After years of hesitation, payers and large health systems have come around to the astonishing clinical and financial benefits of ambulatory surgery centers. As a result, the market is exploding with repeated announcements of new facilities across the US. But in the long term, what does succeeding as an ambulatory surgery center take? What are some of the blockers administrators are facing? And who can help?
At the moment, ASCs have significant tailwinds. Their existence alone is a major benefit for patients seeking easier access to care and a financial windfall for physicians looking for better quality of life. However, for the model to succeed, hospital-informed thinking on how to operate and manage resources needs to be reconsidered.
To really thrive, ASCs need to look to surgeons and proceduralists that have been safely, effectively, and successfully working outside of hospitals for the past 30 years, and how so much of that can revolve around effective anesthesia.
Let’s get into how.
First, a common assumption surgeons (and administrators) make when transitioning to an ambulatory setting is that they are limited to conscious sedation or, barring that, a fully in-sourced anesthesiologist.
In short, the most effective anesthesia partner should be able to provide the anesthesiologist, critical care trained nurses for perioperative care, all drugs, equipment, and billing (though this approach should be as adaptable as it is thorough: an ASC may not require as much support as an office-based practice). In doing so, anesthesia is removed as a limiter to surgical throughput and patient turnover. At that point, the only rate limiting factor on patient volume is how fast the doctors on staff can safely and diligently perform procedures or, in the case of a GI facility, how fast the scopes can be cleaned.
In cases where an anesthesiologist or CRNA is already on staff and where throughput isn’t a limiting factor, there’s still what we’ve come to refer to as the “abrasion factor.” Namely, that even the greatest anesthesiologist or CRNA becomes a single point of failure, not because of their performance, but because they are only one person, and they have a life (that they deserve to live!). They can get sick, they deserve vacation time, and they still need to be managed as an employee of the practice, which means benefits, liability, salary negotiations, interpersonal conflicts, etc. As a result, cases are lost due to lack of an anesthesia provider, or conscious sedation needs to be used instead of a more appropriate approach, or there is an incremental cost to bring in and manage a locums provider.
Succeeding as an ambulatory surgery center means partnering with an anesthesia platform provider removes virtually all of that or, more accurately, makes it somebody else’s complexity to manage. If that anesthesia partner is also the one handling their own billing and negotiating their own contracts with payers, that takes even more off of virtually everyone’s plate.
The next question that often comes up with these discussions is, “what, should I fire Dr. Smith, my in-house anesthesiologist? Or Chris, my CRNA?” No, of course not.
Bringing in an anesthesia partner to resolve the issues above can also be used to fuel growth without requiring additional hiring on the part of the practice or ASC. That means no job postings, no interviews, no CV review, you just call your anesthesia partner and say, “We need more support” and it’s there.
Additionally, there are contract arrangements that can more effectively bring in-house anesthesiologists or CRNAs to the platform, fully removing any management, cost, and billing from the ASC while ensuring excellent pay and continued quality of life (as well as maintaining established working relationships) for the formerly in-sourced anesthesia team. At that point, the anesthesia arm of any practice also has the full backstop of a dedicated anesthesia partner.
The trap of hospital thinking; that everything must be owned, operated, and done by an inside team, is exactly the sort of quagmire that ASCs can be effective at avoiding. They’re built on the premise of exactly that for the surgeons and proceduralists. By extending that same logic that’s leading to such a dramatic boom in the number of ASCs across the country, they truly can lead to a sea change for patients and doctors alike, living up to the intended mission of the quintuple aim.
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