Anesthesia Industry and Market News:

May 18, 2020

Anesthesia Business Consultants, LLC (ABC), a leading provider in anesthesia billing and practice management for the anesthesia and pain management specialty, is an industry leader with a national footprint. As such, it is in a unique position to assess the current state of anesthesia in America by leveraging communications with our extensive client base of over 15,000 anesthesiologists and CRNAs. ABC submitted a survey in mid-May to its clients to gauge the overall movement toward elective surgery in hospitals and surgery centers across the country. This was an effort to determine where its clients are in the ramp-up process to pre-COVID case volumes, and what they anticipate going forward. Nine questions were submitted. Below, we have provided a summary of these questions and our clients’ responses.

The Current State

The first two questions sought to measure where anesthesia practices are at the present time with regard to elective cases. When asked in Q1 if they were still providing COVID-related care outside of regular anesthesia cases, nearly 72 percent responded “no,” indicating that only 28 percent were still engaged in COVID-specific care (e.g., emergency intubations for COVID patients, critical care, proning, etc.).

We asked in Q2: “What is the timetable for your primary facility to begin elective surgeries?” ABC was encouraged to see that over 79 percent of respondents had already begun to perform elective surgeries. A little more than 9 percent said they would begin elective surgeries within a week, and 6 percent anticipated moving to elective surgeries within the next 8 to 14 days. A little over 5 percent were unsure.

Ramp-up Period

ABC was interested to determine what its clients had heard or had already seen concerning the pace toward pre-COVID case levels. Would there be a ramp-up period? If so, how long would it last and what would it look like? Based on these interests, the next three survey questions were formulated. The first of these, Q3, asked: “Once elective surgeries begin, will there be a gradual ramp-up period before resuming a normal pre-COVID caseload or will a normal caseload be reached almost immediately?” Some 81 percent indicated there would be a ramp-up period. That is, there would be a gradual increase in elective cases. Interestingly, 15.5 percent felt the change back to normal would begin almost immediately, with 3.5 percent being unsure.

Q4, asked: “If there is a ramp-up period for elective surgeries, how long will this period last before reaching normal pre-COVID case volume?” Here’s where it gets interesting. The results indicated a fairly equal split between three of the four listed options, which are represented below:

If there is a ramp-up period for elective surgeries, how long will this period last before reaching normal pre-COVID case volume?

• 1 to 15 days 23.48 %
• 16 to 30 days 33.91 %
• 31+ days 20.87 %
• Unsure 21.74 %

Interestingly, well over half believed that the ramp-up to pre-COVID volumes would be complete within a month. When asked in Q5 about the specific percentage of anticipated pre-COVID case levels within the first week of elective surgery ramp-up, our respondents indicated the following:

If there is a ramp-up period, to what extent will elective surgeries be performed during the initial week of such period?

• 1 to 33 percent of pre-COVID case volume 33.63 %
• 34 to 66 percent of pre-COVID case volume 40.71 %
• 67 to 100 percent of pre-COVID case volume 17.70 %
• Unsure 7.96 %

All of these ramp-up questions provide excellent insight into the pace at which our clients are anticipating case volumes to return to “normal” levels.

Other Insights

The remaining questions in the survey dealt with assorted concerns within the general realm of COVID and the practice of anesthesia. The specific inquiry in Q6 revolved around the issue of decision-making. ABC asked: “If there is a ramp-up period for elective cases, who will determine the types of cases that can be performed during such period?” A plurality of 45.61 percent said it would be a hospital committee or administrator. Some 26.32 percent felt it would be a clinical director (e.g., chief clinical officer, director of nursing), with another 28.07 percent feeling it would be some other person or group.

The aim in Q7 was to determine if PPE availability would determine the number of cases performed in the ramp-up period. A sizable 55.26 percent said “yes,” with 27.20 percent indicating “no,” and 17.54 percent being unsure. This would seem to indicate that, for the time being, the ramp up to normal caseloads is still not in normal territory. The wearing of special protective gear—even with restrictions easing—will continue to be the standard protocol for the foreseeable future, at least for a good portion of our clients.

The query in Q8 was as follows: “Does your facility have new protocols to follow for all OR cases (e.g., OR turnover decontamination procedures, revised intubation procedures, etc.)?” A resounding 80.17 percent responded in the affirmative, with only 11.21 percent saying “no.” The final question dealt with the non-hospital setting. Q9 asked: “When will your surgery center location(s) be opened?” The responses were as follows:  

Does your facility have new protocols to follow for all OR cases (e.g., OR turnover decontamination procedures, revised intubation procedures, etc.)?

• Open now 71.55 %
• Open within next 15 days 10.34 %
• Open within next 30 days 5.17 %
• Unsure/not applicable 12.93 %.

That is surely a good sign that over 71 percent of the surgery centers may already be back in operation, with more to follow within the next few weeks.

In summation, it appears that there is the light at the end of the tunnel, at least as to this first wave of coronavirus cases. Tony Mira, president and CEO of Anesthesia Business Consultants, reflects, “ABC’s clients have remained steadfast and strong in the midst of an unprecedented health crisis. The hope is that these survey results will lead to better planning on the part of all.” Obviously, these responses come from practices located throughout the country, with each experiencing its own unique circumstances as it pertains to COVID. ABC, therefore, understands that these results may not mirror what’s happening in every community—especially for those in a current “hot zone.” Mira continues,” these findings generally indicate a rather rapid return to some form of normalcy in the very near future. For that, we can be grateful.”