Session: Anesthesia contracts, the must-haves

Editor's Note

“There's nothing worse than putting a contract together, only for the anesthesia providers to say, ‘Oh, no, we're not going to do that,” Mindy Gingery, MSN, CRNA, ARNP, president of Heartland Anesthesia & Consulting, said, opening this morning session on anesthesia contract best practices for ambulatory surgery centers at the OR Manager Conference.

Gingery advised attendees to consider the importance of creating contracts that are both specific and flexible. It might sound contradictory, she noted, but while contract terms should be specific and include realistic expectations, the parties should stay flexible to adjust as needed. "Your best friend is the addendum to the contract," she said, adding the ability to adjust terms over time is essential.

In discussing contract structuring, Gingery differentiated between "short" and "long" contract versions. The short version suits temporary or smaller facilities, covering basic terms like service payment, indemnification, and certification requirements in about four to five pages. The long version, suited for facilities needing permanent anesthesia coverage, is a more detailed 10-page document on average. Regardless of length, Gingery advised against one-sided indemnification. “Don't allow an anesthesia group to come in and say, ‘Well, you have to indemnify me, but I'm not going to indemnify,” she stressed. “Everyone has to have a dog in the fight.”

One key aspect of anesthesia contracting is flexibility around scheduling and provider needs. Gingery outlined scenarios like case cancellations, additional provider requests, and the specifics of coverage timeframes. For instance, she recommends specifying that an "OR day" runs from 7 am to 3 pm given her past experience of having been the last one working due to a lack of defined timeframes. "I charge overtime after those hours—not to be punitive, but to ensure that everyone knows what’s expected," she explained.

Payment models were another focus area. Gingery described several, including daily fees with overtime and monthly retainers, while noting these vary based on the facility’s volume and needs. She also pointed out that working with anesthesia groups as partners rather than external providers can improve efficiency and morale, particularly when anesthesia is responsible for tasks beyond just patient care, such as preoperative testing guidelines and postoperative recovery.

The session concluded with an in-depth look at Stark Law and Anti-Kickback statutes—critical compliance areas in contracting. Stark Law governs physician self-referral, and Gingery clarified that violations can result in hefty fines, even if unintentional. For anesthesia groups, issues often arise with discounted services or referral patterns that may inadvertently breach these rules. Finally, she encouraged attendees to think beyond "bare-minimum" contract terms, advocating for comprehensive planning. By anticipating issues around provider cancellations, overtime, and compliance requirements, facilities can create robust contracts that support smooth operations and protect against costly conflicts.