2. Why did you regret selling a portion of the ASC to the anesthesia owners?
RG: We had to terminate the anesthesia contract and it was difficult getting the shares back. If you let anesthesia providers purchase shares, you need to have a mechanism in place that allows you to get the shares back if they are no longer working at your facility.
3. How did you address this bad arrangement?
RG: Legal action.
4. Were there any other arrangements you have had with anesthesia providers that did not work out well?
RG: I managed a center in Phoenix years ago that was very difficult because each surgeon had their own anesthesia provider(s) that followed them from one facility to another. We had 150 anesthesia providers at one time. Talk about a credentialing nightmare!
We also had no control over cost containment. They all wanted to use different drugs and equipment and follow different standards of care. An example was surgery site identification for ophthalmology surgery. Some of the anesthesia providers wanted the X above the eye to mean "not this side;" others wanted it to mean "yes this side.” We finally hired a medical director/chief of anesthesia that was the traffic cop.
5. What type of relationship with anesthesia do you prefer?
RG: Employed providers seem to work the best in our environment. They don’t have to worry about getting paid for the procedure and can focus on providing care for the patient. It also allows the anesthesia staff to be part of the facility. They attend staff meetings and have duties assigned as needed. Physicians’ Surgery Center should make about $200,000 in net revenue in 2008 from anesthesia revenues (MDs make $380,000/year and CRNAs make $210,000/year with benefits).
