The anesthesiologist shortage will likely not end anytime soon.
Yet for ambulatory surgery center (ASC) operators, there are fixes that can help keep their centers running smoothly, such as collaborating with anesthesia providers, balancing payer mixes and making sure operating rooms are functioning efficiently.
“In the past, anesthesia, surgeons and surgery centers often had a contentious relationship,” Alfonso del Granado, administrator of Covenant High Plains Surgery Centers in Lubbock, Texas, said on the Ambulatory Surgery Center Association’s (ASCA) Advancing Surgical Care Podcast. “Surgeons thought anesthesia should just do their jobs and put my patient to sleep, and so there was always a little bit of tension and a little bit of hostility.”
del Granado is also an ASCA board member.
Fostering a collaborative relationship between anesthesiologists and the ASC team requires a shift in mindset, del Granado said.
To make sure all the key stakeholders are on the same page, del Granado’s team reframed its approach.
“We view our anesthesiologists as part of the care team, and as a result, we are planning each day, planning each case, taking their needs and their perspectives into consideration,” he said. “We’re all in this together today, and I think that was a bit of a mental change of perspective that was essential for us to be able to establish the types of relationships that we needed.”
The rising cost of anesthesia has changed behaviors, he added.
“We were running some very inefficient rooms, you know, one or two cases, because the surgeons figured, well, nurses are here, techs are here,” he said. “I could throw on a case and at least I’ll make something that day, but with the cost of anesthesia being so high, it’s now impossible to have that kind of attitude.”
Still, by scheduling anesthesia resources efficiently, his center was better able to cope with rising costs.
His facility follows general guidelines common in many surgery centers, such as estimating that three GI procedures or general surgery cases can cover the cost of operating a room, del Granado said. The ASC applies a similar approach when evaluating the productivity of its anesthesia providers.
“We need them to have a profitable day, because if they’re making money, then that lowers or eliminates the subsidy that we have to pay out,” he said.
Balancing competing interests is also key.
“You may see that an orthopedic surgeon wants to put on a big case, but a GI wants to put on eight small cases,” he said. “And in those circumstances, it’s easier to move one case than it is to move eight. And from an anesthesia perspective, those GI cases actually pay fairly well.”
Managing payer mix challenges
With the low reimbursement rates from government payers like Medicare, balancing payer mix is key, del Granado said.
“Unfortunately, Medicare is a little bit over a third of our volume, so we can’t make a blanket exclusion for Medicare cases,” he said.
His team experimented with limiting anesthesia for ophthalmology cases but ultimately found that it was not financially viable.
“We put an extra nurse in the room to monitor the patient,” he said. “The ophthalmologist was supervising, available if, obviously, there’s an emergency. And what we found after two months was that, again, for our payer mix and our configuration, the way our centers are structured, we actually lost money for the anesthesiologist during that period.”
Ultimately, transparency and collaboration between ASCs and anesthesia providers is the best way to start, del Granado said.
“We put our cards on the table, and to their credit, so did our anesthesia group,” he said. “We had not had a collaborative relationship in the past. So obviously there was a little bit of lack of trust at the beginning, but we did our own analysis on costs and revenues.”
Their management company conducted an independent analysis, and the results were nearly identical to the figures reported by the anesthesia group, differing by only 1%, del Granado said.
“There was full transparency, and that won a lot of trust between us,” he said.
