This is where economic credentialing belongs. Economic credentialling is the practice of giving scheduling preference to the surgeons who have a large number of patients with commercial insurance. It is controversial, but it can protect the center’s stability. When you allocate scarce OR capacity, utilization alone is not enough. Better performers look at payer mix and case profitability alongside adjusted utilization. Commercial rates are what cover anesthesia cost. Surgeons whose patients bring that coverage cannot be treated the same as those whose mix creates a predictable shortfall.

Make the methodology transparent and consistent and be clear that the goal is to protect the center’s ability to fund coverage. If you do not have enough commercial volume to offset government shortfalls, you must know it early and plan for it.

Contracting
I have seen that many ASCs negotiate the facility fee and treat anesthesia as an afterthought until the need for a stipend shows up. That is too late. If the cost of anesthesia is about $80 per unit, the blended reimbursement needs to be about $80 just to cover costs. In most markets, commercial rates need to be above $120. Push payers toward a blended unit rate that reflects what it takes to staff the rooms you keep open.

Anesthesia Role in Governance
Bring anesthesia into operations. Successful organizations create a culture where providers feel valued and appreciated. They meet regularly, ask direct questions about satisfaction, compensation and shifts, and act on what they hear.

They also give anesthesia a seat on the medical executive committee and a voice in daily decisions, including case selection, patient criteria, room openings and whether coverage is provided through medical direction or supervision.

What To Do Now
Here is what I would do this quarter. Reevaluate the coverage model and run the fiscal scenarios. Reset block time to 8-to-10 hours and enforce 80 percent utilization. Use economic credentialing to align block allocation with payer mix, profitability and actual use of time. Go back to payers and negotiate toward a blended anesthesia unit rate around $80. Put anesthesia in governance with clear authority for day-to-day decisions. That is how you can reduce the stipend and protect margin in your market.

Jeffry Peters is the chief growth officer and senior vice president of Sullivan Healthcare Consulting headquartered in Alpharetta, Georgia. Write him at jeffry.peters@sullivanhealthcareconsulting.com.

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.