Becker's Spine Review

20 ASC What an ASC did to avoid room shutdowns By Laura Dyrda A ndrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, realized his surgery center had a problem. e demand for services was high, but cases couldn't get scheduled because of gaps in anesthesia coverage. "We were going to maybe potentially shut down rooms or we had to shut down rooms intermittently," said Mr. Lovewell on the "Becker's Ambulatory Surgery Centers" podcast. "at hurts the bottom line because if you can't do surgery, you can't figure out how to pay all the costs associated with running a big ASC like ours." e surgery center had to rethink its anesthesia model to survive. And it's not alone. "One of the biggest things is if you're in the ASC world and you're doing cases, you can't turn your attention away from the anesthesia crisis we're facing," said Mr. Lovewell. "We did a pivot here internally where we've actually taken the stance of employing our own anesthesia group that used to provide services for us." Columbia Orthopedics, which has around 30 musculoskeletal physicians and owns a large surgery center, brought on the anesthesiologists as employees with fully aligned incentives for future growth and expansion. Mr. Lovewell increased the benefit package and compensation level for the anesthesiologists upon employment to stay competitive in the market and make sure the surgery center had top talent. "It's very imperative for us to be able to turn cases over quickly and find people who want to work in that atmosphere," said Mr. Lovewell. "e anesthesia crisis across our country is one thing that everyone in our ASC space is facing and we have to keep that top of mind." Employing anesthesiologists could make sense for the anesthesia group as well, especially if the surgery center has a better benefits package. "If they're a smaller group, they can't get the same rates with health insurance or dental or vision, but let us employ them, let us figure out what the comp model needs to look like, the vacation, the CME to everything that's necessary," said Mr. Lovwell. e lead physician of the anesthesiology practice worked with Mr. Lovewell and his team to align on the mission and model for ASC employment. e group started the transition Jan. 1, and has made adjustments since then. Mr. Lovewell said it has been a "mindset shi" to bring on anesthesia as a different business line. "It's hard to find talent in that area, especially that want to work at the level that's demanded in an ASC because our expectation for turnover times or case turnaround, or all those things, is quite different than the hospitals," said Mr. Lovewell. His surgery center has a turnaround time of 10 minutes or less for most cases, as compared to a 30 minute target for many cases at the hospital. "What we're discovering and finding in the anesthesia space is if we incentivize production and productivity and throughput, make sure our staff are well taken care of, and compensated and well respected, we're creating a winning environment that way," said Mr. Lovewell. n ASCs offer anesthesiologists stipends as competition heats up By Laura Dyrda S ome ASCs have had their patient volumes and bot- tom lines affected by the inability to access anesthesia providers. "The continued shortage of anesthesiologists has led to many surgery procedures having to be canceled and/or postponed both in the hospital as well as the ASC setting," Bruce Feldman, administrator of Bronx (N.Y.) Ambulatory Surgery Center, told Becker's. Surgery centers are rethinking their anesthesia models as the landscape becomes more competitive, which is a daunting prospect. There are clear regulatory hurdles to meet, and securing anesthesiologists may require additional compensation. "We are seeing more and more ASCs needing to offer stipends while still needing to maintain a healthy bot- tom line," said Ashley Hilliard, MSN, RN, administrator of Deerpath Ambulatory Surgery Center. "The shortage of anesthesia providers coupled with the demand for higher wages is something to keep an eye on, especially in the smaller ASCs." Andrew Lovewell, CEO of Columbia (Mo.) Orthopedic Group, is also concerned about the anesthesia provider shortage. His practice now employs the anesthesiologists who provide services at COG's ASC, providing higher sala- ries and better benefits than the group had when it was independent. But employing anesthesiologists has its own set of challenges, and his group is still looking to hire more providers. "We are short in anesthesia personnel, key business office functions and surgical technicians. Our shortages com- pound as payers make the process significantly more com- plicated to get paid for services," he said. "Finding quali- fied anesthesia personnel that embrace the high volume orthopedic ASC is a challenge as well." n

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