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How ASCs Can Reduce Anesthesia Subsidy Pressure
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Here's what to expect on this week's episode. 🎙️
Dr. Brian Cohen, practicing anesthesiologist and founding member and administrative chief of Moss Anesthesia Group, and Lee Kortmansky, Site Administrator at Physician Outpatient Surgery Center, join Grant Duncan to discuss one of the biggest issues facing ASCs right now: anesthesia subsidies and coverage. They break down how anesthesia costs often reveal deeper operational issues around scheduling, OR utilization, staffing models, room flipping, surgeon relationships, patient collections, and case profitability. Lee also shares how his center worked with Dr. Cohen’s team to reduce anesthesia subsidy exposure by nearly $300,000.
In our data segment, we connect the conversation to our 2026 SOTI report and highlight what ASC leaders can learn from block utilization, cancellation rates, patient collections, and case profitability benchmarks.
Resources Mentioned:
2026 State of the ASC Industry Report: https://www.hstpathways.com/resources/surgery-center-industry-report/
Brought to you by HST Pathways.
Recommended
Transcript
Introduction to This Week in Surgery Centers
00:00:00
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guest, and then we'll close the episode by recapping the latest news impacting surgery centers.
Anesthesia Subsidies: Challenges and Solutions
00:00:16
Speaker
We're excited to share with you what we have, so let's get started and see what the industry's been up to.
00:00:24
Speaker
Hi everyone, here's what you can expect on today's episode. I'm especially excited for this one because we're tackling one of the biggest issues on everyone's mind right now, anesthesia subsidies and coverage.
00:00:35
Speaker
And what makes this conversation so valuable is that we didn't just bring on someone to talk about the problem in theory, Grant is joined today by Dr. Brian Cohen, a practicing anesthesiologist in South Florida and one of the founding members and administrative chief of Moss Anesthesia Group, along with one of his partners, Lee Komransky, site administrator at Physicians Outpatient Surgery Center.
00:00:56
Speaker
Together, they walk through what it actually looks like when an ASC and anesthesia group work together to reduce subsidy exposure, improve scheduling, and get more efficient.
00:01:07
Speaker
In Lee's case, that work helped reduce his center's anesthesia subsidy from almost half a million dollars in 2024 to just over a couple hundred thousand dollars the following year. So we're talking about nearly $300,000 in savings here. That's why I'm so excited and I think this episode is going to be so useful for ASC leaders.
00:01:26
Speaker
Brian and Lee get very practical. They talk about surgeon blocks, OR utilization, case mix. staffing decisions, patient collections, and how to have better conversations with surgeons and anesthesia partners.
Insights from the 2026 State of the ASC Industry Report
00:01:39
Speaker
Then after Grant's conversation, we'll spend a few minutes with new data from our brand new 2026 State of the ASC Industry Report. We'll look at OR block utilization, cancellation rates, patient collections, and case profitability.
00:01:53
Speaker
And we'll connect those findings back to the anesthesia challenges that Brian and Lee discussed today. I hope everyone enjoys the episode and here's what's going on this week in surgery centers.
00:02:09
Speaker
Dr. Cohen and Lee, thanks so much for coming on today. To start us out, can you give us a each a quick introduction to who you are, your organization, and what your role is?
00:02:21
Speaker
Sure. I'm Brian Cohen. I'm a practicing anesthesiologist in South Florida. One of the founding members and administrative chief of mass Anesthesia Group, which includes Miami Anesthesia Services and MAS Anesthesia Consultants.
00:02:34
Speaker
And we oversee clinical services and management services over about 20 surgery centers here in South Florida. Hi, and I'm Lee Kortmanski. I am the site administrator for Physician Outpatient Surgery Center, POSC. We are part of Holy Cross Health System, which is ultimately part of Trinity, big health system out in the Midwest. I've been here a little over two years, and I have been running centers for over 14 years in South Florida area.
00:03:01
Speaker
Excited to jump into this topic with both you today we'll be talking about anesthesia in ASC setting.
Anesthesia Costs vs Revenue: Identifying Inefficiencies
00:03:10
Speaker
So let's start with you, Dr. Cohen.
00:03:13
Speaker
When an ASC is struggling with anesthesia costs, what could be some of the items that's actually going on beneath the surface? Yeah, the mismatch of anesthesia costs versus revenue is usually exposing something that's already underlying at the facility.
