Surgeon pays anesthesia for unused block time

[nimbus]

Never thought I’d see this. Doubt that ASC will stay in business very long. If I was a surgeon, I’d just move my cases. That ASC administrator is a dummy.

How 3 ASCs adapt to the anesthesia shortage - Becker’s ASC

"Discover innovative solutions for ASCs facing operational challenges and anesthesia provider shortages. Learn from three successful centers' approaches."

www.beckersasc.com

“1. Bruce Feldman, an administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., is introducing a new approach to anesthesia stipends. His center plans to require surgeons to pay a fee if they don't meet the minimum number of cases required for their assigned block of operating time.

"Let's say a surgeon's block requires a minimum of eight cases, but they only end up doing six cases," he told Becker's. "The anesthesia group will send a bill to the surgeon for $300 for each case that they were short, resulting in a bill of $600 in this scenario. So the financial hit will fall on the surgeon, not the center."

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[Maverikk]

Cornwall is a town of 12k people not close to very much. How many ascs are there? What’s their anesthesia staffing? The fact that it was an administrator of the asc probably speaks to their staffing financial situation

The practice of anesthesia needs people who are either going to pivot and change and hold on to the driver’s wheel or the hospital/amc/other group will. I saw the other bay state thread, I knew one person previously in that group more than 5 years ago, it was highly successful then. If they got subsumed by the hospital then if people don’t see this is a time to change, and not by small amounts, they’ll get left behind. Each situation is different: cost of living, anesthesia market, allegiance to stay.

I’m not saying the idea in the article is good. If Toyota, Amazon or fedex was in charge of your business would they be making the same decisions? At the same speed?

 

[urge]

Doesn’t seem right. The lion’s share of the bill is the facility fee. Think this approach will fail.

 

[nimbus]

Interestingly the surgicenter is a joint venture between surgeons and Montefiore/St Luke’s.

EOASC - About EOASC

Eastern Orange Ambulatory Surgery Center (EOASC) is an accredited ambulatory health care provider in Orange County, New York, providing quality and convenient same-day surgery since its opening in 2007 at the Cornwall Medical Pavilion.

www.eoasc.com

 

[abolt18]

Seems like this would just cause contempt between the surgeons and anesthesia group, especially if the surgeon isn't paying the bill. Wouldn't it make more sense for the surgery center to be an intermediary and charge the surgeons that amount and pay the anesthesia group no matter what?

 

[circleK]

This sounds more like some sort of negotiating tactic by the ASC rather than something that would actually happen in reality.
Like 100% tariffs

 

[UscGhost]

Lol.

Great way to get your surgeons to leave

 

[GassYous]

We also had a subsidy from an asc for time not used but was paid by the facility

 

[nimbus]

Lol.

Great way to get your surgeons to leave

Yeah. Surgeons would fill their block time if they could. It’s in their own interest.

 

[caligas]

we are looking at charging the ASC we cover a minimum if we don’t achieve a certain revenue per physician day.

Its owned by surgeons so it’s almost the same thing, no?

 

[AKMD_1984]

Facility should pay not surgeon
Or just have a “day rate” arrangement
Facility needs to consolidate and reduce points of service and figure instead of 5 rooms doing 6 hr block time each

Just do 3 rooms with 10 hr block time with am/pm sessions.

 

[ryanjmy]

This type of stuff only works if you’re the only game in town. You can put all kinds of rules and penalties in place for bad surgeon behavior but if he can go up the road and operate without penalty, he will. And that other facility will reap the reward$.

 

[nimbus]

we are looking at charging the ASC we cover a minimum if we don’t achieve a certain revenue per physician day.

Its owned by surgeons so it’s almost the same thing, no?

IME doctor owned surgicenters are the cheapest around. But revenue guarantees are becoming much more common.

 

[psychbender]

This type of stuff only works if you’re the only game in town. You can put all kinds of rules and penalties in place for bad surgeon behavior but if he can go up the road and operate without penalty, he will. And that other facility will reap the reward$.

That can work for a while, until the new place encounters the same issues and has the same response. At my old job, a pair of neurosurgeons would change where they operated every few months. They'd demand flip rooms, guaranteed teams that were not part of the "consolidate to X rooms at 5pm," or even ask for Saturday case time. The hospital would say no, they'd take their business to another hospital or surgicenter that would give them what they asked. Not long after, the new place would realize that they were not efficient enough to utilize flip rooms, ran late all of the time, etc, and would push back. They'd again threaten to take their cases elsewhere, and the cycle continued. I think they ultimately built their own two-room ASC, and tried to hire their own anesthesiologist, as well.

 

[DirtDocMD]

The “minimum” may be pretty low (say, 2-3 cases). It could definitely be a way to keep “certain” surgeons from hogging block time, only to NOT use it. Perhaps it doesn’t apply if they are willing to relinquish their block time a few days early?? We have some (egotistical) surgeons who raise a stink when the hospital threatens to pull their block (when they’ve routinely only scheduled 1-2 cases in it), or REFUSE to relinquish time to other surgeons (when it’s 5 pm the day before, and they STILL haven’t filled their block).

