Marc Koch, MD, MBA, is an anesthesiologist and president and CEO of Somnia Anesthesia Services.
Q: What are the major challenges ASCs face with regard to addressing their anesthesia needs?
Dr. Marc Koch: One of major challenges is realizing that options exist. Although local clinical talent can be found in communities throughout the country, an often overlooked alternative is enlisting the assistance of a long-tenured anesthesia management company to help oversee the creation and management of a department of excellence. The best anesthesia management companies view local clinical talent as a key ingredient in that effort; they also appreciate the importance of other, non-clinical facets of providing anesthesiology services such as the determination of the right mix of MDs and CRNAs, the implementation of best practices and quality management programs and contracting with payors to ensure that billing and collections are optimized. Certain of these companies can also address the full array of human resource management. Beyond coalescing local clinicians to create a stellar clinical team, they can ensure that vacation contingencies are addressed, benefits and payroll are effectively managed and any conflicts are identified early, before they can negatively impact patient safety or bottom lines.
Q: What factors are driving these issues?
MK: Just as clinical problems and solutions have grown more complex, so too have administrative and operational concerns. They both are important and impact each other. For instance, ineffective payor contracting and revenue management leaves insufficient resources to launch a quality management program or, more fundamentally, to hire good clinicians. It also may result in a request for subsidization from the surgery center — a need that would be eliminated if processes and programs were efficient and effective from the start. Similarly, ineffective, inefficient or untalented clinical staff can generate dissatisfaction among patients and surgeons, a result even the best management cannot masquerade. Complicating effective and cost-effective management is the imbalance between anesthesia provider supply and demand. The number of clinicians who want to retire or scale back exceeds that of those who are entering the field, a reality complicated by the burgeoning growth in office-based surgery which has created even more demand. This has escalated compensation to levels that may be sobering to surgery centers whose volume and payor mix falls a little short of where it needs to be.
Q: Why hire an anesthesia management company instead of an anesthesiologist?
MK: Working with an anesthesia management company lets the ASC focus on its core competency: providing a safe and secure environment for outpatient surgical patients in the most fiscally prudent manner. They offer sole-source accountability and responsibility for the many facets of a successful anesthesia department and can offer the support and managerial foundation that allows local clinical talent to focus on patients and their needs. At their core, most anesthesia management companies are stewards of value — that is, they know how to achieve the best outcomes given available resources. And in today's environment, where resources are short and providers costs high, that job is not easy.
When issues or potential problems arise, an anesthesia management company can swiftly and efficiently develop and implement solutions while addressing existing relationships with surgeons and nurses and overcoming personality issues. In a case where an existing anesthesia group might follow a blended model, employing MDs and CRNAs, the management company can often mitigate seniority or governance issues and facilitate a better outcome.
Finally, it is a misconception that anesthesia management companies "parachute in" clinical staff from all over. The best companies recruit local talent and work closely and collaboratively with them to create centers of excellence at the facilities they serve. By doing so, they create mutually beneficial relationships among patients, clinical and administrative surgery center staff and anesthesia providers. That's an ideal situation for everyone.
Learn more about Somnia Anesthesia Services.