As discussed in the first two installments of this three-part series on the valuation of anesthesiology services, despite the increasing demand for anesthesiology providers, Medicare reimbursement for anesthesiology has decreased over the past few years. Additionally, like other healthcare providers, anesthesiology clinicians face a range of federal and state legal and regulatory constraints that affect their formation, operation, procedural coding and billing, and transactions. These dual pressures—declining reimbursement coupled with increasing regulatory scrutiny—create a need for reliance on emerging technological innovations in order to survive. Consequently, this final installment will review the technological advancements impacting the delivery of anesthesiology services.

Anesthesiology is “inextricably dependent” on technology.¹ Anesthesiology differs from other specialties in that the nature of the work relies upon immediate onset, continued and sensitive control, and extremely quick offset, of employed pharmaceuticals.² Further, the tools and supplies used during the administration of anesthesia (e.g., intubation), as well as monitoring technology (such as those used to monitor oxygen levels cardiac performance), have accelerated the specialty’s advancement over the past few decades. Going forward, it is anticipated that most technological advancements in anesthesia will shift focus “from hardware to software to digital solutions.”³

Recent innovations in anesthesia include new drugs, improved monitoring systems, and the use of artificial intelligence (AI). New drugs are being added to anesthesiology providers’ repertoire, and new applications of existing drugs are being discovered, to improve the inducement of general anesthesia and/or sedation, with the overall goal of creating a hypnotic that has both rapid onset and rapid termination, results in minimal side effects, and is tightly controllable.⁴

As regards monitoring systems, the rise in anesthesia information management systems (AIMS) have improved operating room management, billing, and documentation.⁵ AIMS are a unique form of electronic health record (EHR) system that typically provides clinicians with a summary of patient data collected during the perioperative period. This summary is then used to oversee quality, which allows patient information to be reported without biases, increasing the efficacy of the data. The utilization of decision support systems (DSS) can further the advantages of AIMS by limiting or eliminating errors in the delivery of anesthesia services.⁶

These technologies are expected to be further supported by advancements in AI and automation. These technologies may help ameliorate the anesthesiologist shortage by automating mundane, repetitive, and low-value tasks, as well by allowing anesthesiologists to oversee a greater number of clinicians/sites.⁷ In addition, research is currently being conducted (with promising results) on using a machine learning algorithm for the continuously automating dosing of propofol.⁸ If successful, it may eventually become feasible “for computers to maintain patient unconsciousness with no more drug than is needed, thereby freeing up anesthesiologists for all the other responsibilities they have in the operating room, including making sure patients remain immobile, experience no pain, remain physiologically stable, and receive adequate oxygen.”⁹

Given the current conditions of the anesthesiology services industry, providers may experience significant opportunities and challenges in the coming years. The market for anesthesiology services is expected to experience increasing demand in the coming years, due to an aging U.S. population requiring more surgical interventions and procedures, as well as technological advancements that make these interventions possible and safer for a wider array of patients. As demand increases, the supply of anesthesiologists is anticipated to decrease, but the supply of non-physician anesthesiology providers, i.e., certified registered nurse anesthetists (CRNAs) and certified anesthesiologist assistants (CAAs), is expected to increase. Coupled with the promise of technological advancements taking some of the administrative burden off of clinicians, appropriately-structured anesthesia care teams may be able to meet the increasing demand over the next several years.

Although this potential influx of patients may provide valuable revenues, the uncertain reimbursement environment for anesthesiology providers may challenge providers’ operations, particularly those whose payor mix is significantly comprised of government payors. While attempting to navigate these issues, anesthesiologists must continue to withstand increasing regulatory scrutiny related to healthcare fraud and abuse laws. These obstacles may create a challenging environment in which anesthesiologists must be both clinically and economically efficient in order to thrive.