It’s easy to look at this as abusive TO surgeons, but it could just as easily be a good way to discourage “certain” surgeons who routinely abuse the privilege of block time (not allowing their own surgical colleagues to use it, when they don’t have enough cases to fill it).

Again, the “devil is in the details”. If they are allowed to relinquish their block, say, 2/3/7days before, with no financial penalty, then maybe ok. However, if they’re doing it, even when the surgeon is telling you a week beforehand “I don’t have enough cases, release my block.”, then THAT is pretty crappy.

 

[AKMD_1984]

That can work for a while, until the new place encounters the same issues and has the same response. At my old job, a pair of neurosurgeons would change where they operated every few months. They'd demand flip rooms, guaranteed teams that were not part of the "consolidate to X rooms at 5pm," or even ask for Saturday case time. The hospital would say no, they'd take their business to another hospital or surgicenter that would give them what they asked. Not long after, the new place would realize that they were not efficient enough to utilize flip rooms, ran late all of the time, etc, and would push back. They'd again threaten to take their cases elsewhere, and the cycle continued. I think they ultimately built their own two-room ASC, and tried to hire their own anesthesiologist, as well.

Good.

Let them take the risk of setting up their own asc and paying for their own inefficiencies.

And good luck to the anesthesia hire.

Sounds like a “bitch” job. No thanks. Lots of “solo
Md flips” between two rooms with literally no relief or break. Ever.

I’m sometimes forced into doing it at one of my facilities when there are two rooms, surgeon has a pa but they can’t find/ or want to pay for a second anesthesiologist.

We charge a premium for that labor. Last month I did that and my day was 730 am to 9 pm and back to back 6 spines - ACDF x 2/ thoracic Lami/ lami/ scs implant x 2.

Bylaws have to be ok with anesthesiologist leaving the patient in OR to tend to pacu if needed esp if they’re working solo. I’m always concerned about something happening in pacu when I’m back with another patient. Esp ACDF etc.

In any case - that plan will not last a long time for the anesthesiologist esp if they’re going this 5 days a week. It’s fantasy if they’re think it will be that easy. If they do find an extremely motivated and hard working anesthesiologist, the income would need to be 750-800k range. Thats literally 50-55h / week minimum of doing cases for two spine surgeons and no turnover time of break or relief. IMO that’s a 2-3 md rotation type of gig to avoid burnout.

The correct staffing would be 2 MD or 1:2 md/ Crna for two rooms. And that’s expensive for what they’re wanting to do to generate facility fee through volume.

I also question all and every spine surgery in an asc. These patients tend to have many comorbid conditions.

 

[Maz777]

Never thought I’d see this. Doubt that ASC will stay in business very long. If I was a surgeon, I’d just move my cases. That ASC administrator is a dummy.

How 3 ASCs adapt to the anesthesia shortage - Becker’s ASC

"Discover innovative solutions for ASCs facing operational challenges and anesthesia provider shortages. Learn from three successful centers' approaches."

www.beckersasc.com

“1. Bruce Feldman, an administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., is introducing a new approach to anesthesia stipends. His center plans to require surgeons to pay a fee if they don't meet the minimum number of cases required for their assigned block of operating time.

"Let's say a surgeon's block requires a minimum of eight cases, but they only end up doing six cases," he told Becker's. "The anesthesia group will send a bill to the surgeon for $300 for each case that they were short, resulting in a bill of $600 in this scenario. So the financial hit will fall on the surgeon, not the center."

I've never heard of block time measured in number of cases rather than hours. Surgeons fill their block time by being slow and/or doing too many cases. I hate the notion of block time. It just incentivizes surgeons to be slow AF and/or go over their block time and make us all stay late.

 

[Maz777]

Facility should pay not surgeon
Or just have a “day rate” arrangement
Facility needs to consolidate and reduce points of service and figure instead of 5 rooms doing 6 hr block time each

Just do 3 rooms with 10 hr block time with am/pm sessions.

Spoke like a true admin trying to squeeze everyone at that ASC. Heaven forbid anyone work a shorter day and go home at a reasonable time. 10-hr block times means most rooms are going past 5pm.

 

[AKMD_1984]

Spoke like a true admin trying to squeeze everyone at that ASC. Heaven forbid anyone work a shorter day and go home at a reasonable time. 10-hr block times means most rooms are going past 5pm.

???

do the math. it has nothing to do with being an admin. it has to do with efficiency.

you are operating three days vs 5 days for the same hours (30 hrs)

unless you prefer to waste 3-5 hours in between cases from 10:30 am to 1:30 pm be my guest.

i prefer to be busy, work, and then go home when its done and not wait on people.

also, working 3 days vs 5 days means you get two days off.

 

[Maz777]

???

do the math. it has nothing to do with being an admin. it has to do with efficiency.

you are operating three days vs 5 days for the same hours (30 hrs)

unless you prefer to waste 3-5 hours in between cases from 10:30 am to 1:30 pm be my guest.

i prefer to be busy, work, and then go home when its done and not wait on people.

also, working 3 days vs 5 days means you get two days off.

