Latest / Becker’s Healthcare Podcast / How Healthcare Organizations Are Navigating Growing Anesthesia Staffing, Cost, and Coverage Pressures

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How Healthcare Organizations Are Navigating Growing Anesthesia Staffing, Cost, and Coverage Pressures · Becker’s Healthcare Podcast

• 0:00
  - Hello, everyone. This is Erica Spicer Mason with
• 0:02
  - Becker's Healthcare. Thank you so much for tuning
• 0:05
  - in to the Becker's Healthcare podcast series.
• 0:08
  - Today, we're going to talk about how healthcare
• 0:10
  - organizations
• 0:11
  - are navigating growing anesthesia
• 0:13
  - staffing, cost, and coverage pressures
• 0:15
  - and what it takes to build a more
• 0:17
  - sustainable and flexible model for the future.
• 0:20
  - So joining me for this conversation, we have
• 0:22
  - two leaders from MedHQ,
• 0:24
  - Steve Mason, the president,
• 0:25
  - and Zachary Phillips, vice president of advisory services.
• 0:30
  - Zach, Steve, great to have you with us
• 0:31
  - today. Thanks so much for being here. Pleasure
• 0:34
  - to be here. Thank you. Thank you for
• 0:35
  - having us.
• 0:37
  - Well, it's great to have you both on
• 0:38
  - the line. Before we get into the discussion,
• 0:40
  - wondering if you could just tell us a
• 0:42
  - little bit about yourself and your work in
• 0:44
  - the health care space. Steve, you wanna get
• 0:46
  - us started?
• 0:47
  - Yes. Happy to do that. Thank you. I
• 0:50
  - am president
• 0:51
  - of MedHQ.
• 0:53
  - My background,
• 0:54
  - is over thirty years in the health care
• 0:56
  - space.
• 0:57
  - I've been,
• 0:59
  - both in management
• 1:00
  - positions and leadership positions within the hospital system.
• 1:04
  - I've also led a multistate
• 1:07
  - MSO for a large specialty practice group.
• 1:11
  - I've served in a leadership position for a
• 1:14
  - firm that provides audit services to large physician
• 1:17
  - practices and health care systems.
• 1:20
  - And prior to joining MedHQ, most recently, I
• 1:22
  - served as the chief operating officer for a
• 1:24
  - national physician company.
• 1:26
  - And, now I serve as the president for
• 1:28
  - MedHQ.
• 1:30
  - Fantastic. Thank you, Steve. And Zach, tell us
• 1:33
  - about you.
• 1:35
  - I serve as the vice president of advisory
• 1:37
  - services at MedHQ,
• 1:39
  - and my background
• 1:40
  - includes about a decade of experience in anesthesia
• 1:43
  - practice management
• 1:45
  - where I oversaw national multi site operations,
• 1:49
  - led financial performance improvement,
• 1:51
  - and drove administrative function for cross functional teams.
• 1:54
  - So really glad to be with you today
• 1:56
  - and looking forward to the conversation.
• 1:59
  - Thanks so much, Zach. And and, again, it's
• 2:02
  - great to have you both with us, especially
• 2:04
  - to walk through some of the growing pressures
• 2:06
  - that I know we're seeing in the anesthesia
• 2:09
  - space.
• 2:10
  - For a lot of organizations right now, they're
• 2:12
  - feeling pressure from the staffing side of things,
• 2:15
  - costs, and then coverage as well.
• 2:18
  - So I'm curious if you can set the
• 2:20
  - scene for us just in a little bit
• 2:22
  - more detail.
• 2:23
  - What are you hearing from anesthesia groups and
• 2:25
  - their facility partners about what's making this moment
• 2:28
  - particularly difficult?
• 2:30
  - I... I'll tackle that one. I think what
• 2:33
  - we're seeing in the anesthesia space in general
• 2:35
  - is a convergence
• 2:36
  - of multiple challenges
• 2:38
  - that have frankly been building for a number
• 2:41
  - of years.
• 2:42
  - Anesthesia
• 2:42
  - really is a people intensive business,
• 2:45
  - with
• 2:46
  - the provider side.
• 2:48
  - And there's been workforce shortages
• 2:51
  - for a number of years
• 2:53
  - contributing to increased labor costs.
• 2:55
  - In addition to that, reimbursement
• 2:57
  - pressure,
• 2:58
  - on the side of the insurance payer, side
• 3:01
  - of the equation
• 3:02
  - and, frankly, a growing demand for the services.