00:03:30
Speaker
And maybe it just hasn't surfaced yet. So we've seen, you know, many of these inefficiencies may be there, but were less imperative to address when margins were good and the dividend checks were, you know, being delivered in the mail.
00:03:44
Speaker
But ah all of these issues like payer mix, case type, OR, gaps, end up affecting the bottom line of the ASC just as much as the anesthesia side.
00:03:55
Speaker
But we seem to be that canary in the coal mine right now. Yeah, certainly. And Lee, you've made anesthesia coverage a bigger priority for your team.
00:04:09
Speaker
When did you decide, hey, this is something I want to dig into more? I started in April of 24. Dr. Cohen's group took over the January four months before.
00:04:21
Speaker
Literally the my first day, Dr. Cohen and I started talking. What jumped out at me that day was $75,000 plus iipends we were paying for anesthesia coverage. It's just a nature of the beast when I started. We didn't have that, of course, but now it's spread through South Florida and of course the country.
00:04:39
Speaker
That's just a matter of fact. You know, to have a center, you need, and then you have anesthesia, you'd have have a stipend. ah We also had people talking the wrong, saying the wrong things. They were saying the wrong things to the offices, saying things like, no, we can't open a room because anesthesia won't allow it or putting the onus on anesthesia. That's not how this works. When you're in partnership with anesthesia, it's not driven by anesthesia.
00:05:05
Speaker
It's driven by the center. The center is the one that makes the center administrator usually is the one that decides, you know, what costs so are we going to allow? What costs we're not going to allow? There's a lot of factors that go into it. But what drove it, that's, we're spending a lot of money on things that were, because we weren't inefficient.
00:05:20
Speaker
Yeah, I can imagine when you joined new, of course, anytime you join a a new role, there can feel like there are hundreds of priorities to focus on.
00:05:32
Speaker
So what helped you narrow in on, okay, hey, here's gonna be one of my big rocks. Was it the fact that you were seeing those costs and then the ability to shape how you are working together better?
00:05:48
Speaker
You know, it's not only looking at it through the lens of how this is going to affect anesthesia, because when anesthesia is efficient, so is the center, right? If I'm running an effective center and I'm staffing appropriately anesthesia staffing, I'm also staffing my own people.
00:06:08
Speaker
So our costs are 100% aligned. So it wasn't really that I went in there and went, oh my God, I got to fix this anesthesia issue. It was, we have some inefficiencies that are affecting anesthesia. It was actually the opposite.
00:06:22
Speaker
So when we got our own house in order is when we started to see fruits of that labor. Yeah. Yeah. I'm excited to to hear more from both of you on what that partnership has looked like.
00:06:35
Speaker
Dr. Cohen, when you're working with NASC like Lees, let's say you're coming in fresh, what are some of the early data points or maybe patterns and operations that you're looking at?
00:06:48
Speaker
Yeah, we try to dig deep into those before we even begin at ASC, right? Because part of this is about, you know, projecting out what reality would be and being sort of honest and transparent about it. So we run these extensive models looking at case types, volumes, payer mix and OR utilization hours.
00:07:06
Speaker
And then that allows us to sort of develop these models that that estimate costs, but also allows us to try to pick out some opportunities even before we start. I just had a call this morning with a center that operates on two different levels, two different floors of the building, five ORs on each level, and saw very quickly when I looked at the OR utilization that three out of the five rooms on one of the floors was being utilized 35% of the time or less.
00:07:35
Speaker
So in my mind, that's an opportunity. That's a huge opportunity to start stacking those cases. And now you've gone from five ORs to four ORs, which is actually in the anesthesia world, that's an exponential change because it changes how you staff.
00:07:50
Speaker
That one change alone, I was able to show that change is a $50,000 a month subsidy to a $7,000 a month profit, being able to make that one switch. So those are the data points and that we look at even beforehand. And then obviously, once we start at an ASC,
00:08:06
Speaker
our whole view kind of changes from 2D to 3D, right? Because then you start to be able to pick up on some of these, more of the intangibles, like the strength of the staff, the physical layout of the place. Those things affect turnover times. They affect, you know, what you can do, how you can do it.
00:08:22
Speaker
But, you know, that first and the most, one of the most important factors that that impact our ability to drive efficiency is typically going to be all those factors surrounding and put into the surgeon block and how they're using those blocks. So, you know, that's sort of leading up to it. And then as we get in and manage it dayto- day to day.
