ASCs vs. anesthesia coverage: 10 things to know

ASCs continue to grapple with the anesthesia provider shortage as demand for outpatient surgeries grows.

Here are 10 notes on ASCs and anesthesia:

1. ASC growth is impacting anesthesia staffing

The rapid growth of ASCs has made surgeries more accessible to patients, but it has also spread the existing pool of anesthesiologists across more facilities as more operating rooms means more demand.

“Now, you’re not just running 12 operating rooms, you’re running 12 operating rooms and six rooms over at that ASC,” Mark Thoma, MD, and chair of anesthesia at San Francisco-based The Permanente Medical Group told Becker’s. “Maybe you need at least 18 people in the morning instead of 12, and where are they coming in? Whether it’s an anesthesia practice or whether an anesthesia care team with [certified registered nurse anesthetists], you just need those bodies. Within the hospital, we’re seeing the horizontal explosion of non-OR anesthesia – so catheterization labs, gastroenterology, interventional radiology, etc..”

2. Quality anesthesia is driving ASC growth

Many ASC leaders feel top-tier anesthesia coverage is essential to growth.

“The best way to grow your ASC business is to secure top-quality anesthesia coverage,” Adamina Podraza, MD, medical director at Morris, Ill.-based Deerpath Ambulatory Surgical Center, told Becker’s. “An experienced anesthesiologist is invaluable for ensuring efficiency of OR turnover and excellent patient care. For optimal patient satisfaction, it’s crucial that patients can comfortably ambulate from the surgery center with minimal pain or discomfort following their anesthetic and operation.”

3. Rising costs threaten ASC margins

The increase in anesthesia coverage costs are putting pressure on ASC budgets, particularly for independent centers.

“The biggest threat to ASCs right now is stable, cost-effective anesthesia coverage. Subsidy and stipend requests are acutely affecting all our bottom lines,” Kelly Fowler, administrator of Vestavia Hills-based Surgical Institute of Alabama, told Becker’s.

4. ASCs are investing in anesthesia

Many ASCs are shifting their investment strategies to prioritize anesthesia coverage above other needs.

“The biggest investment we will make this year is in staffing and anesthesia coverage,” JoAnn Vecchio, administrator and vice president of ambulatory surgery services at Ambulatory Surgery Center of Western New York, Catholic Health System in Amherst, told Becker’s. “There is a critical shortage in the ASC arena, and being able to keep up with the pay rates at the acute sites and other independent ASCs has been a consistent challenge.”

5. ASCs are pivoting to anesthesiologist employment 

ASCs are adapting their anesthesia strategies by directly employing anesthesiologists, offering them higher salaries and better benefits than they would receive in independent practice.

Andrew Lovewell, CEO of Columbia (Mo.) Orthopedic Group, told Becker’s his practice now employs the anesthesiologists who provide services at COG’s ASC.

“We are short on anesthesia personnel, key business office functions and surgical technicians. Our shortages compound as payers make the process significantly more complicated to get paid for services,” he said. “Finding qualified anesthesia personnel that embrace the high volume orthopedic ASC is a challenge as well.”

6. Other ASCs turn to stipends

ASCs are turning to stipends to attract anesthesia providers in a competitive market.

“We are seeing more and more ASCs needing to offer stipends while still needing to maintain a healthy bottom line,” Ashley Hilliard, MSN, RN, administrator of Deerpath Ambulatory Surgery Center, told Becker’s. “The shortage of anesthesia providers coupled with the demand for higher wages is something to keep an eye on, especially in the smaller ASCs.”

7. Strong data can minimize anesthesia costs

Sophisticated data analytics are now available for surgery centers and Buffalo Surgery Center in Amherst, N.Y., is beginning to embrace the metrics and key performance indicators to drive a stronger business.

“Transparency around first case on-time starts, average case times and surgeon block utilization will help us plan our surgical block time to a higher degree of accuracy,” said Kathleen Regan, RN, BSN, administrator of Buffalo Surgery Center. “In turn, we can capitalize on adding cases for higher daily volumes while also minimizing unnecessary staffing and anesthesia expenses when necessary.”

8. Anesthesiologists are treating higher-risk patients in ASCs

As more complex procedures migrate to outpatient settings, anesthesiologists are dealing with higher-risk patients in ASCs.

“Despite an ever-increasing percentage of patients on Medicare, which typically represents an older and sicker patient population, our profession is taxed with annual cuts, Christian Welch, MD, anesthesiologist at UT Health San Antonio, told Becker’s. “In addition, we are taking care of more ASA 3 and sometimes ASA 4 patients in ASCs. Anesthesia has become very safe, mostly due to the work of the Anesthesia Patient Safety Foundation. That does not mean, however, that our role as perioperative physicians and “guardians” of the OR should be taken for granted.”

9. Anesthesia provider shortage is driven by increased demand and providers leaving the industry

There is expected to be a shortage of 6,300 anesthesiologists by 2026, according to a 2024 white paper from Medicus Healthcare Solutions. There are currently over 7,700 people per one anesthesiologist in the U.S, while over 17% of current providers are nearing retirement and over 56% are over 55.

10. Anesthesia leaders are calling for systemic changes

Addressing the anesthesia provider shortage will require more than just increased pay, according to some industry leaders.

“We cannot solve this just by throwing money at it,” Rafael Cartagena, MD and CEO of North American Partners in Anesthesia said in a sponsored roundtable discussion at Becker’s Hospital Review’s 13th Annual Meeting in 2023. “Professionals under 40 are looking for a different type of work-life balance than the baby boomers they’re replacing. The mismatch in supply and demand means compensation is going up dramatically, but as pay increases, more professionals are choosing to just work less.”