Exploring Anesthesia Business Models

Of course, safety must be paramount regardless of the number of cases getting done, Dombrowski says. He supports getting paid by case, but there is a down side.

“If you’re starting an ASC, you might not be busy, so the anesthesiologist who normally makes $300,000 is going to be making $150,000 and he ain’t gonna like that, but it can grow and then he’s got an incentive for it to grow,” Dombrowski adds.

Anesthesia business models are changing nationwide, says Laurence Wiener, MD. Wiener is chairman, CEO and founder of Professional Anesthesia Consultants, PC, an anesthesia practice management company (APMC) that provides turnkey anesthesia solutions.

“The gold standard, vendor type, fee-for-service anesthesia model is changing,” Wiener says. “Gone are the days when an anesthesia group could receive an exclusive, financially lucrative anesthesia contract.”

The best practices service model for the ambulatory setting is usually different than the traditional hospital environment, and requires more respect and humility for the workplace and staff, Wiener says.

“APMCs that specialize in the ambulatory healthcare setting realize that ‘we are guests in their home,’” he adds.

Anesthesia management practices can be broadly divided into three categories: operational, clinical and financial. ASC teams should carefully understand the relationships they want to develop with their anesthesia department, regardless of whether a consultant or management team is involved.

“It is important for them to decide (if) they are looking for a vendor or partner — there is a difference,” Wiener says. “APMCs come in different varieties ranging from a short-term, consultative service to those companies that offer a suite of services in a long-term scenario.”

Finding a common value system is one of the most important aspects of choosing an APMC, Wiener adds. He recommends asking the following questions in-house before making any choices:

>>Do we want to have a vendor or a partner?

>>Do we understand the financial, clinical and management implications of various models?

>>Have we thoroughly researched various APMCs?

>>Was an anesthesia assessment and analysis conducted for our facility?

>>Does the APMC in question have values that are similar to ours?

>>Have we talked with staffs or visited other facilities with whom our potential APMC has contracts?

Small, low-volume, single-specialty centers may not be interested in contracting with an APMC whereas a larger, high-volume, multi-specialty center may have more of an incentive to outsource anesthesia, Wiener adds.