Key Considerations for Anesthesia Contracts

Anesthesiology agreements typically cover all sites within a facility that require anesthesia. These include inpatient operating rooms, outpatient operating and procedure rooms, and obstetrical services.  They typically include coverage for a defined number of ORs for specified hours and days of the week.  This is to ensure the availability of an anesthesiologist for both scheduled and unscheduled cases.  Emergency services may be provided by an in-house or on-call physicians.  At minimum, coverage is for general anesthesiology services but may also include subspecialists like cardiac, pediatric, obstetrics, and pain management.  Often, anesthesia contracts can be the largest, most complex physician agreements that a hospital will negotiate.

When analyzing an anesthesia contract for renewal or to create a new agreement, here are the most important factors to consider:

  • What are the total number of surgical cases, births, operating rooms, covered sites, and hours of on-site coverage required? Make sure you know the entire scope of the agreement so that the negotiated rate makes sense.
  • Is in-house coverage required after 7pm and on weekends?  Restricted call rates are typically higher, as is weekend/holiday coverage.
  • Does the contract require anesthesiologists with specialized training and certification in fields such as cardiac or pediatric anesthesiology?  If so, this might impact rates.
  • Is the proportion of Medicare, Medicaid, or unsponsored patients extraordinarily high or low?  Some contracts include payments for uncompensated care.
  • What are the average number of cases per day, per year, per room, and per physician, and how do they compare to industry benchmarks?
  • For contracts based on collections or unit value guarantees, are the annual per physician compensation amounts or unit values based on fair market value assumptions for those values?
  • Are both the aggregate and the per physician per diem payments reasonable?  Have you compared them to industry benchmarks?


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