• 3:04
  - So it's a convergence of all those things
• 3:06
  - with... Without enough providers, increased labor costs, decreased
• 3:10
  - reimbursement,
• 3:11
  - and a greater demand for more and more
• 3:14
  - services.
• 3:15
  - It creates a pretty challenging operating environment.
• 3:19
  - Hospitals and and ambulatory surgery centers really, at
• 3:23
  - their core, they need predictable,
• 3:24
  - dependable anesthesia coverage,
• 3:27
  - simply because their, their surgical operation depends on
• 3:30
  - it. And if the anesthesia coverage isn't there,
• 3:34
  - patients can be impacted, cases can be delayed,
• 3:36
  - schedules get disrupted, and and ultimately,
• 3:40
  - the the
• 3:41
  - the patient experience,
• 3:42
  - can suffer from that.
• 3:45
  - Yeah. Yeah. Absolutely.
• 3:47
  - I appreciate
• 3:48
  - how you outline that, Steve. Zach, what would
• 3:50
  - you add here?
• 3:51
  - Yeah. I would add just maybe a little
• 3:53
  - more detail. So in particular on the staffing
• 3:56
  - side, what we're seeing as an organization
• 3:58
  - is,
• 3:59
  - you know, facilities and groups across the country
• 4:02
  - work hard to recruit and retain clinicians
• 4:06
  - while trying to maintain a reliable level...
• 4:09
  - A reliable coverage level
• 4:11
  - across multiple facilities. So
• 4:13
  - at at the core, it's not just about
• 4:15
  - a shortage of providers, but it's about having
• 4:18
  - the right model, the right mix of providers,
• 4:21
  - and the ability to flex
• 4:23
  - with needs as facilities change.
• 4:25
  - On the financial side, as Steve alluded to,
• 4:28
  - you know, reimbursement just isn't keeping up with
• 4:31
  - the cost to deliver care.
• 4:34
  - And since labor is such a big component
• 4:36
  - of the overall cost structure, efficiency is critical.
• 4:40
  - Even small inefficiencies
• 4:42
  - can have a big impact on profitability.
• 4:45
  - So to summarize those comments,
• 4:47
  - really, the challenge that we're seeing is that
• 4:50
  - the issues across the country are not independent
• 4:52
  - of one another.
• 4:54
  - Staffing decisions affect cost.
• 4:57
  - Cost affects sustainability,
• 4:59
  - and coverage affects the facility's ability to operate.
• 5:03
  - So, really, what we do is look at
• 5:05
  - the entire system
• 5:06
  - as opposed to trying to solve each problem
• 5:09
  - individually.
• 5:11
  - Yeah. And I'm sure when something is a
• 5:14
  - system level
• 5:15
  - challenge,
• 5:16
  - of course, that makes it a little bit
• 5:18
  - more daunting to take on and to solve.
• 5:20
  - And so I'm curious,
• 5:22
  - and, Zach, maybe you have a little more
• 5:24
  - insight here.
• 5:25
  - Where does the pressures that we've talked about,
• 5:28
  - especially pressures on the system in general, where
• 5:30
  - does it show up first? Is there a
• 5:32
  - point where a group realizes that its current
• 5:34
  - model isn't going to hold the way that
• 5:36
  - it is?
• 5:37
  - That's a great question. And, typically, what we
• 5:40
  - see is the pressure usually shows up first
• 5:43
  - in day to day operations.
• 5:45
  - So that looks like more difficulty filling out
• 5:48
  - schedules on a day to day basis.
• 5:51
  - We see an increased reliance on premium clinical
• 5:54
  - labor.
• 5:55
  - We see last minute changes, and maybe the
• 5:58
  - one that we see most often is
• 6:02
  - the leadership team, particularly clinical leadership,
• 6:05
  - spends more time putting out fires on the
• 6:07
  - administrative side of things.
• 6:09
  - So on the financial piece, you know, we
• 6:11
  - look at
• 6:13
  - increased labor at a rate that that revenue
• 6:16
  - just can't keep up with and relationships
• 6:19
  - that used to
• 6:20
  - be steady
• 6:21
  - now have become,
• 6:22
  - you know, unsustainable.
• 6:24
  - So that point of realization,
• 6:25
  - just to circle back to your original question,
• 6:27
  - is
• 6:28
  - the current model appears
• 6:30
  - that it won't be sustainable
• 6:33
  - when those one offs become a pattern. Those
• 6:35
  - individual issues
• 6:37
  - become the norm as opposed to the exception.
• 6:41
  - Mhmm.
• 6:42
  - Yeah. It's a very clear kind of symptom
• 6:45
  - list, that you shared back, so I appreciate
• 6:47
  - you,
• 6:48
  - providing more detail on that.