Sure. I'll crank those numbers after I start my last ACL case at 4:30pm with a slow-ass surgeon that overbooked their room for fear of being short of their block time.

 

[AKMD_1984]

Sure. I'll crank those numbers after I start my last ACL case at 4:30pm with a slow-ass surgeon that overbooked their room for fear of being short of their block time.

I am sorry, you are not making any sense.
That is no different than a 430 PM case starting at a community hospital.
Issue is not the ASC rather surgeon behavior and facilities enabling this behavior.

 

[Maz777]

I am sorry, you are not making any sense.
That is no different than a 430 PM case starting at a community hospital.
Issue is not the ASC rather surgeon behavior and facilities enabling this behavior.

You want to consolidate the number of ORs and extend block time to "5pm." Well, I call BS and tell you that most of those rooms are now going past 5pm. People are staying late. Everyone hates their job and now leaves. You have the mentality of a short-sighted admin squeezing employed people dry.

 

[AKMD_1984]

You want to consolidate the number of ORs and extend block time to "5pm." Well, I call BS and tell you that most of those rooms are now going past 5pm. People are staying late. Everyone hates their job and now leaves. You have the mentality of a short-sighted admin squeezing employed people dry.

First of all, I’m a practicing anesthesiologist. Not an admin. I believe I made it clear earlier.

Lol again non sensical if you think you can control surgery time and want it end at 4:59 pm exactly.

Are you a doctor or nurse? I go home when work is done. Be it 2 pm or 7 pm. And yes I do cases in the evening when surgeon finishes clinic and add patients. Mostly at hospitals but some times at ASCs.

Lots of surgery has moved to ASCs due to insurance deeming it far cheaper than hospitals due to facility fee. It’s not upto you to decide where the surgeon takes the patient. Unless you do please let me know.

What I was referring to is called consolidation which admins and surgeons do not want. They want vertical scheduling which is a waste of time and resources for anesthesiologists.

Vertical scheduling means - 1-2 cases spreads out and not a full guaranteed day. It directly affects anesthesiologists and production because unlike surgeons, we do not have clinic to pack our schedule. That is why anesthesiologists demand 8-10 h guaranteed pay so their days are not wasted.

And if once in a while you happen to work after 5 you should be compensated for that time.

3x10s is far superior than 5x6s imo.

 

[Maz777]

First of all, I’m a practicing anesthesiologist. Not an admin. I believe I made it clear earlier.

Lol again non sensical if you think you can control surgery time and want it end at 4:59 pm exactly.

Are you a doctor or nurse? I go home when work is done. Be it 2 pm or 7 pm. And yes I do cases in the evening when surgeon finishes clinic and add patients. Mostly at hospitals but some times at ASCs.

Lots of surgery has moved to ASCs due to insurance deeming it far cheaper than hospitals due to facility fee. It’s not upto you to decide where the surgeon takes the patient. Unless you do please let me know.

What I was referring to is called consolidation which admins and surgeons do not want. They want vertical scheduling which is a waste of time and resources for anesthesiologists.

Vertical scheduling means - 1-2 cases spreads out and not a full guaranteed day. It directly affects anesthesiologists and production because unlike surgeons, we do not have clinic to pack our schedule. That is why anesthesiologists demand 8-10 h guaranteed pay so their days are not wasted.

And if once in a while you happen to work after 5 you should be compensated for that time.

3x10s is far superior than 5x6s imo.

You convinced me, so eloquent. The next time I'm stuck in a ******* elective case past 5pm (which is more common than not to make the greedy admins happy) getting paid peanuts, I will just think back on your amazing points and say, "Don't fret, some rando online says this is the superior way of providing anesthesia. Working late all the time to accommodate surgeons and make more money for the hospital/ASC is awesome."

And, no, I don't work 3 days/week. That's called a CRNA.

One of the local hospitals here extended all block time to 7pm for every OR with no change in compensation. Guess how happy those jackals are.

 

[AKMD_1984]

You convinced me, so eloquent. The next time I'm stuck in a ******* elective case past 5pm (which is more common than not to make the greedy admins happy) getting paid peanuts, I will just think back on your amazing points and say, "Don't fret, some rando online says this is the superior way of providing anesthesia. Working late all the time to accommodate surgeons and make more money for the hospital/ASC is awesome."

And, no, I don't work 3 days/week. That's called a CRNA.

One of the local hospitals here extended all block time to 7pm for every OR with no change in compensation. Guess how happy those jackals are.

I don’t need to convince fools.

Secondly, you don’t like how you’re treated at work, answer with your feet and walk. No one put a gun to your head to work.

 

[Gern Blansten]

???

do the math. it has nothing to do with being an admin. it has to do with efficiency.

you are operating three days vs 5 days for the same hours (30 hrs)

unless you prefer to waste 3-5 hours in between cases from 10:30 am to 1:30 pm be my guest.

i prefer to be busy, work, and then go home when its done and not wait on people.

also, working 3 days vs 5 days means you get two days off.

You should work all five days until the surgeon doesn’t want you to any more…then pay for his subway ticket…