00:08:42
Speaker
Yeah, and when you're doing that upfront contracting the analysis beforehand, how do you suggest anesthesia groups and ASCs think about the negotiation or the potential changes, like you said, like, Hey, we suggested they change the number of ORs they're using at least until they can get case volume up.
00:09:05
Speaker
How do you suggest you have that kind of two-way dialogue to build that partnership even before it's technically a legal contract? Well, it's a yeah, it's exactly what you said. It's two-way dialogue and it's upfront. And I think one of the most important things that we try to do as a company is this whole ASC world, the anesthesia world, healthcare care in general, is it's not static. It's very dynamic. And so if I'm looking at data from 2025 and projecting what's going to happen in 2027, I mean, come on, we don't know. So the way we approach it is here's
00:09:44
Speaker
in black and white sort of our formula and how we approach these things. Number one, from here our costs, here are projected collections based on this, and here are some of our ideas, right? And so being able to show them even ahead of time, what the impact of those changes could bring to their center is step number one. Step number two then is working with them to implement those, which again is not always a financial decision.
00:10:09
Speaker
It includes getting of the partners on board with maybe shifting their schedules around a little bit, which is not always as easy as we think. So the third piece then is or second, fourth, wherever i ended up, is how you treat the actual costs as you move forward, right? So whatever numbers we threw out there and we're gonna put into a contract,
00:10:31
Speaker
That is one possibility, but what we like to do is operate on an actual. So if those, if that center and those partners are actually taking the initiative to make these changes like, like Lee and his partners did to shift into these models that actually do decrease cost with keeping the same revenue that should pass back to the
Effective Anesthesia Contracts and Collaboration
00:10:52
Speaker
center. And that's how we've worked our company a little bit differently in collaboration to let the rewards of these changes pass back in savings.
00:10:59
Speaker
And that's really been the difference and a game changer in in encouraging the maintenance of these changes instead of just kind of a you know one-time fix. Right. And, you know, so we're talking through some of the areas of opportunity in terms of surgeon blocks, overall OR utilization, how many ORs are even keeping online.
00:11:22
Speaker
Either of you, you know, feel free to chime in. What are some other sometimes issues you see in ASCs, maybe from staffing or the scheduling or other utilization things that may drive up those issues?
00:11:37
Speaker
anesthesia costs or subsidy exposures or maybe change the utilization at a center overall? First of all, I think, you know, what we've seen, is it's become imperative to have a leader like Lee.
00:11:51
Speaker
And that leader needs to be willing and able to participate in these literally day-to-day operation discussions and decisions. One one example that I always like that sort of highlights what you're saying in the fact that We could all be doing what we think is right, but what is actually that translating to is if we look at this from a scheduler's point of view, right? And you really have two sets of schedulers that are in play. You're the surgeon schedulers and you have the surgery center schedulers.
00:12:23
Speaker
And they have very specific marching orders. Put as many cases on as you can and do what the surgeon wants me to do when he or she wants me to do them. So let's say a surgeon scheduler sends over...
00:12:36
Speaker
cases and says, I have two cases. a surgeon has to start at 7 a.m., but he has clinics starting at 9, so he can only do these two cases. So the ASC scheduler gets these two cases and slaps them on the schedule because That's what she's here to do is put as many cases on the schedule as possible and just based on volume. So if those two cases happen to be Medicare cases and maybe they happen to be carpal tunnels, well, the anesthesia, we just essentially dedicated $1,600 to staff that room with the CRNA and we just collected about $360 for those cases.
00:13:09
Speaker
for those two cases Maybe no other surgeon wanted to come at nine o'clock and start more. So that room just sits empty. So that those both sets of schedulers without oversight and direction did their jobs, but their actions actually cost the center $1,240 loss.
00:13:29
Speaker
just in that one room. And if you do that multiple times over a week, over a year, that's where these costs stack up. And that's where, you know, I've seen the value of strong ASC leadership, being able to direct some of these in collaboration with the anesthesia team to really create that optimization. And that's what, sort that without the margins that used to be, this is all about using the minutes that we have and the rooms that we have every day.
00:13:56
Speaker
but it's not like the administrator should be sitting there and thinking only about anesthesia every day. i know that. Right. one I know. We can talk more about that, Lee. Yeah.
