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Why ASCs are Moving Anesthesia Services In-House: A Conversation with David Kadish

As the healthcare landscape continues to evolve, ambulatory surgery centers (ASCs) are looking for innovative ways to enhance patient care and drive revenue growth. One avenue gaining momentum is the integration of anesthesia services as an ancillary service.  

To shed light on how ASCs are making this idea work, nimble’s Executive Vice President of Anesthesia Operations, David Kadish, penned an article for ASC Focus titled “Adding Anesthesia as an Ancillary Service.”    

In his article, David recognizes the crucial steps ASCs need to take to ensure a successful integration of anesthesia.  

Diving deeper into this topic, David sat down to answer the top 5 questions ASCs should consider before adding anesthesia as an ancillary service.

Q1: What are the key advantages for ASCs in embracing anesthesia as an ancillary service?

David Kadish (Answer):

Adding anesthesia as an ancillary service brings in another source of revenue for ASCs, but it also has costs associated with it. That’s why it’s important for ASCs to assess the process of bringing anesthesia in-house.  

For starters, ASCs can negotiate favorable contract agreements and manage the cost structure of anesthesia when they have this service in-house, which can reduce expenses and improve profitability.  

Having an anesthesia team on-site often facilitates better coordination and scheduling of procedures, which improves operational efficiency, patient throughput, and convenience for patients.  

Lastly, when ASCs have more control over the claims process, they can ensure anesthesia claims are submitted on time and coded appropriately for each procedure. Choosing one revenue cycle provider with expertise in both anesthesia and your ASC’s specific specialties further ensures precise alignment. If the coding on both the anesthesia claim and the procedure claim match, your ASC will improve accuracy and turnaround time on your collections.  

Q2: Why are more ASCs adding anesthesia to their services? Has anything changed recently in the healthcare landscape to contribute to this trend? 

David Kadish (Answer):

In response to concerns about staffing shortages in the field of anesthesiology, ASCs are moving ahead to recruit their own anesthesiologists.  

Additionally, advances in surgical technology and the advances in anesthesia techniques help patients recover faster, which brings more complex cases to the outpatient setting. As ASCs bring on more cases, having an in-house anesthesiologist becomes a huge benefit for scheduling because it helps streamline the booking process. 

In terms of advances in surgical technology and administering anesthesia, certain surgical procedures are moving away from general and monitored anesthesia care. Local anesthesia is becoming necessary for certain procedures based on insurance carrier guidelines.

For example, the ability to perform spinal surgeries without general anesthesia shortens patient recovery time. Monitored Anesthesia Care combined with Regional anesthetic blocks in the spine reduce, recovery time and anesthesia-related complications, which is why ASCs are finding it more practical to add anesthesia as an ancillary service.

Q3: Does having anesthesia as an ancillary service benefit ASC patients?

David Kadish (Answer):

In-house anesthesiologists can improve patient satisfaction by providing a more convenient, efficient patient experience. They eliminate the need for separate preoperative evaluations or anesthesia consultations. This can also reduce costs associated with separate providers and facility fees, resulting in more affordable surgical options for patients.  

ASCs can also provide a greater level of value and care by enhancing patient safety. To reduce surgical complications, ASC anesthesia providers can establish rigorous standards, advanced monitoring equipment, and comprehensive anesthesia assessments. The training, process, and standards for emergency preparedness can be fine-tuned for each patient and procedure including crisis management protocols and emergency drug kits for cardiac arrest, airway emergencies, and anaphylaxis.  

Q4: Could you explain the key factors ASCs should consider before incorporating anesthesia services into their facilities?

David Kadish (Answer):  

ASCs should carefully assess the financial investment required along with potential revenue generation to determine their break-even point and assess a profitability timeline. This involves negotiating competitive reimbursement rates with payers, staying compliant with Medicare regulations and payer guidelines, and accounting for initial investments like hiring and training an anesthesia team.

Q5: How can ASCs ensure optimal anesthesia revenue cycle management, including coding and billing, when offering anesthesia services in-house? 

David Kadish (Answer):  
The coding and billing process for anesthesia can be complex. ASCs should prioritize comprehensive documentation of administered medications, supplies, equipment, and anesthesia techniques used.  

Relying on professional anesthesia coders will ensure the time thresholds and services provided are billed appropriately. Additionally, regular internal audits of coding and billing practices can help identify trends including claim issues, coding accuracy, and days in accounts receivable (A/R).  

Overall, anesthesia revenue cycle specialists ensure billing accuracy and consistency in your rate of collections.   

To explore this topic further, read the full article in the September issue of ASC Focus.