When its anesthesiology group pulled out roughly two years ago, a Buffalo, N.Y.-based ASC had to rethink how it delivers anesthesia. That meant new supervision policies, retraining for its clinical staff and a new surgical schedule.
Kimberly Fullone, administrator of Niagara Falls, N.Y.-based Ambulatory Surgery Center of Niagara, said no local anesthesia group was willing to take on the center, so it moved to a certified registered nurse anesthetist-based group.
More ASCs are making the switch to CRNA-only anesthesia models as CRNAs gain broader authority to practice independently in many states and as anesthesia workforce shortages deepen.
Dan Zahumensky, administrator of Seattle-based Proliance Surgeons’ ENT service line and executive director of Bellevue and Puget Sound Ear, Nose and Throat, and South Seattle Otolaryngology, made the switch at his center after their provider wasn’t able to provide coverage through the summer because of a lack of anesthesiologists.
He expects this shift to be a long-term solution to the anesthesia provider shortage that doesn’t show signs of slowing down.
“I don’t see a reason to abandon CRNAs and restart recruitment of anesthesiologists only,” he said. “Of course, the anesthesia shortage isn’t going away soon. If MD groups keep demanding higher compensation and stipends, they may price themselves out of the market. If CRNAs can provide the same services at a lower cost, the shift to CRNAs may accelerate.”
For the Ambulatory Surgery Center of Niagara, the move changed the surgeons’ role most of all. Under the old model, anesthesiologists ran anesthesia. Without one on site, the center’s surgeons now supervise the CRNAs.
“It was a big change for our surgeons,” Ms. Fullone said. She added that the surgeons weren’t trained in anesthesiology and didn’t want that responsibility at first.
The new model also changed how anesthesia fits into the center’s economics. Its CRNA group bills payers directly. Ms. Fullone said CRNA salaries have risen with demand, and payer reimbursement hasn’t kept pace.
“What the insurance is reimbursing does not even cover what they need to pay their CRNAs,” she said.
That gap shapes the whole arrangement, she said. To make the economics work, the anesthesia group needs full, efficient days, and the center needs a staff that can support the anesthesia team.
CRNA salaries grew 59% from 2019 to 2026, rising from $181,000 to $288,000, according to Marit Health and AANA data, which is nearly twice the 29% growth rate for anesthesiologists over the same period, according to a report from healthcare consulting firm Veralon.
Ms. Fullone was clear that the center values its anesthesia partners.
“Our anesthesia group is wonderful,” she said. “We love CRNAs.”
Ms. Fullone said the center’s goal was to make surgeons comfortable in their new role and to give the anesthesia team more clinical backup. The changes include:
- Advanced Cardiac Life Support certification for surgeons: Surgeons supervising CRNAs must now be ACLS certified.
- ACLS certification for nurses: Most of the center’s full- and part-time nurses are now certified too.
- Mock code training: An outside emergency response trainer led in-service training on code blues and walked staff through the code cart.
- Code cart overhaul: The cart now lists every emergency medication with its dosing, so staff don’t have to work out doses during a code.
- Higher-acuity hires: The center hired three ICU nurses to raise the level of nursing care.
“We just cleaned everything up and did a lot of training,” she said.
The new model also changed which cases the center takes on. Its strabismus surgeon wasn’t comfortable supervising anesthesia for children in an outpatient setting, so the center stopped pediatric cases.
“We had to be now more selective on what we’re doing and what we’re comfortable doing in the surgery center,” Ms. Fullone said.
The model also depends on full days. Some physicians had worked half days or left block time unfilled. Under the CRNA arrangement, a half day isn’t worth the anesthesia team’s trip.
“It wasn’t like, can you please try to fill your block times? It was like, fill your block times [or] we’re gonna lose the block time,” Ms. Fullone said.
The center closed on Fridays and consolidated cases into four full days.
Ms. Fullone said physician buy-in came down to communication and education. Many surgeons hadn’t understood why partial days hurt the center, including the cost of keeping full-time staff busy.
“If you only have a half day, we can’t run the room,” she said.
The center keeps in close contact with the surgical schedulers in physician offices so the standard holds. Ms. Fullone said that if the center lets cases dwindle and accepts a light day, physicians start treating light days as normal.
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