Anesthesia plays a crucial role in the efficiency and success of ASCs, particularly in gastroenterology procedures.
Five GI leaders recently joined Becker’s to discuss growing challenges and what they believe needs to change to ensure ASCs can continue providing high-quality care.
Question: What is the biggest challenge ASCs face regarding anesthesia today, and if you could change one thing to address it, what would it be?
Seth Gross, MD. Clinical Chief of Gastroenterology and Hepatology at NYU Langone Health (New York City): There are two key challenges ASCs face in regard to anesthesia. There is a shortage of both CRNAs and anesthesiologists, which can limit patient access. Secondly, reimbursement for the service to align with rising operational costs.
Neal Kaushal, MD. Chief of Gastroenterology and Chair of the Department of Medicine at Adventist Health (Roseville, Calif.): I think the biggest challenge ASCs face regarding anesthesia today is the potential for site neutrality legislation to cause major changes in cost structures and reimbursement patterns in ASCs in a hospital outpatient setting versus stand alone centers. I think it is important for physicians and managers to recognize potential changes to reimbursements in the near future and adapt their operations accordingly.
Omar Khokar, MD. Gastroenterologist of Illinois GastroHealth (Bloomington): Simple — rising wages and workforce shortages. Anesthesia helps us run more efficiently so it’s important to have a mutual conversation with them on staffing, CRNA scope of practice and intraprocedure responsibilities so that it’s a “win-win” for the center.
Benjamin Levy, MD. Gastroenterologist and Clinical Associate of Medicine at University of Chicago Medicine: ASCs need to recruit more anesthesiologists and nurse anesthetists due to increased demand for colonoscopies. After the American Cancer Society and GI societies recently changed the screening guidelines to begin screening colonoscopies at age 45 instead of 50, approximately 19 million additional individuals entered the pool of patients needing procedures. Furthermore, the U.S. is experiencing a relative shortage of anesthesiologists and CRNAs due to preferences for propofol during GI endoscopy, increased surgical volume, in general at ASCs, the baby-boomer generation aging, and an aging workforce. It would be great if the federal government could increase funding for graduate medical education in order to expand the number of residency spots to train more anesthesiologists and physicians in general. In 1997, Medicare capped the number of residency positions it funds. In 2021 and 2023, Congress voted to expand Medicare support for graduate medical education and added a limited number of new residency slots. However, it has not been enough to keep pace with the number of anesthesiologists needed, especially when considering the increased needs in gastroenterology endoscopy. In gastroenterology, we are working hard to increase colorectal cancer screening rates nationally to remove polyps before they turn into cancer — so we need additional gastroenterologists and anesthesiologists to help this effort.
