Exploring Anesthesia Business Models

Much of what anesthesiologists are responsible for — relieving pain and managing vital functions such as breathing, heart rhythm and blood pressure¹ — is a clear-cut science. Anesthesia as a business, however, is not always tangible. The profession has its own culture, some say, and finding the best anesthesia business model for your practice can be difficult.

There are many considerations, including a shortage of anesthesiologists at the physician level and a shortage of mid-level anesthesiology providers.

Staffing is competitive, says Gerald Maccioli, MD, FCCM. Maccioli is director of critical care medicine at Raleigh Practice Center and Critical Health Systems of North Carolina, a company that provides management and consulting services to anesthesiologists and pain management physicians. He also directs the North Carolina Society of Anesthesiologists and chairs the Committee on Critical Care for the American Society of Anesthesiologists (ASA).

“A smaller/new center might have difficultly providing a commensurate level of salary and benefits as an older or larger established practice, which could make recruiting professional personnel difficult,” Maccioli says.

The most cost-effective model for staffing personnel is the anesthesia care team (ACT) model whereby an anesthesiologist (with a physician’s degree) medically directs two to four mid-level providers, according to Maccioli.

The primary focus must always be on safety, patient outcome and quality of service. “A well-run practice focusing on those three over-arching goals in the ACT mode of delivery is a good business model,” he says.

A less formal but still effective approach involves an “eat what you kill” mentality, says John Dombrowski, MD, owner of the Washington Pain Center in Washington D.C. This philosophy means that an anesthesiologist is paid by the volume. At the other end of the spectrum is the option of paying the anesthesiologist a set rate regardless of volume, and there are any number of permutations in between.

“I’m a capitalist, so I’m a real big believer in ‘eat what you kill,’ Dombrowski says. “This puts things back in a natural balance. If I have an incentive to do more cases, then I’ll do more cases, versus if I just get paid and someone’s saying, ‘Let’s hurry up and get this knee scope done.’ (The anesthesiologist) might say, ‘Why, why should I bother?’ But you put a dollar sign at the end of that knee scope (and the anesthesiologist has more incentive). It’s a lot more tangible if you actually collect from each patient.”