00:14:07
Speaker
Yeah. Because our efficiencies align so almost perfectly having ah center, Having running the rooms efficiently just by default help anesthesia in your subsidy.
00:14:18
Speaker
But you do want to run efficient center just to squeeze out as much as you can for the partnership, right? We have a fiduciary responsibility to them. But not every decision that the administrator listening to this is going to say is driven just by cost.
00:14:32
Speaker
Right. And even in Dr. Cohen's example, let's say that ophthalmologist is a new ophthalmologist. who's They're starting, you're wooing them. You want them to start breaking more cases. You might say, it's okay.
00:14:43
Speaker
Come. I don't want you to have 10 cases. I want you to come with just two. You don't even know what the bathroom is. You know, come with your two, figure it out. You know, when this lunch, this is the changing room.
00:14:53
Speaker
Yeah, it wasn't a great, the room wasn't great. We didn't make money in the room, but we're entertaining a relationship. it That's not long-term strategy, but that happens. And we've done that you know with hand surgeons. We do that with surgeons.
00:15:06
Speaker
We don't want to overwhelm them. We don't want to say, no, the minimum is X, Y, and Z. And there are plenty of specialties where two is fine. We make good money on two cases, spine pain, totals. We go down a list.
00:15:19
Speaker
So it's not just... Have a set number, tell your scheduler, I only want these two, and that's it. If you don't do it, just say no. It's a give and take. And every day, the scheduler and I are always talking about you know what will work, what you know what we can get away with.
00:15:36
Speaker
You don't want to... piss off your doctors either. You know, we're here for the service, especially the ones that come constantly and and consistently. Hey, maybe they had seven. Maybe it was going really good day and they had three cancellations. You know, do you cancel the room now that the ophthalmologist only has four.
00:15:51
Speaker
No, you don't. You don't do that to somebody, right? But then you have onesie twosie that had the one. and indeed There's a lot of go that goes into this that that it's very dynamic. You used the word before, Dr. Cohen.
00:16:04
Speaker
It's not just a spreadsheet looking at numbers and going, oh, it's not profitable. Can't do it. Because you start saying the do you start saying to the surgeons, and this happened at the beginning, well, you know it costs us $2,600 to open a room. Not that I got to write a check to Dr. Cohen and say, here, you know please send me somebody.
00:16:20
Speaker
It's, these are the costs. These are the revenue. This is the average, what it's going to cost to have that room operational. We need to have more revenue of that. They hear it's going to cost $2,600, and oh my God, I can't believe that's so greedy why they're sending you a bill.
00:16:34
Speaker
That's not, you know, have be careful. That's not what's going on. They'll They don't care. I mean, you want if I say, no, I wanted someone there for that room, they'll send somebody.
00:16:44
Speaker
That's not the point. The point is overall, you know, are we doing right by the partnership? A lot that goes into it. Yeah. And I think what you see is when you scale this, right, or whether you're scaling it from one center to five centers to 20 to 200, or whether you're scaling it from one day to one week to one month to one year at the same center, right?
Scaling Operations: From Single to Multiple Centers
00:17:07
Speaker
there's there are all of these different factors and there's all these different scenarios and there are different right answers for different reasons. So what we've been able to experiment with over the past 10 years and really work towards and hope to continue to improve over the next 10 years is finding the ways to peel out the predictable factors that are more black and white and present those in a way that are actionable, you know, to the centers.
00:17:39
Speaker
And then while allowing the whole team to take into account those great factors, the gray zone and make the decisions. And as Lee said, our approach has never been and really can never be or should never be.
00:17:52
Speaker
Here's what we think is right. No, here is what we see. And as a vendor of services to the surgery center, the surgeons and the patients, what would you like us to do based on this information? And that's really the collaboration that started to evolve between anesthesia groups and surgery centers in order to be successful.
00:18:12
Speaker
Yeah, makes a lot of sense what you're both saying. that reminds me, we... At H2T we had this tool to be able to predict case profitability before it gets scheduled.
00:18:24
Speaker
And there's so many conversations that people can have, like you were saying, where were, hey, I'm going to be okay taking some unprofitable cases If it's going to help for the whole day or for the month or to establish that relationship.
00:18:41
Speaker
So it's really good. You're calling out that you can't just look at one case or one day on. And so, and you have to take that holistic perspective and have that back and forth. Like you were saying, Dr. Conn.
