For many ASCs, anesthesia stipends, recruiting struggles and soaring provider pay are a new and painful reality. For CCI Anesthesia, they’ve been the cost of doing business for two decades.
Founded in 2004, Pensacola FL.-based CCI has focused on rural and non-urban markets from the start, staffing hospitals and surgery centers in small towns across New Mexico, Kansas and North Dakota. At many of those sites, a single anesthesia provider covers the day, and the nearest hospital may be 50 miles away.
“A lot of the things that we see in the market nowadays, as far as difficulty recruiting and scarcity of providers, none of it’s really a big surprise to us because of the difficult markets we were already in,” said Kiernan Zumwalt, CCI’s COO.
Subsidies are a clear example. Rural facilities have long had to cover the gap between what anesthesia costs and what it collects. Now, as provider compensation climbs and reimbursement declines, that gap has arrived at ASCs, too.
“That gap of money needs to be filled by somebody,” Mr. Zumwalt said. “Typically, it comes in the form of subsidies. That’s not necessarily something surgery centers are used to paying.”
Here are three lessons from CCI’s experience.
1. Past a certain point, money stops working
Compensation for anesthesia providers has “gone through the roof,” Mr. Zumwalt said, whether for CRNAs, anesthesiologists or anesthesiologist assistants. But he said many facility leaders overestimate how much another raise will buy them.
“If I’m making $400,000 or in that ballpark as a CRNA, I’m not going to uproot myself and my family and my practice to take even maybe a $25,000 raise down the street,” he said.
At that income level, he said, providers prioritize work-life balance, time off to avoid burnout and a workplace where they feel heard. That matters in a market where providers are fielding calls from recruiters and locums companies constantly.
“It’s exhausting,” he said. “You have to have a proper work-life balance, and you have to have a good local presence, local culture in order to keep you at that particular area.”
2. CRNA-led models can work, with the right support
Most of CCI’s providers and leaders are CRNAs, and in some of its rural states, the company has almost no physician anesthesia coverage.
“We are a very CRNA-friendly, very CRNA-focused group,” Mr. Zumwalt said.
He said autonomy is a major draw for CRNAs, particularly as more states opt out of physician supervision requirements. But autonomy works best when local leaders have backup. CCI supports its site chiefs, whether they’re CRNAs or anesthesiologists, with a medical affairs team of anesthesiologists and a clinical leadership team of CRNAs, so local leaders can push back when needed, including with surgeons.
He also offered a mixed outlook on the workforce. He expects the CRNA shortage to ease as more training programs open, but believes the anesthesiologist shortage will continue to worsen, driven by pandemic-era departures and an aging workforce.
3. The real cost of anesthesia isn’t on the invoice
The biggest financial mistake Mr. Zumwalt sees is hospitals and surgery centers judging anesthesia contracts by the upfront price. “It’s a pretty hefty sum of money, no matter if it’s coming from CCI, from NorthStar or any other company,” he said. “But making sure you’re comparing truly apples to apples” is critical, he said.
Many costs of poor anesthesia coverage never show up in the anesthesia budget. When a facility has to close an OR for a day because it can’t staff it, the canceled cases hit revenue elsewhere. “That’s not going to be reflected in your anesthesia spend,” he said. “But it’s definitely money that you’re not bringing in somewhere else.”
Locums are another hidden drain. Mr. Zumwalt said that at some of CCI’s rural facilities, five to seven months of locum costs could equal the facility’s entire margin. That’s why he urges leaders to evaluate anesthesia partnerships over years, not months, and to get the decision right the first time.
“Once a surgery center or a hospital makes a switch in anesthesia groups, or decides to outsource, or decides to bring it in house, that’s not a light switch,” he said. “You can’t flip it back next year.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
