Strategy

Building and Maintaining a Strong Hospital-Anesthesia Service Relationship

By , Senior Physician Executive · Published

Building and Maintaining a Strong Hospital-Anesthesia Service Relationship

Strong relationships help independent anesthesia groups remain viable, employed groups succeed, and hospitals and ASCs sustain resilient anesthesia service lines.

For hospitals and ambulatory facilities, a strong relationship with an employed or contracted anesthesia group is the foundation of a high-performing, stable, and sustainable service line. The same is true for independent groups; strong relationships with contracted hospitals and ASCs are essential to long-term viability.

Conversely, weak or absent relationships underlie many underperforming or failing anesthesia services, whether contracted or employed, and often threaten the viability of independent groups. Too often, the relationship is defined mainly by awkward, contentious escalating subsidy requests with little communication in between. Unsupported financial asks, lack of transparency, and recurring anesthesia budget overruns erode trust, weaken relationships, and can lead to expensive, disruptive transitions.

Do not let the outcome (subsidy number) overshadow the process. Prioritize maintaining the relationship throughout contract and subsidy negotiations.

In a competitive labor market, retaining a strong current service provider—or building one—often depends on trust among stakeholders. That trust can be the differentiator in successful negotiations, subsidy discussions, and stable staffing in an unstable environment.

Strong relationships help stakeholders proactively address, and often avoid, common anesthesia service-line problems, including staffing shortages that limit access and growth, escalating and unanticipated expense overruns, surgeon dissatisfaction, attrition, recruiting difficulty, high premium labor costs, and major transitions.

Building the Hospital-Anesthesia Group Relationship

Strong relationships are built on trust. Trust grows through consistent, repeated behaviors characterized by engagement, transparency, honesty, respect, open communication, and aligned interests.

Aligned interests and common goals are often overlooked bridges to the trust that underlies strong relationships. Too often, the default attitude is “us versus them”—hospital or ASC administration versus the anesthesia group—with each side assuming a zero-sum game in which one side’s win must be the other side’s loss. The best place to start is an open, frank discussion that challenges those assumptions.

The next step is to define shared interests, discuss them openly, and emphasize a willingness to work together toward a simple common, mutually beneficial goal: a high-performing service line and a great place to work. Each stakeholder’s reasonable and logical needs should be acknowledged and respected.

A hospital executive and an anesthesiologist shaking hands in a sunlit hospital atrium

Hospital needs and reasonable expectations

  • Engaged group leadership and strong governance
  • Consistent, reliable patient and surgeon access to services
  • Clinical and service excellence
  • Surgeon satisfaction
  • Operational efficiency
  • Transparent financials that demonstrate ongoing financial rigor and stewardship to support subsidy requirements

Group needs and reasonable expectations

  • Engaged and supportive administration
  • A long-term commitment to the group for services
  • Adequate financial subsidization to support market-competitive compensation packages and reasonable overhead costs
  • A supportive and safe work environment
  • Clear communication about service requirements and growth planning

Hospitals and ASCs need to value their anesthesia service provider, and service providers need to demonstrate their value to the hospital.

Trust builds strong relationships, and strong relationships sustain long-term, resilient, high-performing anesthesia service lines.

Strong Relationship Checklist

Hospital/ASCService Provider/Group
Financial Subsidy
  • Provide adequate financial support for market-competitive compensation and reasonable overhead, including bonus structures when needed to support recruiting and retention.
  • Help the group secure optimal payer rates through contract negotiations and TIN strategies.
  • Outsource anesthesia revenue cycle management if performance is below expectations.
  • Support compensation requirements with national and regional market data and productivity benchmarks.
  • Provide transparent financials and quarterly reporting to support and verify revenue, expenses, and subsidy requirements.
  • Optimize payer rates, renegotiate contracts, and include appropriate escalators.
  • Demonstrate that revenue cycle management performance meets expected standards.
Leadership
  • Designate an executive leader for the anesthesia service line and establish regular meetings and communication.
  • Support surgical services executive committee governance.
  • Provide reasonable compensation for administrative duties, including medical director responsibilities.
  • Include anesthesia leadership in operational and strategic growth decisions.
  • Identify qualified group leaders and establish a clear governance, reporting, meeting, and communication structure.
  • Establish and lead the surgical services executive committee.
  • Lead or co-lead surgical services initiatives.
  • Provide facility-level anesthesia leadership, including medical director support.
  • Provide daily anesthesia board leadership at each facility.
ClinicalConsider clinical performance-based financial incentives.
  • Implement protocol-driven best practices.
  • Own patient safety processes, including checklist use.
  • Meet anesthesia quality metrics.
Operational
  • Consider operational performance-based financial incentives.
  • Review OR utilization and coverage to improve efficiency and reduce cost.
  • Support recruiting needs.
  • Meet or exceed OR KPIs.
  • Help the hospital optimize operational and staffing models to reduce costs.
  • Proactively manage staffing, align on future needs, and plan accordingly.
Strategy
  • Establish a deliberate system anesthesia strategy and integrate anesthesia into the enterprise mission and growth plan.
  • Consider joint ventures, MSO partnerships, equity opportunities, and employment SWOT analysis.
  • Act as a strategic partner, not a vendor or staffing company.
  • Demonstrate measurable value.
  • Be willing to share risk and align incentives when appropriate.
  • Consider joint venture, co-owned, or co-managed MSO models, and discuss employment SWOT analysis.

Explore AOC’s anesthesia consulting services to learn how we help hospitals and anesthesia groups strengthen service relationships, align financial and operational expectations, and build sustainable anesthesia programs. Contact AOC to discuss an anesthesia service-line assessment.

Related: anesthesia subsidy benchmarking, anesthesia staffing and care team models, and strategies for improving operating room efficiency and service-line performance.

About the Author

Senior Physician Executive

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