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March 4, 2021

Understanding the Pros and Cons of Anesthesiologist and CRNA Employment Options for Your Facility

March 4, 2021

by Joe Gribbin, Sr. 

Hospital and facility administrators are challenged by the inability to control their revenue cycle when anesthesia services are outsourced. If you aren’t aware of how much revenue is being generated, it’s difficult to maximize cash flow. 

This is our third post in this series highlighting the challenges hospital administrators face and how my 12 years of experience in that role can help you make the best employment decisions for your facility. 

In the first post in this series, I mentioned the relationships healthcare facilities have with anesthesiologists and CRNAs and the characteristics that make anesthesia billing more complex. Read blog 1 in the series here! 

In the second post, we covered the complexities of provider credentialing and how to close gaps in cash flow. Read blog 2 in the series here!

To Employ or Not To Employ

Hospitals and healthcare facility administrators need to know how much revenue is generated by their anesthesia department and CRNAs. It’s much more difficult to get this insight when anesthesia services are outsourced. I always recommend employing a strategic mix of anesthesiologists and CRNAs whenever possible. You get control over scheduling, operations, and billings, which can increase profit even after factoring in expenses for overtime and on call.  

It’s possible you don’t have the option of converting contract anesthesiologists to employees due to legacy contracts and relationships. Whether your facility employs anesthesiologists or not, you should directly employ CRNAs if possible because it is strategically and financially beneficial.

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From An Anesthesiologist’s Perspective

Many anesthesiologists prefer to operate independently because of the income and flexibility. Others prefer to work as salaried employees because it is simple. They don't have to work long hours, and their income is predictable. 

All anesthesiologists have a complicated relationship with CRNAs due to concerns that CRNAs will replace them. This has happened to some extent in the military, and most anesthesiologists spend a good bit of time supervising CRNAs. We believe that when anesthesia services and billing run smoothly, facilities, anesthesiologists, and CRNAs all benefit.

Case Study: Anesthesia Employment Options

Let’s see these scenarios in action. Most hospitals can provide anesthesia services in four ways:

  1. A CRNA practicing without an anesthesiologist involved in anesthesia delivery.
  2. An anesthesiologist practicing alone.
  3. Four medical direction model variants consisting of one anesthesiologist directing one to four CRNAs.
  4. A supervisory model where one anesthesiologist supervises more than four CRNAs. 

Assuming demand is consistent when simulating these four scenarios and quality of care does not change, let’s consider factors including, but not limited to:

  • Medical billing rules
  • Inpatient procedures with average demand (and below-average demand)
  • Per procedure results
  • Average billed amount
  • Education costs

When assessed, we find that CRNAs acting independently is the most cost-effective model for healthcare facilities, and you receive the most benefit from these outsourced anesthesia services. Independent CRNAs provide anesthesia services at the lowest economic cost, and net revenue is likely to be positive under most circumstances. See the full case study here.

Minimizing Cost and Maximizing Revenue

One of the advantages of employing anesthesiologists and CRNAs is the benefits derived from managing your anesthesia billings. These billings are complex and require a different skill set from standard medical billings.

But if you get it right, anesthesia services can be an important profit center for your facility. Outsourcing your anesthesia billing to specialists like MBM has a variety of benefits. You get:

  • Improved charge capture
  • Greater accuracy
  • Faster reimbursement speed
  • A tremendous relief to your team

At Medical Business Management, we make our clients’ billing process more manageable and maximize anesthesia revenue. For a free consultation, contact us

*Our white paper, How Healthcare Facilities Can Reduce Anesthesia Overhead and Maximize Revenue, addresses these topics and others in a practical and in-depth way. Click here to download your free copy! 

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