00:18:54
Speaker
yeah who When you two started working together, when you were digging into the model, Lee, what were some of the insights or aha moments that you came across?
00:19:05
Speaker
Okay, I'm not clinical. My my background is in business. That's what my degrees are in. So Dr. Cohen and I connected basically from day one. So what I needed from him was I needed him to let me know what, because I'm pretty conservative when it comes to patient safety.
00:19:22
Speaker
i needed I needed him to tell me what models are available and what models he thinks are safe, right? I mean, you could technically have one doctor here and have four rooms running.
00:19:33
Speaker
Like one doctor that's it. yeah That's not, one's going to do that. I'm saying that, of course, tongue in cheek, and he's not going to do that either. But my point is is that there are different models. CMS, you know, mandates, you know, if you have a doctor and CRNAs, there's ratios and what they supervise and things of that nature that, you know, you don't have if there are mds And that is not something that really occurred to me, like that you can come up with a model. He came up with a model where he says, well, you know, it's actually cheaper if we if I send you doctors and no CRNAs.
00:20:03
Speaker
That kind of thing was more of a aha moment because that never really occurred to me because doctors, you know generally speaking, make more than CRNAs, that kind of stuff. That's great example. Our model is is that depending on the specialty, we only have any CRNAs.
00:20:17
Speaker
won't have any sereades Which is not something that you would be that's intuitive that you would think beforehand. Yeah. I mean, the, the, there's two really good examples that come out of that Lee is, and again, this is more of the ability to drill down to not every day is the same at every center, right? So if you have a day, granted you have four operating rooms at your center, but let's say only two of them are being run.
00:20:40
Speaker
And let's say it's not a heavy orthopedic with a lot of blocks type of day. Right. It is financially less cost to put an MD in one room and an MD in another room instead of an MD supervising two CRNAs. That's purely you've eliminated an entire person. So yes, hourly, maybe it is more, but the total cost is less.
00:21:02
Speaker
And is it still an efficient model? Yeah. If you're not doing 50 blocks in a day, is it still a safe model? say Safety profile the same. So you start weighing those together. And there's other examples like that, but it all comes back to Having the drive and reason to look at the detail, even of the types of cases and the speed of the cases and the surgeons, you know, for example, rather than just saying two rooms, three rooms, it's not all the same.
00:21:32
Speaker
And that again is what is needed. That level is needed now in the ASCs because of kind of those loss of margins that we all used to have there. Right. Yeah, certainly.
Innovative Models in Anesthesia Management
00:21:44
Speaker
So we've been talking through a number of changes that you two made or you've seen done at other ASCs. Are there other types of changes related to what we're talking about that you've seen that may be worth mentioning for listeners?
00:21:59
Speaker
Yeah, I mean, something that we've kind of grown and evolved with over the years is kind of along the same lines of what we were just mentioning with the ability to shift models based on case type.
00:22:12
Speaker
is that nothing really can be all or nothing or doesn't need to be all or nothing. And that starts to surface more with the types of specialties that are at a center. you know Ophthalmology is a unique case mix right now. And so is GI for two very different reasons, but but are two of the most high volume specialties in ASCs right now. So ophthalmology, if the majority are being done with cat you know cataract surgery, and if those cataracts are being done with you know maybe a little bit of Versed sedation,
00:22:40
Speaker
You can start looking at different types of models that take into account efficiency, safety, CMS compliance, and reimbursement opportunities. And so, for example, I'm not saying, what I'm saying is it doesn't have to be, is our model CRNA?
00:22:57
Speaker
Or is our model MD? Or is it a one to four? There are models in between. and And those can be, you know, again, a little more customized to what needs to be done there because,
00:23:10
Speaker
The fact that you're using a light sedation gives you the opportunity to provide a little more of a zone coverage, like I i like to call it, approach, rather than kind of that man-to-man coverage. And I'm not talking about zone over patients. I'm talking about zone between MD anesthesiologists or anesthesiologists and CRNAs and how they interact together within the rooms in the center.
00:23:33
Speaker
On the flip side of that is which... which historically has been a very popular field to do all CRNA models with, which allows those CRNAs to function under the license of the gastroenterologist, which again, it works as a necessity in a lot of the more rural areas. It may work in some of the other areas as well.
