ASCs are poised for growth over the next several years as CMS and payer policy, patient preference and demand for surgical services push more cases into the outpatient setting.
While this potential for growth is promising for many ASCs, anesthesia coverage remains a core issue as the shortage of anesthesia providers persists across the country, particularly in more rural or underserved areas.
Adam Kuz, CRNA, is an executive board member at Dearborn, Mich.-based Specialty Medical Center. He told Becker’s that in order to meet the hike in demand, healthcare organizations must first and foremost recognize the threat that the anesthesia provider shortage poses to care access.
“The biggest advocacy I’ve tried to do in this profession is to address the issue of access to care,” he said. “Whether it’s elective surgery or emergency surgery or chronic pain over the years, it’s still an access issue. The biggest thing [moving forward] is how we are modernizing healthcare.”
A pivotal moment in care access came during the COVID-19 pandemic, he said, when federal policies enabled nonphysician providers to practice at the top of their license to meet the spike in demand for healthcare services. In the years following the pandemic, numerous states have opted out of the federal Medicare physician supervision requirements for CRNAs or have passed other legislation to grant CRNAs more autonomy in their practice.
“We have this untapped resource. If everyone would just practice to their fullest training, their fullest level of licensure, then that can at least one aspect address the shortage of providers,” Mr. Kuz said.
“What I try to do is advocate that with the board, and there’s many physicians on the board, as well, and say, ‘Hey, if there’s any concerns, we have to have this clear talk like any other ASC would, where, if we’re doing CRNA-only cases as an anesthesia provider, versus with an MD [anesthesiologist]-supervision or versus an anesthesiologist-only case, what are your concerns?’” he continued. “And let’s bring that to the table now and have this open transparent discussion.”
He said that many of his fellow board members were not even aware that other staffing models were possible, having come from hospital settings with physician supervision models.
“When we broke down the economics of it all, I told them: We have the evidence and the economics,” he said. “I brought studies that showed no difference in safety and outcomes depending on who the anesthesia provider was, as well as the evidence or the economics [that demonstrate] this is why more and more ASCs are going to CRNA only models, or maybe collegial models.”
A white paper from Medicus Healthcare Solutions found that 75% of CRNAs reported practicing without physician oversight, as of 2023. Additionally, CRNAs now account for over 80% of anesthesia providers in rural counties and administer more than 50 million anesthetics annually in the U.S., according to the report.
While momentum is building around CRNA-centered practice, critics continue to argue that physician-led models offer higher standards of care.
“Anesthesia-without-physician oversight is rare. Nearly everyone in our country –– 95% of the population – lives where a physician-led, team-based model of anesthesia care is the expected, standard practice. The nation’s top-rated hospitals all employ the physician-led model; not a single one of these institutions allows nurse-only anesthesia care. Physician-led care is the status quo and the model that safeguards patient safety,” Ronald Harter, MD, immediate past president of the American Society of Anesthesiologists told Becker’s. “While a handful of states are removing physician supervision requirements, the physician-led anesthesia model of care is still the predominant one being used.”
But CRNA advocates counter that CRNA-only or hybrid models maintain a high standard of patient safety.
“There have been numerous studies showing that nurse anesthetists’ outcomes are the same as physician anesthesiologists. It’s already happening — CRNAs are already working independently,” Melissa Picceri Croad, a CRNA who provides anesthesia services throughout Massachusetts and New Hampshire and serves as the government relations director for the Massachusetts Association of Nurse Anesthetists, told Becker’s in 2024. “If we were unsafe and killing people, we would know it. My response to that would be, ‘Where are we stuffing the bodies?’ The best study is the status quo. CRNAs are already working independently everywhere and we just don’t see a problem with that. Especially in the rural areas.”
Mr. Kuz maintains that this shift is a necessary part of navigating the shortage of providers and challenges of healthcare in 2025.
“I always go back to modernized healthcare. It’s just part of that. How can we address this shortage and declining anesthesia reimbursements while still being able to survive as an independent ambulatory surgery center?” he said. “And [the board members] read the articles, asked questions, and they saw how this is a feasible answer to the short term problem of anesthesia provider shortages right now.”