Q: What are some anesthesia trends/advances you’re seeing in the ASC setting?
Timothy Beisner, vice president, Anesthesia Healthcare Partners (AHP): The request for a dedicated anesthesiologist and/or certified registered nurse anesthetist (CRNA) to administer propofol sedation is still “catching on” in many parts of the country and gaining much more attention for endoscopic procedures performed in an ambulatory surgery center (ASC) setting.
Marc E. Koch, MD, CEO, Somnia Inc.: Lagging marketplace perception concerning the non-congruency between ASC and anesthesia financials. ASC facility fees almost always dwarf anesthesia professional fees. As a result, a surgery center may turn a profit for a given operating room surgical volume on a given day but this volume may not provide ample compensation to support an anesthesiologist working for market rates. As more and more surgery centers sprout up, the volume of surgery occurring in any one ASC operating room is unlikely to keep pace and what may be a compelling and profitable venture for a surgeon or ASC management company may not be so for the anesthesia clinician. Over the next five to 10 years, we predict that anesthesia subsidies will become more commonplace in the ASC setting.
Dave Simion, vice president of sales, Alpine Surgical Equipment, Inc.: More ASCs are concentrating or adding spine, pain and orthopedic cases. The ability to perform these cases increases the profitability to the ASC substantially. Also, the introduction of new ventilation modes within the anesthesia delivery systems themselves. One in particular would be PSV mode (pressure support ventilation). Pressure support is a spontaneous mode of ventilation. The patient initiates the breath and the ventilator delivers support with the preset pressure. With support from the ventilator, the patient also regulates the respiratory rate and the tidal volume. This in turn could allow for quicker recovery time as well as an increase in the well-being of the patient. Due to this, there could be a time savings per case, which would allow more cases to be performed in a single day.
Arnaldo Valedon, MD, board member, active surveyor, AAAHC: A major trend we have seen in the last 15 years is a greater range of procedures being performed that were previously exclusively done in inpatient settings (e.g., anterior cervical disectomies/fusions, partial knee replacements). As surgical and anesthesia advances continue, we expect more neurosurgical and orthopedic procedures to be performed in ASCs.
