MNASCA ANNUAL EDUCATION CONFERENCE

APRIL 14-15, 2011

Presented by: Mary Sturm, Sr. VP Clinical OperationsSurgical Management Professionals

Strong Anesthesia Relationships for a Strong Center

Presented by: Mary Sturm, Sr. VP Clinical OperationsSurgical Management Professionals

Goals of Anesthesia in an ASC

Must Drive Value and

Improve Quality

Anesthesia Business Models

Traditional model

Employment model

Owner Provider Model

Traditional Model Independent group practice model is most common

Pros Typically do not receive compensation from ASCIn a large metro area- may be able to “ shop” providers Can attempt to cover service levels in contract language

ConsASC may have less control

(even with a contract in place)Smaller markets may only have one game in town Can bring hospital mentality to the ASCCan be more complicated if anesthesiologists and CRNAs have separate contracts with center

Employment Model

ProsMore control Can be a revenue center Can be a recruitment benefit (life style)

ConsTypically salaried, so center assumes risk of compensation even when volumes are lowRecruitment can be difficult in some markets

Owner Provider Model (not common in Midwest)

A separate anesthesia corporation is established under the same ASC ownership as facility. Anesthesia technical and professional fees are billed thru this corporation and profits are set up as distributions to the owners. The income for anesthesia providers is typically less than if they billed separately. –model is prevalent in GI centers in southern states.

Potential for corruption of medical judgment and potential for kickback concerns

Current and Future Supply and Demand of Anesthesia Providers

Anesthesia Supply Side

Average age of MDA and CRNA in United States is 49

Steady decline in # of graduating anesthesiologists

54% of states report shortage on MDAs 60% of states report shortage of CRNAs Surplus of CRNAs predicted by 2020

Anesthesia Demand Side

Demand for anesthesia service in ASCs grew 300% in last ten years

Aging population increases need for anesthesia services

Anesthesia Clinical Models

Anesthesia Care Team (ACT) is prevalent in most prevalent in Midwest

MDA supervising CRNAs (up to four per MDA) Data to show cost effective as well as quality

delivery model Minnesota has been “opt out” state since 2002

The “Culture” of Anesthesia

Are anesthesia providers in the service business providing anesthesia?

OR

Are anesthesia providers in the anesthesia business providing service?

Strategies for “On Boarding” Anesthesia

Clinical competence, safety, patient outcomes are assumed.

Selection and control on specific anesthesia providers in the ASC

Clinical competence in ancillary services such as pain management program, regional anesthesia

Provides the same culture of flexibility that you expect from ASC employees

“On Boarding” Anesthesia – cont’d

Engagement in ASC center activities– Policies and Procedures– Compliance with Infection Control Policies– Protocols for pre op phone calls and patient management– Engagement in QI– Mandatory education compliance – Expectations for expense management

(supplies & pharmaceuticals)

Some Potential Hills to Die On

Restrictive clinical guidelines for patient acceptance (i.e. BMI) Restrictive policies on surgery schedule start and end times Restrictive policies on opening another OR Restrictive policies on same day add- ons Rush to discharge or transfer patients late in the day

Anesthesia Providers as ASC Shareholders

Align Incentives Wherever Possible Anesthesiologist who perform pain procedures as

ASC Investors Safe Harbor Implications

If anesthesia providers are not performing procedures per se, may consider model of real estate investment opportunity

Conclusion

An effective anesthesia model should be a thing of beauty