Session: Riding the Wave—Considerations to Making Anesthesia Profitable in Today’s Labor Market

Editor's Note

The OR Business Management Conference this year for the first time offered a lineup of sessions that was fully dedicated to content relevant to ambulatory surgery centers (ASCs). In this session, Collin Pick, MSN, CRNA, ARNP, CMPE, chief of anesthesia, Physician Partners of America, explored the ongoing anesthesia staffing crisis, its financial impact on ASCs, and practical strategies for nurse leaders and facility administrators to optimize anesthesia services while maintaining profitability. The discussion covered the shortage of anesthesia providers, rising labor costs, declining reimbursements, and practical solutions to mitigate these challenges.

Some key insights included:

1. Anesthesia staffing crisis, financial pressures

   • There is a high demand and low supply of anesthesia providers, particularly certified registered nurse anesthetists (CRNAs) and anesthesiologists.
   • 17% of anesthesiologists are projected to retire in the next 10 years.
   • CRNA and anesthesiologist assistant (AA) programs have limited capacity and long training timelines, leading to slower workforce replenishment.
   • Over 50% of anesthesia providers report feeling overworked and stressed, and 60% would accept lower pay for better work-life balance.
   • Labor costs have doubled since 2020, with CRNA hourly rates increasing from $100–$125/hour to $175–$200/hour.
   • Sign-on bonuses post-COVID-19 skyrocketed, with some hospitals offering $140,000+ incentives to attract anesthesia providers.
   • Hospitals have more financial leverage to compete for anesthesia staff, making it harder for ASCs to retain talent.

2. Declining reimbursements, supply chain disruptions

   • Medicare reimbursement has declined by 5.5% since 2019, with another 8.5% reduction projected.
   • Blue Cross Blue Shield now limits CRNA reimbursement to 85% of standard Medicare rates.
   • Insurance carriers are increasingly capping anesthesia reimbursement based on estimated surgical times, meaning any additional anesthesia services beyond the set timeframe are unpaid.
   • Some insurers briefly proposed capping anesthesia time reimbursements, though this was retracted following industry backlash.
   • COVID-related supply chain issues continue, impacting IV fluids and essential anesthesia medications.
   • Major manufacturing plant shutdowns (eg, Baxter plant fire in North Carolina) have contributed to persistent shortages.
   • National Drug Shortage Alerts are available via ASHP to help ASCs plan ahead.
   • High-cost anesthesia drugs like Sugammadex (Bridion) should be carefully reviewed to ensure cost-effective utilization.

3. Optimizing anesthesia staffing, cost management

   • Staffing solutions:
     • Leverage CRNAs where permitted by state regulations, as they provide the most cost-effective anesthesia coverage.
     • Maintain a deep bench of 1099 contractors to cover PTO, illness, and unexpected provider shortages.
     • Self-scheduling platforms can offer cost savings over traditional recruitment agencies.
     • Secure anesthesia coverage 3+ months in advance to avoid last-minute cancellations and high-cost locum fees.
   • Efficiency and cost reduction strategies:
     • Maximize anesthesia provider utilization by implementing the team care model (one anesthesiologist supervising multiple CRNAs or AAs).
     • Prevent overtime expenses by adjusting scheduling, including stacking longer recovery cases in the morning to minimize late-day overtime costs; implementing moderate sedation protocols for certain GI and pain management cases, reducing reliance on anesthesia providers; engage surgeons in cost discussions, particularly around CRNA supervision requirements, to gain buy-in on cost-effective anesthesia models.
   • Reducing waste in anesthesia services:
     • Minimize drug waste by ordering smaller vial sizes and reducing pre-drawn but unused medications.
     • Ensure sharps containers are used only for sharps to avoid unnecessary disposal costs.
     • Turn off oxygen between cases and at the end of the day to avoid unnecessary usage and costs.

4. Leveraging technology, data to improve efficiency

   • Implement electronic health records to streamline anesthesia documentation and reduce redundant charting.
   • Monitor case start times to prevent idle OR staff costs—adjust block times for consistently late surgeons to avoid paying staff for unnecessary downtime, and improve surgical time accuracy to prevent under- or overbooking.
   • Benchmark anesthesia provider performance, ensuring documentation accuracy and compliance with value-based payment initiatives such as MIPS (Merit-Based Incentive Payment System).
   • Build flexible anesthesia staffing models that can adapt to new surgeon onboarding without overcommitting full-time anesthesia salaries.
   • Consolidate anesthesia coverage across multiple ASCs to maximize provider efficiency.
   • Charge surgeons for unused block time or reallocate OR slots if utilization consistently falls below expectations.

The anesthesia staffing crisis, rising labor costs, and declining reimbursements pose significant challenges for ASCs, but proactive scheduling, cost containment strategies, and efficient staffing models can help nurse leaders and administrators navigate these issues.