00:23:57
Speaker
But for those, again, I like to take into account the clinical oversight, and i don't care if it's MDs, CRNAs, AAs, anybody, it's hands. and the ability to have enough hands to provide support for specific cases as they happen.
00:24:12
Speaker
Upper endoscopy, I'd rather do 50 open heart crashing onto bypass cases than one upper endoscopy because it's an unprotected airway, it's coughing, it's things that we often see each other, our own peers and colleagues asking for assistance with and needing help with. so You know, it, this all comes down to looking at the specialty, looking at the case type, adding that into the mix and being able to do that at scale in a consistent manner with the team that you're working with there.
00:24:42
Speaker
Yeah, those are great examples. Lee, anything you would add for other changes you've seen? Yeah, one of the things that completely different direction that Dr. Cohen went, one of the pressures on the AAC is that the doctors love to be flipped. If you're not familiar with flipping, it was giving one surgeon with enough volume two rooms. And in the past, that just meant two teams and two anesthesia providers. That was just what it meant.
00:25:08
Speaker
These days, though, we kind of cheat. and we can And as long as anesthesia is okay with it, and that's part of it, right, is that we tell anesthesia, no, it's two rooms, but we only want one of you for these two rooms. And I'll bring in two teams because the cost really ah was loaded in the anesthesia a subsidy.
00:25:27
Speaker
It's really not in the staffing. mean, there's a margin there. We can argue about that time. So the surgeon feels like they're flying faster because they have two rooms and they have a team setting up the room and you're saving on an anesthesia provider.
00:25:41
Speaker
And I think that's like a good cheat, especially for somebody that you want to help, but don't want to invest in the two providers. Yeah. So that's more the flop instead of the flip.
00:25:52
Speaker
My nurse my manager told me that word. i haven't adopted it yet. i like it. I'm embracing i'm embracing it. All right. It makes it clear in my head. Nice. I think NBA or soccer when you say flop. So and look so when we, when you were making these changes and improving ASC, is there anything else from the process that you would want others to know or you give advice for how they should think about proceeding? Yeah, it could be proceed carefully. And what i mean by that is, you know, your relationship with the anesthesia is one thing, but you also have relationship with your staff, your relationship with the management company, you a relationship with the surgeons, and everyone has different needs and wants, and they're not all going to aligned. I still maintain that the AAC aligns with anesthesia,
00:26:42
Speaker
You know, they make money, you make money. But sometimes you may, you might have surgeons that aren't partners that don't care about your dividends and just want to be getting in and out. Right. They all care about its speed.
00:26:53
Speaker
So they want all the resources on hand. We don't care about the cost associated. with it Right. So don't be talking to them about it's going to cost too much money. You know, you better work that differently, you know, and that's like to be there. They don't want to be home.
00:27:08
Speaker
You know, so. so Be careful how you word it. Be careful how, you know, please don't lay it at anesthesia's feet. Take ownership of it. You know, you're making these decisions. I'm talking to the end talk about the administrators that are going to be listening to this.
00:27:22
Speaker
It's going to your decision. You know, you're going to see the big picture. You're going make a decision. If it's for the best for the center to align with anesthesia, then you say that. But don't say it's because it's anesthesia.
00:27:34
Speaker
then you're to have conflict with anesthesia. You're going to have other people having conflict. Because that's what we saw when I took over. right Right, Dr. Drum? It was like, oh, anesthesia making us do that. like, no, that's not what happens.
00:27:45
Speaker
Yeah. And ultimately lead to your point, you know, you're going to be the one that walks into the board meeting and gives a readout of what's going on. It's not going to be pointing fingers at someone on your team or something else. So empowering yourself or you know, empowering each administrator to take that, that leadership presence is super valuable.
Aligning Operations for Mutual Profitability
00:28:07
Speaker
Right. Yeah, and the fact that he's able to walk into those board of meetings and say, he's not just saying, here's what I decided, you know, and he's able to show, we looked at this and this, and because of all of these factors, this is what we decided is best for the center. So it's a very different...
00:28:25
Speaker
approach and it puts a lot on the plate of the administrators to take into account for literally every case that is being scheduled at the center and every staff that is being hired and and booked. It's, you know, it's a lot.
00:28:36
Speaker
Yeah. and Busy, right? You know, so one aspect that we hear some ASCs focusing on that we haven't touched on is around patient collections and ensuring that both the ASC can collect on their side, but also sometimes helping anesthesia collect their patient collections.
