical Center (Kahului, Hawaii): The key mission of the anesthesiologist is to provide optimal care within safe limits. During preoperative evaluation, providers should always keep in mind the “yellow light” — the caution zone between a safe go-ahead and a clear red light indicating the patient is not appropriate for the ambulatory setting.
Cory Koenig, DO. Vice President of Operations, Providence Anesthesiology Associates (Charlotte, N.C.): The expansion of ASC-eligible procedures by CMS is only the first step in a much larger challenge. The Medicare Physician Fee Schedule is unsustainable for anesthesia, as years of cuts to the conversion factor and inflationary pressures have made reimbursement inadequate. As a result, the additional Medicare volume may not cover expenses. To succeed, ASCs must maintain a proper commercial payor mix, maximize OR utilization and partner closely with a well-managed anesthesia group to avoid higher anesthesia costs.
Andy Briggs, CRNA. UCHealth Memorial Hospital Central (Colorado Springs, Colo.): As more complex cases migrate to the ASC setting, anesthesia teams must remain prepared for emergencies by ensuring access to advanced airway equipment, resuscitation capability and clear pathways for escalated care. Many outpatient centers do not have blood products or specialized equipment readily available, which increases risk. On the financial side, higher-acuity cases require new resources and additional staff, which raise costs while payers continue to scrutinize facility fees and limit coverage. Providers should consider the long-term cost benefits of medications, such as reversal agents, even when they appear more expensive upfront. Finally, it is critical to align staffing models with state law, patient acuity and provider skill sets to maintain both safety and financial sustainability.
