Hmm
I negotiate these contracts for my group we have 3 hospitals, 1 eye center and 1 ASC, here is my experience
#1) I am unaware of any ASCs who pay a subsidy. They can often get an MD or CRNA to cover these centers even if they generate less as a lifestyle option. Or they simply use a constant rotating group of mixed providers to cover on a PRN basis with one (or no) permanent staff. This really comes down to OR utilization, volume and payer mix.
#2) There are no "anesthesia unit prices" specific to ASCs, only the facility fee is different at a hospital vs an ASC (higher at hospitals).
#3) Your anesthesia conversion factor (what you are paid per unit) is determined by your negotiation with the payor, who and how good your negotiator is, the number of 'lives' under that insurance you will be serving in your contract and lastly the options in the area who are in network.
Clearly I can negotiate better $/RVU than someone who just works at an ASC could simply because we cover more lives and are the only game in town than someone who just covers an ASC trying to make it fee for service.
In theory an ASC has a much better payor mix than a hospital does. An average payor mix at a hospital is 60/40 medicare + medicaid / Private insurance whereas one would assume an ASC would have much higher private insurance %. However, my experience has been this is not always the case. At our ASC we do MORE medicare/medicaid (MC/MA) than at the hospital because the ASC cannot negotiate a facility fee deal that is better than what they get paid from MC/MA. So what results in happening is that the insurance cases are brought to the hospital and everything else (including cash pay deals) are at the ASC.
I would also mention that my experience has been that ASCs have unrealistic expectations of coverage as it related to OR utilization and case volume, particularly if surgeons are owners. They feel all rooms should be avaliable at all times and all hours whenever they want to add-on a case. You have to be VERY aggressive and willing to walk away when this happens and base your coverage on OR utilization and total volume numbers. You play this as a win win as they can decrease labor costs by not having staff sitting all day covering an unused room waiting for that one case someone MIGHT add-on. Remember they aren't paying YOU so they dont care about your time but they ARE paying RNs and techs.
Does that all make sense?
Generally zero subsidies.
Do some research. Stand a lone anesthesia only contracts at ASC's are becoming very rare.
Part of it has to deal with how insurers pay anesthesia only contract at ASCs. (Hint: if anesthesia contract is bundled with ANY hospital contract the anesthesia reimbursement is much much higher per unit than if a single ASC only solo contract)
