Weathering the storm in Anesthesiology: making the business case and demonstrating the value of Anesthesiology

There are significant challenges in the field of Anesthesiology.

While demand is growing for Anesthesiology services, there is a severe shortage of Anesthesiologists, CRNAs and Certified Anesthesia Assistants, and the field of Anesthesiology is feeling the brunt of disruptions and realignments in healthcare. In addition to navigating the labor crisis, Anesthesiology can also elevate its value proposition and find strength in numbers.

During the Becker's ASC Review and Becker's Spine Review 19th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference, in a workshop sponsored by SCA Health, Kathy Grichnik, MD, Chief of Anesthesia Services at SCA Health, discussed key challenges Anesthesiology operators are facing in the outpatient market and how to overcome them.

Four key insights were:
1. Anesthesia is critical to the entire ASC care experience. Anesthesia does not begin and end in the operating room; it plays a central role across the entire spectrum of care delivery, affecting clinical outcomes and overall patient satisfaction. The involvement of anesthesiologists spans decision-making as to the appropriateness of referring a patient to an ambulatory facility, pre-surgical optimization, preoperative assessment, interoperative care, acute recovery, and discharge. "Part of managing value-based care rests on our ability to collaborate with all physicians, especially those with independent practices," Dr. Grichnik said.

2. Despite their centrality, anesthesiologists are facing a hostile operating and business environment. Some of the trends causing headwinds include consolidation among independent physician practices, narrowing provider networks, cancellation of contracts and continuously sliding reimbursement rates by commercial and private payers. These shifts are impacting anesthesiologists' negotiation leverage even as demographic-driven demand for their services is increasing. The Association of American Medical Colleges predicts a shortage of 12,500 anesthesiologists by 2033.

3. To demonstrate value against challenging market forces, anesthesiologists need data. The most direct way to show the role of anesthesiology in achieving quality outcomes is by having access to performance metrics. "It gives you the opportunity to have a data-aligned discussion," Dr. Grichnik said, noting that alignment among surgeon, anesthesia and facility management stakeholders is essential to a high-performing ASC.

For example, alignment is necessary around preoperative assessment, interoperative protocols, medication choices and types of anesthesia. Key performance indicator dashboards that keep track of quality metrics such as case cancellation reasons, first-case on-time starts, clinical hours worked per case, medication spend, and post-anesthesia care unit (PACU) length of stay can support such discussions.

4. Financial support for anesthesiology operators comes from becoming preferred providers and aiming for economies of scale. To achieve revenue continuity, anesthesiologists should consider partnering across multiple sites in a geographic region, be open to all types of value-based agreements and potentially merging with another or larger anesthesia group instead of going it alone.

High-quality anesthesiology services are crucial to ASCs’ goals to increase volume, profitability, and growth. To highlight the value they bring, Anesthesiologists should be able to demonstrate performance metrics, staffing alignment with the Facilities. support of revenue cycle operations and alignment with the construction of value-based programs.

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