A Blueprint for Change: The Anesthesia Audit

By Epix Healthcare

By Tim Adams, M.D., President and Chief Medical Officer

As the healthcare industry continues to undergo a massive upheaval of its existing payment models and reimbursement structures, physicians and hospital leaders alike are faced with the daunting challenge of meeting new standards and adapting to significant changes.

The road hasn’t been easy: According to The Cecil G. Sheps Center for Health Services Research at University of North Carolina (UNC), 76 hospitals have closed since 2010, with the number of closures increasing each year. In addition, the National Rural Health Association has identified more than 280 rural hospitals across the United States in danger of closing their doors in the coming years. Not only would these closures leave thousands unemployed, but they would put certain patient populations in a vulnerable position with no inpatient health facility nearby.

One significant revenue stream hospitals can optimize is the OR, which can generate up to 70 percent of a hospital’s revenue, according to HealthLeaders Media. This places the anesthesia department in a prime position to bolster a health system’s financial stability and future growth.

Unfortunately, many anesthesia departments in hospitals nationwide are failing to meet the needs of their health system. This has led to a significant increase in the number of hospital administrators seeking to change anesthesia providers. According to a recent study by Enhance Healthcare Consulting, more than half of the hospitals surveyed were seeking an alternative to their current anesthesia provider, citing inadequate service, high subsidy rates and a lack of leadership.

To best assess the current performance of the anesthesia department and whether or not a change is necessary, hospital administrators can conduct an audit of the current clinical, business and political realities within their organization.

The coordination of clinical staff and resources is a critical part of the anesthesia department’s role and the overall success of the hospital. The leaders of the anesthesia department must be able to appropriately allocate their resources and properly manage their clinical staff members to meet patient needs.

Furthermore, the leaders of the anesthesia department and their team must be customer service-focused and engaged in an active partnership with the hospital managers to solve problems and improve performance. If the anesthesia department fails to meet these requirements, a change may be in order for the well-being of the hospital.


In today’s rapidly changing landscape, the anesthesia department must serve its hospital and patients proactively, demonstrating quality and efficient leadership that generates improved outcomes. 

Along with ensuring the anesthesia department fulfills the basic staffing needs and scheduling requirements, hospital leaders should re-evaluate the subsidy rate to ensure it accurately reflects the cost of labor and services provided. 70 percent of hospitals pay their anesthesia department a subsidy of up to $3 million annually, according to a survey by the American Society of Anesthesiologists (ASA). However, in an increasingly competitive market, hospital leaders should determine whether the amount paid is appropriate and fair for both sides of the transaction. In addition, administrators should track the rate of same-day cancellations of surgery and the reasons behind delayed start times or rescheduled procedures. If any of these metrics reflect poorly on the integrity or punctuality of the current anesthesia provider, hospital executives may want to switch to a more reliable partner.


The political reality is the third crucial area for hospital leaders to examine. Because of the nature of their work, surgeons and anesthesiologists can have deeply entrenched relationships that keep both parties satisfied. Hospital leaders must walk a fine line to avoid disrupting surgeon satisfaction but also to ensure both hospital and patient needs are being met.

On the other hand, surgeons and/or patients may already be dissatisfied with the current anesthesia provider, and may support an alternative to improve care and overall service. Hospital leaders must be aware of the political climate of their organization to understand the relationships that may be affected should they choose to maintain their current anesthesia provider or make a change.

To learn more about how to accurately assess a current anesthesia provider’s performance, please contact us at info@EpixAnesthesia.com.