Profitability is often the key to fostering a positive relationship between anesthesiologists and ambulatory surgery centers. "If there is a harmonious relationship between the surgeons and everyone has the same goal, that's ideal," says Charles Tullius, MD, a board certified anesthesiologist in Pittsburgh. "But you ultimately want to be profitable and to have a lot of patients."
Dr. Tullius and Neil B. Kirschen, MD, a board certified anesthesiologist in Rockville Center, N.Y., discuss profit-driven strategies for improving the relationship between anesthesiology groups and ambulatory surgery centers.
1. Maintain strong relationships with endoscopists and pain management physicians. Anesthesiologists can increase their productivity within the ambulatory surgery center, and thus maintain a positive relationship with the center, by keeping in consistent contact with physicians who can repeatedly perform cases there. "Even though we're anesthesiologists, we're acting as surgeons — trying to solicit work or keep it in the ASC," says Dr. Kirschen.
Anesthesiologists that maintain strong relationships with endoscopists and pain management physicians, for example, can more readily encourage them to perform cases in ambulatory surgery centers. To accomplish this, Dr. Kirschen says, it is important to give these physicians consistent and respectful personalized attention. "Make sure you don't cancel too many cases, make sure you personally handle what is brought to you," he says. "Being personal, affable and affordable is the best way to meet with a physician."
2. Tailor anesthetics to the ambulatory surgery center setting. Anesthesiologists can also maximize their productivity by ensuring that patients are alert and awake soon after surgery. Ambulatory surgery centers prefer to admit and discharge patients expediently, and anesthesia technique should be adapted to this strategy, Dr. Kirschen says.
If the anesthesiologist provides a higher dosage of certain painkillers, patients may experience post-operative nausea that will delay recovery and discharge, for example. "You have to know how to use short-acting agents appropriately," Dr. Kirschen says. The best-case scenario is when a patient is awake and able to speak as they are brought to the recovery room following the operation. "You can't give them enough medicine so that they spend the night," he says.
For some anesthesiologists, however, this type of anesthesia care is not intuitive. "Most doctors who work in hospitals have never had to learn about fast turnover, so for them, it really is about learning a new technique," Dr. Kirschen adds. "Those doctors either have to stay in the hospital or take an apprenticeship under another anesthesiologist to learn to find out what the [ambulatory surgery center] techniques involve."
3. Bring shorter cases to the surgery center. Shorter cases such as gastroenterology procedures and podiatry cases will minimize scheduling issues and reduce the risk of time gaps between cases, says Dr. Tullius. "You want to aim for cases that are under an hour, and a lot of them," he says.
Shorter cases are more conducive to profitable billing for the anesthesiology group and, ultimately, the surgery center, says Dr. Tullius. "Anesthesia billing goes by base units, then time units," he says. "Time units aren't worth very much once you cross over the two-hour mark, so in order to justify and generate a salary for anesthesiologists and nurse anesthetists, you need to have to have four CRNAs being supervised by one anesthesiologists, all performing a lot of cases."
4. Ensure that the surgery center is appropriately located in a patient-heavy market. Prior to contracting with a surgery center, an anesthesiology group should verify that the center has enough patients in its catchment area, or the population from which the facility would draw cases, Dr. Tullius says.
A market populated with cases lasting longer than four hours is not likely a profitable option for an anesthesia group because those procedures are not typically performed in ambulatory surgery centers, he says. Sick patients or morbidly obese patients with sleep apnea, for example, are not good candidates for surgery centers because the patients often require more postoperative care and would be more likely to have the procedure done in a hospital.
Anesthesiology groups may also cancel lengthier cases because they are not profitable, says Dr. Tullius, which can lead to friction between the group and the surgery center. To avoid the surprise of cancelled cases, he says, "it should be hammered out in the contract, in advance, that the anesthesia group has the final word on which cases are done."
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Dr. Tullius and Neil B. Kirschen, MD, a board certified anesthesiologist in Rockville Center, N.Y., discuss profit-driven strategies for improving the relationship between anesthesiology groups and ambulatory surgery centers.
1. Maintain strong relationships with endoscopists and pain management physicians. Anesthesiologists can increase their productivity within the ambulatory surgery center, and thus maintain a positive relationship with the center, by keeping in consistent contact with physicians who can repeatedly perform cases there. "Even though we're anesthesiologists, we're acting as surgeons — trying to solicit work or keep it in the ASC," says Dr. Kirschen.
Anesthesiologists that maintain strong relationships with endoscopists and pain management physicians, for example, can more readily encourage them to perform cases in ambulatory surgery centers. To accomplish this, Dr. Kirschen says, it is important to give these physicians consistent and respectful personalized attention. "Make sure you don't cancel too many cases, make sure you personally handle what is brought to you," he says. "Being personal, affable and affordable is the best way to meet with a physician."
2. Tailor anesthetics to the ambulatory surgery center setting. Anesthesiologists can also maximize their productivity by ensuring that patients are alert and awake soon after surgery. Ambulatory surgery centers prefer to admit and discharge patients expediently, and anesthesia technique should be adapted to this strategy, Dr. Kirschen says.
If the anesthesiologist provides a higher dosage of certain painkillers, patients may experience post-operative nausea that will delay recovery and discharge, for example. "You have to know how to use short-acting agents appropriately," Dr. Kirschen says. The best-case scenario is when a patient is awake and able to speak as they are brought to the recovery room following the operation. "You can't give them enough medicine so that they spend the night," he says.
For some anesthesiologists, however, this type of anesthesia care is not intuitive. "Most doctors who work in hospitals have never had to learn about fast turnover, so for them, it really is about learning a new technique," Dr. Kirschen adds. "Those doctors either have to stay in the hospital or take an apprenticeship under another anesthesiologist to learn to find out what the [ambulatory surgery center] techniques involve."
3. Bring shorter cases to the surgery center. Shorter cases such as gastroenterology procedures and podiatry cases will minimize scheduling issues and reduce the risk of time gaps between cases, says Dr. Tullius. "You want to aim for cases that are under an hour, and a lot of them," he says.
Shorter cases are more conducive to profitable billing for the anesthesiology group and, ultimately, the surgery center, says Dr. Tullius. "Anesthesia billing goes by base units, then time units," he says. "Time units aren't worth very much once you cross over the two-hour mark, so in order to justify and generate a salary for anesthesiologists and nurse anesthetists, you need to have to have four CRNAs being supervised by one anesthesiologists, all performing a lot of cases."
4. Ensure that the surgery center is appropriately located in a patient-heavy market. Prior to contracting with a surgery center, an anesthesiology group should verify that the center has enough patients in its catchment area, or the population from which the facility would draw cases, Dr. Tullius says.
A market populated with cases lasting longer than four hours is not likely a profitable option for an anesthesia group because those procedures are not typically performed in ambulatory surgery centers, he says. Sick patients or morbidly obese patients with sleep apnea, for example, are not good candidates for surgery centers because the patients often require more postoperative care and would be more likely to have the procedure done in a hospital.
Anesthesiology groups may also cancel lengthier cases because they are not profitable, says Dr. Tullius, which can lead to friction between the group and the surgery center. To avoid the surprise of cancelled cases, he says, "it should be hammered out in the contract, in advance, that the anesthesia group has the final word on which cases are done."
Learn more about NAPA Anesthesia Management.
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