As certified registered nurse anesthetists gain broader authority to practice independently in many states, and as anesthesia workforce shortages deepen, more ASCs are adopting CRNA-only anesthesia models.
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, spoke with Becker’s about why one of his centers made the switch, and what other ASCs should know.
Question: What prompted the decision to transition to the CRNA-only model? Can you walk me through how that process unfolded?
Editor’s note: This interview was edited lightly for clarity and length.
Dan Zahumensky: I think it was more that we were forced into a decision. Around July 2024, our anesthesia provider — which was a physician group — wasn’t able to provide coverage through the summer because of a lack of anesthesiologists. That’s been an issue happening over the last three to five years.
We were trying to run two rooms in our ASC four days a week, and some days we didn’t have any anesthesiologist. Sometimes we only had one, which really impacted our ability to provide patient care in a timely manner. Initially, we thought it would only last through the summer, but it pushed into August and September. We had many conversations with the anesthesia provider group, asking if this was on our end or still a staffing issue. We learned it was a combination: lack of anesthesiologists, increased demand for coverage, rising compensation, and the fact that we weren’t as busy as other ASCs or hospitals they covered.
By late September or early October, their leadership decided not to renew the contract, which ran through the end of 2024. So our team — myself, our medical director and our ASC director — began looking at other options.
Initially, we looked at other physician anesthesiology groups. Our former group hadn’t charged us a daily stipend—they just collected billing, which is a common model. But in the market, we found that groups were now asking for both billing and daily stipends. I began reaching out to CRNA groups in Seattle and across Washington. We eventually contracted with the group we have now. We do pay a daily stipend, but it’s relatively low and varies based on ASC scheduling hours, while they collect billing.
Q: What were the key steps in the transition, and how did you manage communication with staff, surgeons, and patients during the process?
DZ: There was a lot of communication internally to make sure this was the right move. It went before the quality committee, and we had to collect and submit records on the CRNA group we chose.
Our physician partners were involved in discussions, meeting the CRNAs, and even helping with interviews. Staff were totally on board — no hesitation there.
For patients, we explained who our providers were and their skill sets. So far, we haven’t had any issues. We’ve been able to get clearances done more quickly, and we haven’t had to move ASC cases to the hospital due to provider or patient concerns.
In fact, another Proliance ASC in a similar situation consulted with me several times. They ended up contracting with the same CRNA group. They’re also very happy, so this model may expand further in Proliance.
Q: Do you see CRNA-only models as a long-term solution for your ASCs, or do you anticipate further evolution in anesthesia staffing strategies as workforce shortages continue?
DZ: I do see it as a long-term solution. We’re nine months into our first year, and unless something catastrophic happens, I don’t see us going back to anesthesiologists-only.
I don’t see a reason to abandon CRNAs and restart recruitment of anesthesiologists only.
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.
That could force MD groups to reconsider their pricing models, or they risk losing business. In states like Washington, where CRNAs can practice independently, that shift could be even stronger.
Q: What advice would you give an ASC looking to make a similar transition?
DZ: If I were advising another ASC considering this transition, I’d stress engaging surgeons early and often. They need to be part of the decision.
Groups should also carefully consider their risk tolerance. We haven’t had issues with CRNA care, but it’s important to vet concerns from staff and patients. Financially, groups should run long-term models: What would reimbursement look like if you employed MDs or CRNAs directly? Would the rates be acceptable?
Finally, culture matters. At Proliance, we value an amazing ASC culture, so we wanted partners who fit, not just providers who “put patients to sleep and wake them up.” Finding a group invested in the relationship, not just a transaction, was key.
