Anesthesiology growth located 'outside the hospital-based operating room,' physician says

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ASCs are a key growth opportunity for anesthesiologists, according to Andrew Leibowitz, MD. 

Dr. Leibowitz is a professor and chair of the department of anesthesiology, perioperative and pain medicine at New York City-based Mount Sinai Health System. He spoke with Becker's ASC Review about anesthesiology reimbursement challenges and opportunities for growth. 

Editor's note: This interview was edited lightly for clarity. 

Question: What's the most significant opportunity for growth in anesthesiology?

Dr. Andrew Leibowitz: Currently, the demand for anesthesiology services exceeds supply, but that will not last forever. The main growth opportunity is to think outside the hospital-based operating room. Opportunities such as ASCs, participation in joint-quality improvement projects, patient satisfaction initiatives and fine tuning operations to minimize cancellations and complications while optimizing early discharge are all key to maintaining a large clinical operation and demonstrating your worth before and after the patient is anesthetized. Anesthesiologists should also note their critical care expertise, particularly in cardiac surgical intensive care units.

Q: What are the biggest reimbursement challenges in anesthesiology?

AL: Anesthesiology practices with a large governmental payer mix require a substantive subsidy from the sites they staff. Anesthesiologists may provide on average 10,000 to 15,000 [American Society of Anesthesiologists] relative value units of work per year. In most states, Medicaid pays approximately half what Medicare does. So, the biggest reimbursement challenge is to not succumb with commercial payers to a "multiple of Medicare contract" when Medicare is so grossly underpaying anesthesiologists to begin with. Further, many anesthesiology groups have experienced commercial payer contracts unilaterally revoked and rates significantly decreased before the end of the written contract cycle.   

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