August 28, 2023

By far, the greatest challenge facing most anesthesia practices today is the ability to generate enough revenue to recruit and retain a sufficient staff of qualified providers to meet the clinical and coverage requirements of the facilities they serve. It is the economic reality of today’s market that has made it necessary for most practices to request significant financial support from hospital administrations; fee for service collections simply do not generate enough revenue to cover the growing cost of anesthesiologists and CRNAs.

As a result of such financial challenges, many anesthesia practices have been exploring potential sources of additional revenue. As the nation’s largest provider of billing and management services to anesthesia practices, our staff has been monitoring the various initiatives and evaluating their success. Unfortunately, given the nature of the specialty, viable options are quite limited.

Bring on the Blocks

One of the most successful enhancements to the traditional scope of services has been the use of nerve blocks for acute, post-operative pain management. Virtually all insurance plans recognize the value of interscalene, femoral, sciatic and TAP blocks. Up until last year, they even made separate payment for the use of ultrasonic guidance (USG) in connection with these blocks (although, as of January 1, 2023, payment for USG is now bundled into the payment for the most common blocks).

For most practices, the employment of pain blocks has resulted in additional revenue for a variety of orthopedic cases. Many even perform TAP blocks for certain abdominal procedures. As is so often the case, though, now that the use of nerve blocks has become the norm, one can only wonder how long it will be before this revenue source is cut off.

Places of Service

A significant percentage of practices have tried to expand their scope of coverage to a variety of additional venues, including other hospitals, surgery centers and doctors’ offices. Such expansion can require a significant modification of the basic practice model. Meeting staffing requirements of the coverage and call requirements of a hospital can be challenging in itself, but having to schedule and coordinate staff among a variety of outlying venues inevitably involves the creation of a team of schedulers and potentially new software applications.

The ultimate challenge is always the evaluation of the profitability of each of these new venues. What might first seem like a logical way to deploy manpower more effectively can often become a financial loss leader. Practices that expand successfully are constantly monitoring the profitability of each venue so they can pull out of those that do not enhance the overall financial picture of the practice.

Chronic Pain Component

A team of chronic pain management specialists has become an integral part of many practices, but the jury is still out on its true value to an anesthesia practice. The management requirements of chronic pain are completely different from those of an anesthesia practice.

What makes some chronic pain practices so successful is their entrepreneurial spirit that may not be consistent with the philosophy and objectives of an anesthesia practice that is essentially captive to the contractual requirements of a hospital contract. Many a group of chronic pain specialists has broken off from the original anesthesia practice once they realized their true business potential. It should also be noted that, from a billing perspective, a chronic pain practice poses numerous unique challenges.

Exploring Ketamine Clinics

A small number of practices are attempting to explore the potential of the anesthetic agent Ketamine as a treatment option for chronic depression. This is another example of a very creative alternative.

While innovation is often the key to success in business and is often at the core of key developments in medicine it is the rare inventor who actually changes the world. It turns out that what today’s anesthesia practices really need to focus on is not finding new sources of revenue but ways to use the existing revenue more effectively. Appropriate staffing and cost management are the real keys to success in the current environment.  

If you have any questions on this topic, please reach out to your account executive.

With best wishes, 

Rita Astani
President—Anesthesia