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5 Areas Where Problems Occur Between ASCs and Anesthesia Groups — and How to Fix Them

Conflicts are bound to arise between surgery centers and contracted anesthesia providers, but Thomas Wherry, MD, says open communication combined with a few simple steps can thwart problems and develop healthy working relationships between partners.

Wed Aug 29 2012By Jayme McKelvey

Conflicts are bound to arise between surgery centers and contracted anesthesia providers, but Thomas Wherry, MD, says open communication combined with a few simple steps can thwart problems and develop healthy working relationships between partners.

Dr. Wherry is the principal for Total Anesthesia Solutions in Ellicott City, Md., and a consulting medical director for Health Inventures. Here are seven areas he most frequently sees problems, as well as painless ways to resolve conflicts.

1. Schedule management. If a surgery center schedules are mismanaged or using time inefficiently, then the anesthesia providers' practice can suffer as a result. Dr. Wherry says this can occur when a new center tries to grow by adding an operating room. Until the center's case load fully uses the room, anesthesia providers may be forced to cover the patients at a loss.

Solution:
The solution must be a two-way street, Dr. Wherry says. Both the surgery center and the anesthesia group need to understand each other's needs and strive for compromising solutions.

"Always include the anesthesia provider in the thoughtful utilization of space before giving away a block of time," he says. "Be sensitive to the group's concerns." On the other hand, though, "The anesthesia group has to understand the surgery center is trying to run a business. They can't be held hostage."

Be flexible and creative with your schedule, and allow the anesthesia group to have both access and input. Dr. Wherry also suggests giving the providers remote access to the schedule to help them be as efficient as possible.

2. Payor contracts. Some ASC specialties can be beneficial for one party but not the other. Cosmetic cases, for instance, can be profitable for anesthesia groups but unprofitable for ASCs. The self-pay rate for anesthesia cosmetic fees is greater than some private payor fees. However, the facility fee the surgery center makes from cosmetic procedures is less profitable, and surgery centers make larger profits from private insurers and out-of network fees. Anesthesia providers may get a pushback from the surgery center for wanting to take on cosmetic cases.

Some ASCs also expect anesthesia groups to contract with all of the same payors as the surgery center. Though convenient for patients, this can be unrealistic. Some insurance rate offers are so low for anesthesia providers that they cannot make a reasonable profit. Conflict arises when one group feels pressured to accept a contract with unfavorable terms.

Solution:
"The key is to be unified," he says. "Do not let insurance companies use tactics to split you up. If they are forcing the anesthesia group to take something less than market value, then surgery centers need to be sensitive to that."

Anesthesia groups should try to be in-network with as many of the surgery center's payors as possible and be willing to negotiate rates on a case-by-case basis with out-of-network patients. Surgery centers must also understand that the anesthesia group cannot enter into payor contracts that are below fair market value. Open and honest dialogue can ease tensions and ensure both parties are amenable to payor contracts.

3. Equipment costs. Anesthesia equipment prices are rising, which can be a challenge for cost-conscious ASCs. Two of the most common tools — an ultrasound for regional anesthesia and a glide scope — are practically standard, Dr. Wherry says, making it difficult for anesthesiologists to perform jobs without them.

Solution:
Surgery centers should be mindful of the anesthesia market and accommodate their provider as much as possible. "If you want to secure your service, provide your group with superior technology," he says.

However, anesthesia providers used to working with hospitals may have unrealistic expectations for what the center can afford to provide. The anesthesia machines themselves can range from $20,000 to $100,000. While a hospital with a larger capital budget may be able to afford the more expensive machine, it is not crucial for proper patient care. "What they have at the hospital may be overkill," he says. "You don't necessarily need to replicate it at the surgery level." Anesthesia groups should make sure to consider the ASC's budget before requesting unnecessary high-end machines.

4. Supply costs. Even general supplies can be expensive and ASCs are generally mindful of qualifying their cost per medication or disposable supply. But anesthesia groups don't always take the time to understand the financial challenges of purchasing ASC supplies.

"Often they want the more expensive disposable product they are used to having at the hospital when the less expensive is still suitable," Dr. Wherry says.

Solution:
Quality and safety are non-negotiable. But for less expensive supplies that still meet safety standards, ask the anesthesiologists to try an alternative product to see if it's satisfactory.

Work with the group and educate them on prices. "Let them have some victories," he says, "but also get them to accept some products. You can usually win them over because they want the center to be successful."

5. Policies and procedures. There is nothing worse for an anesthesia group than coming into a center and having to abide by seemingly arbitrary, mandated rules, Dr. Wherry says. Some ASC policies may even work against the anesthesia provider's goals.

Most often this occurs with policies regarding pre-operative screening and recovery. An ASC may want a patient screened a certain way, while the anesthesiologist has different requirements. With recovery, anesthesiologists often want to get the patient up and moving quickly, but the surgery center may have a more cautious, delayed discharge. Being cut out of policy development can create tension between the two groups.

"They will think it's what we want, but they may have never asked us," Dr. Wherry says.

Solution:
From the beginning of the provider's contract, the leaders of the anesthesia group and the ASC should meet on a regularly scheduled basis — not just as needed — to give feedback and foster a strong relationship. "Get (the anesthesia group's) input on policies," he says. "They are there every day and can have great ideas in the overall management."

"Sometimes surgery centers make assumptions that are [well-meaning] but probably overkill," Dr. Wherry adds. "Some anesthesia input could make the policy more streamlined."

Conflicts escalate when providers feel they do not have a voice in how the center is run. "Include the group as a partner and as a solution, versus a vendor and a problem," he says. "If you do that, you'll have a more sustainable relationship."

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