00:28:59
Speaker
Because if anesthesia is getting more of their portion, well, again, they're going to need less of a subsidy because they're out of pocket less money. Have you all seen some groups, some ASCs help with the anesthesia collections, whether it's they mentioning, Hey, you're going to be getting multiple bills.
00:29:20
Speaker
They're not all from us, or you know, even having like a terminal or, you know, what have you seen? in this regard? Well, actually, we just talked about it recently. And actually, clarity may be ah solution that's sitting at Lee's center that helps with that. There's, this has become more complicated, but also more simple over the past few years. And it's the reason, the one reason it's become more simple, it goes back to everything else we've talked about is our incentives are now aligned.
00:29:48
Speaker
So that this is less of us saying, hey, we'd like you to do something for us. This is, hey, let's, we'd like you to help us do something, you know, with us because of everything you said, it helps drive down the subsidy.
00:29:59
Speaker
So the conversation is much easier to have, but it's much easier to get the centers on board with trying to help with collection piece. The execution has been a little bit challenging when you're dealing with a variety of management companies, health systems, compliance and technology challenge that sit within a center or their or the departments, whether it's something as simple as having an additional you know, component there to scan credit cards, who's going to do it, where's it going to go, and the exchange of data and information that's under more scrutiny now, you know, understandably than it ever has been in the past.
00:30:34
Speaker
So that's sort of what has led us back to the conversation of looking at existing internal options that are already built, and trying to lean into that a little bit to help capture some of that upfront cost, because without getting into the complexities of anesthesia collections just on the patient side alone, you know that that is something that is very challenging for revenue cycle management companies to deal with because of the unknown or challenge to get full pictures of where the patients sit with their deductibles and et cetera, going into procedures as opposed to facilities and surgeon offices. so
00:31:10
Speaker
Anything and everything helps. And we're seeing a lot more collaboration because of that. It's just finding the right way to get the data exchange of what has to happen or to get internal solutions that are already built in like clarity to see if we can sort of streamline that.
00:31:24
Speaker
But to answer your question, and we do tell the patients that they will receive multiple bills from multiple people. We do tell them that. We've been telling that for years actually, but think Dr. Cohen did a really good job of of summing that all up.
00:31:38
Speaker
that it's very complex because the management companies, you know, view us separate, you know, anesthesia and the center are separate entities. Sometimes they're referred to as vendor, which I don't accept.
00:31:51
Speaker
They're not vendors. They're partners. Cannot do this without them. You know, it's we're in this, it's a joint venture. We can't do what we do without our anesthesia partners, but there are people that don't understand that whole clinical world and how We work together and don't understand. So they concentrate on the things that Dr. Cohen already mentioned about the compliance and the credit cards and but maybe we shouldn't get involved or we can get involved. So it is a lot more complex than i think even I thought it well it's a slow work in progress. you have Yeah.
00:32:25
Speaker
Well, there are definitely plenty of complexities in healthcare these days, but hopefully that will get easier over the years.
Advice for ASC Leaders: Improving Surgery Centers
00:32:33
Speaker
Yeah. Well, this has been extremely insightful. I'm, I know our listeners are going to love this. Last question for you here. And we do this every week with our guests.
00:32:42
Speaker
What is one thing our listeners can do this week to improve their surgery centers? Well, that didn't expect that. So I would say the one thing they can do, call their anesthesia partners, ask for a sit down meeting.
00:32:56
Speaker
And that request that i'm meeting is to collaborate and find opportunities for improvement. It's amazing. as we go into new centers and new opportunities, how often the response back is, well, this is the first time we've really had a lot of this information presented to us.
00:33:12
Speaker
So I would encourage them to take advantage, you know pick the brains and find out how to figure out how to work together. I'm gonna go a different direction because the you know talking with anesthesia is obvious because you know we have you on the call here, Dr. Cohen.
00:33:27
Speaker
In a week, we're gonna go live with the forecasting tool with HST. I would say if you have something like that, because I don't, I would fan on the guests that there's many administrators out there in the country that don't know if their cases are profitable or not.
00:33:42
Speaker
And there's a misconception that a case is the case. And I think that people should spend a lot more time, even if it's by hand, they can go up and see if the cases that you're doing are profitable, where you do them.
