from the gist of the article, it seems that payor mix will worsen as the population ages (ie the proportion of Medicare will be higher).
That’s logical.
At the same time, facility fees for hospitals are rising.
Essentially there is a transfer of revenue from physicians to the hospital.
Hospital revenue is predicated upon completion of service (anesthesia/ surgeon).
-Who’s going to pay for anesthesiologists time on call - already shortages of plus desire for no-call/ no weekends gigs; like ASCs and daytime. Eventually the hospital will. They don’t have a choice.
No way an anesthesia group can be profitable unless you’re a boutique practice etc as the article suggests.
- maybe direct hospital employment isn’t bad after all
Atleast there is stability?
Payor mix will inevitably worsen for a number of reasons; aging population and hospitals building towards service lines that bring in good revenue to them but are not typically high anesthesia reimbursement or time efficient for anesthesia (Cardiac, EP, spine, etc), and outpatient private payors cases being diverted to surgery centers.
So hospital work is fruitless. It’s low paying and high resource/time intensive.
Anesthesia groups will die without a few things;
1.) outpatient/surgery center work subsidizing your hospital work
2.) a stipend to cover the delta between staff/partner income expectation and payor mix or avg $/unit as well as call requirement that costs the most to staff but brings in the least.
So, the choices are; heavily subsidize your hospital work with surgery center work, get a large stipend, or go hospital employed. Unless there’s a paradigm shift.
Alternatively, and I think this is the answer for long term sustainability; argue that all of these surgical services are service lines and they require anesthesia. Want a trauma service so your entire hospital can bill at a higher rate? Cut in anesthesia or you can’t do it. Want a TAVR and other structural heart programs (Watchman etc)? Guess what? You need anesthesia, pay us. You want to recruit a handful of spine surgeons to do 2-3 big spines/day which pay us garbage but bring in $$$ in device/hardware/facility fees? You need us. We have leverage, they can’t create or deliver on any of these service lines without us. And, this is the dirty secret, they don’t understand anesthesia finances/reimbursement, and it would be more expensive for them to employ us on a per doc/CRNA basis than if they simply provided the delta.