Surgery center owners and administrators are keeping a close eye on the landscape.
ASCs rely on great anesthesiologists and anesthesia group partnerships to perform their procedures, but in some markets independent anesthesiologists are hard to find.
"In the last decade, you saw a lot of independent anesthesia groups forming their own PCs and working in office-based surgery centers and hospitals," said Elisa Auguste, CASC, Administrator of Precision Surgery Center and board member of the New York State Association of Ambulatory Surgery Centers, on the Becker's Healthcare Podcast. "Now, especially with payer trends and especially in New York, there has been a significant decrease in reimbursements for anesthesia, making it difficult for independent groups to survive. What I feel is happening right now is a lot of groups are either breaking apart or selling off to hospital systems to become employed, or different surgery centers are employing their own individual anesthesiologists or paying stipends to keep independent groups afloat."
Medicare reimbursement for anesthesia dropped 2 percent from 2022 to 2023 while the demand for anesthesiologists increases, according to a report from VMG Health. The anesthesiologist shortage has increased competition, leading to a 15 percent increase in anesthesiologist pay from 2021 to 2022 and 4.4 percent increase in CRNA pay, according to the MGMA 2023 Provider Compensation and Production Survey Report. Anesthesiologist compensation is now nearly $500,000 per year.
The anesthesiology workforce is also changing. The Association of American Medical Colleges reported around 43 percent of active anesthesiologists are younger than 55 years old, meaning more than half of the currently practicing anesthesiologists are nearing retirement. By 2023, there is a projected shortage of 12,500 anesthesiologists nationwide.
"Going forward, health systems, ASCs, and anesthesia partners may need to consider alternative partnerships including acquiring the practice, negotiating a new professional services agreement or amending an existing one, and/or considering recruitment assistance. Regardless of the avenue, the anesthesia practice will likely require some sort of direct support (e.g., through revenue guarantees or subsidy arrangements) to ensure they are able to recruit and retain providers," wrote Mallorie Holguin and Patrick McGinn in the VMG Health report.
ASCs will need to get creative to ensure anesthesia coverage for safe and efficient patient care. Owners must also consider regulatory guardrails for compliant anesthesia partnerships as they pivot.
"I think what's going to happen over the next decade is you're going to see a lot of either stipends being paid or anesthesiologists being hired directly by their own surgery centers," Ms. Auguste said. "I think we're heading towards the last days of independent anesthesiologists."