• 6:51
  - So coming back to you both on this
• 6:52
  - one,
• 6:53
  - when a client comes to you knowing that
• 6:55
  - something isn't working, you know, they're seeing some
• 6:57
  - of these symptoms arise, whether that's,
• 7:00
  - difficulty filling appointments,
• 7:02
  - clinical leadership spending an inordinate amount of time
• 7:05
  - on the administrative fires,
• 7:07
  - you know, and and they're not sure where
• 7:09
  - or how to start addressing those problems. How
• 7:12
  - do you lead them through that? And in
• 7:14
  - that assessment, is there anything that surfaces that
• 7:16
  - tends to surprise them?
• 7:18
  - Yeah. I'll I'll take a crack at that
• 7:20
  - one and then would welcome comments from Steve
• 7:23
  - as well. The the first thing that we
• 7:25
  - do, just the complexity of the issues that
• 7:28
  - I described
• 7:29
  - previously,
• 7:30
  - you know, we really take the opportunity to
• 7:32
  - slow things down,
• 7:34
  - really understand
• 7:35
  - what's going on.
• 7:37
  - We oftentimes
• 7:38
  - have a client that comes to us and
• 7:40
  - says,
• 7:41
  - we think we have a staffing problem, or
• 7:44
  - we think we have a financial problem, or
• 7:47
  - maybe we have a relational problem.
• 7:50
  - But, really, when we take the time to
• 7:52
  - dive into that, those are just symptoms of
• 7:54
  - a bigger problem. So we start by looking
• 7:57
  - at the business holistically.
• 8:00
  - What that means is we understand
• 8:02
  - financial performance and staffing and scheduling practices,
• 8:06
  - operational workflows,
• 8:08
  - all the details that go into
• 8:11
  - a practice,
• 8:12
  - a group, a facility relationship, and the data
• 8:15
  - behind that. But we don't just want to
• 8:17
  - understand the numbers.
• 8:19
  - We want to understand why the numbers are
• 8:21
  - telling us what they're telling us. So, for
• 8:24
  - example,
• 8:25
  - if labor costs are increasing,
• 8:27
  - is that because there's genuinely a shortage of
• 8:30
  - providers?
• 8:31
  - Could it be the way that schedules are
• 8:33
  - being built, or are there inefficiency
• 8:35
  - in how providers are deployed?
• 8:38
  - Those are very different problems, and they require
• 8:41
  - very different solutions.
• 8:43
  - So after that point, we
• 8:45
  - prioritize what items can we tackle in the
• 8:49
  - short term,
• 8:50
  - what can be improved over the medium term,
• 8:52
  - and then what are the items that need
• 8:54
  - a bigger picture, you know, long term
• 8:57
  - attention. So it... One thing that I would
• 8:59
  - note is, you know, it's important to us
• 9:01
  - and, you know, our approach as we work
• 9:03
  - with facilities and groups across the country is
• 9:07
  - we take into account what's important to the
• 9:09
  - leadership teams that are in place
• 9:11
  - to make sure that we're aligned on what
• 9:13
  - success looks like. You know, we don't come
• 9:15
  - in with a predetermined answer.
• 9:17
  - Instead, we wanna understand what's important to the
• 9:20
  - client, what's working, and then identify some opportunities
• 9:24
  - to build a more sustainable path forward.
• 9:27
  - Yeah. And if I could just build on
• 9:28
  - what Zach just outlined, I I think, you
• 9:31
  - know, in terms of surprises, what we often
• 9:33
  - hear from our clients is
• 9:35
  - how interconnected
• 9:37
  - all of those,
• 9:38
  - different elements are that Zach just referenced.
• 9:41
  - Frequently, we'll hear comments like, we know we
• 9:44
  - have a shortage of providers,
• 9:46
  - but as we look at the data and
• 9:48
  - start diving in deeper,
• 9:50
  - we frequently find that while there may be
• 9:53
  - a provider shortage, there also could be challenges
• 9:56
  - related to how the schedules are set up,
• 9:58
  - what utilization
• 10:00
  - rate is,
• 10:01
  - how the different coverage needs are structured across
• 10:04
  - different locations.
• 10:06
  - You know, another example would be a client
• 10:08
  - may believe that, that it's strictly a reimbursement
• 10:12
  - issue,
• 10:13
  - that's making the anesthesia provision kind of untenable,
• 10:17
  - but there's opportunities to improve expense management or
• 10:21
  - operational
• 10:22
  - visibility or or alignment of contracts that really
• 10:25
  - can address that issue.