00:33:55
Speaker
You can move the needle pretty quickly and get in the black. just by doing that alone. um And divide we've the collaboration between his Lee's team and our team, you know, we went 2024, their center paid almost a half a million dollars in subsidy.
00:34:13
Speaker
And last year, just over a couple hundred thousand. So all these things we talked about, you know, do translate into cost savings and managing to do it with keeping all the stakeholders happy as Lee referenced, you know along the way. So it is doable. It just takes effort.
00:34:30
Speaker
Yeah, you guys are a great success story. Thanks so much for coming on. Thank you. Appreciate it.
00:34:43
Speaker
A lot of ASC leaders are trying to solve anesthesia subsidy and coverage issues right now. But the first place to look may not be the anesthesia contract. It may be the schedule. And that's one of the clearest themes that shows up in our 2026 State of the ASC Industry Report, or SODI as we call it.
Impact of OR Block Utilization on Financial Health
00:35:00
Speaker
In our SODI report, OR block utilization ranges from 71% in smaller centers to nearly 50% in larger centers. And cancellation rates are also hovering around 20%.
00:35:12
Speaker
And that matters because empty time on the schedule is not really empty. If anesthesia is staffed and rooms are open and cases are spread in efficiently across the day, the center is still carrying the cost and the revenue just may not be there to support it.
00:35:28
Speaker
And that's where anesthesia subsidies can become a symptom of a much bigger operational issue. One of the most practical places to start is with the scheduling team. Block utilization doesn't improve just because leadership talks about it in a single meeting.
00:35:43
Speaker
It improves when the people building the schedule understand how blocks work, how open time should be managed, when unused time should be released, and how those decisions affect the entire day as a whole.
00:35:56
Speaker
That means that scheduler training can actually become a financial lever. If the schedule is tighter, if unused block time is managed earlier, and if cases are stacked more efficiently, the ASC gives anesthesia a better day to staff.
00:36:10
Speaker
And that can directly affect the pressure around coverage in subsidies. And that's what made Kramansky's example so powerful. His center was paying almost half a million dollars in anesthesia subsidy.
00:36:21
Speaker
After working with Dr. Cohen and his team, they were able to save Lee's center nearly $300,000 the following year. But the important part is how they got there. It wasn't just one magic fix.
00:36:31
Speaker
It was better visibility into the schedule, stronger alignment between the ASC and anesthesia group, better conversations around surgeon blocks and a clearer understanding of which cases were actually working for the center.
00:36:45
Speaker
And that connects to another important point from our SOTI report, which is case profitability. One of the best practices we highlight is understanding whether a case is likely to be profitable before it's actually performed.
00:36:58
Speaker
And that means looking at staffing hours, supply, implant costs, expected reimbursement, patient responsibility, and how that case fits into the broader day. Because a case is not just a case.
00:37:12
Speaker
Some cases strengthen the schedule, and others can make the day harder to staff, harder to cover, and harder to make profitable. The same thing applies to patient collections. In our SOTI report, the centers analyzed expected to collect about $380 million dollars in patient deposits $255 million, or roughly about 67%.
00:37:31
Speaker
but only collected about two hundred and fifty five million or roughly about sixty seven percent And when collections fall short, revenue becomes less predictable.
00:37:42
Speaker
And when revenue becomes less predictable, the pressure around coverage, stipends, anesthesia subsidies, it all gets harder to manage. So if your center is trying to get anesthesia costs under control, start by looking upstream.
00:37:56
Speaker
Look at block utilization, look at cancellations, look at how cases are stacked throughout the day, Look at whether your scheduling team has the training visibility they need to manage unused block time.
00:38:09
Speaker
Look at whether patient collections are matching expectations. And look at whether you understand case profitability before the case is performed. that's exactly why we created our 2026 SOTI report. It gives ASC leaders the benchmarks they need to ask better questions, identify operational gaps, and compare their own performance against what is happening across the industry. You can click the link in the description of this podcast to explore the report yourself.
00:38:38
Speaker
You can either read it online, listen to it in podcast format, or even request a free printed copy. And if this conversation was helpful, please share it with a colleague who is thinking through anesthesia coverage, subsidies, OR utilization, or case profitability at their center. It's the number one way to support the podcast. And of course, it helps us get this information in front of other ASC leaders who are looking for it.
00:39:03
Speaker
Thanks as always for listening to this week in surgery centers. We'll see you next week.