• 10:27
  - And it's not simply the reimbursement side of
• 10:30
  - things. Ultimately, it's it's not always the initial
• 10:34
  - problem that a client may think that they
• 10:37
  - have, but it's really digging a little deeper
• 10:39
  - and and it's multifactorial.
• 10:41
  - And so
• 10:42
  - as Zach said, you know, we really try
• 10:43
  - to dive in and and really make sure
• 10:45
  - that we're covering all the fronts. And chances
• 10:48
  - are there's gonna be more than more than
• 10:50
  - one factor, and and we can make progress
• 10:52
  - on all of those. If there was an
• 10:53
  - easy solution, they probably would have found it.
• 10:55
  - It's truth is there's there's a lot of,
• 10:59
  - nuance
• 11:00
  - when the problems that exist in in anesthesia
• 11:02
  - coverage today are considered.
• 11:04
  - I think the biggest opportunity isn't necessarily doing
• 11:08
  - more.
• 11:09
  - It's giving our clients and and the folks
• 11:11
  - that we're privileged to work with the right
• 11:13
  - tools and resources and and and truthfully, just
• 11:17
  - having better visibility
• 11:18
  - into the factors,
• 11:20
  - that are contributing to to an anesthesia problem,
• 11:24
  - so that they can make better decisions with
• 11:26
  - what what what they already have.
• 11:29
  - Mhmm.
• 11:30
  - Yeah. Steve, I appreciate your your build on
• 11:32
  - there. And it reminds me of something that
• 11:35
  - Zach had mentioned earlier, which was that when
• 11:38
  - you're working with
• 11:39
  - your clients,
• 11:40
  - there's not necessarily a single predetermined template or
• 11:44
  - plan that you're handing them. It's more of
• 11:46
  - customized support given the nuances that you just
• 11:49
  - touched on, Steve.
• 11:51
  - So can you give us a sense of
• 11:52
  - what that looks like in practice? And is
• 11:55
  - there a partner who comes to mind who's
• 11:57
  - really getting this process right and these improvements
• 12:00
  - are happening?
• 12:01
  - The customizable support to us means we recognize
• 12:05
  - that every anesthesia relationship and organization
• 12:09
  - is different.
• 12:10
  - You may have a a clinically strong group
• 12:12
  - with great leadership, but
• 12:15
  - need some help on payer contracting and financial
• 12:18
  - reporting.
• 12:20
  - Another group may have a great administrative infrastructure
• 12:23
  - but need support with recruiting or workforce planning
• 12:27
  - or operational performance.
• 12:29
  - Then there are other groups that need help
• 12:32
  - in a variety of those areas, and a
• 12:34
  - more comprehensive solution is is required. So
• 12:38
  - the summary comment is we don't believe that
• 12:41
  - every organization needs the same level
• 12:44
  - or type of support.
• 12:46
  - So what that looks like is we start
• 12:48
  - by understanding the existing capabilities
• 12:51
  - where the existing leadership team wants to take
• 12:54
  - the organization
• 12:56
  - and then identify what resources are needed to
• 12:58
  - get there.
• 12:59
  - At that point, we can help build a
• 13:02
  - customized support structure
• 13:04
  - to reach that goal, which might include some
• 13:06
  - of the things that I referenced, financial planning
• 13:09
  - analysis, payer contracting, recruitment,
• 13:11
  - operational leadership, HR, or strategic planning. The key
• 13:15
  - for us is we're not trying to replace
• 13:18
  - what already works.
• 13:19
  - Our goal is to strengthen it.
• 13:22
  - In my opinion,
• 13:23
  - the best partnerships are the ones where there's
• 13:26
  - a clear understanding of roles and responsibilities,
• 13:30
  - strong communication,
• 13:31
  - and a willingness to continuously
• 13:33
  - evaluate what's working and what isn't.
• 13:36
  - And to elaborate on that, I I just
• 13:38
  - would double down and highlight the characteristics of
• 13:41
  - of partnerships that really work well
• 13:44
  - and the strongest partnerships. Really, they tend to
• 13:47
  - have engaged clinical leadership with with really transparent
• 13:51
  - communications
• 13:52
  - to make sure that,
• 13:53
  - that the objectives are clearly outlined, that there's
• 13:56
  - a shared understanding of of both the clinical
• 13:59
  - objectives and the business objectives.
• 14:01
  - And recognizing that,
• 14:03
  - the way that anesthesia provision has been looked
• 14:06
  - at historically,
• 14:08
  - should evolve. It should evolve to meet the
• 14:10
  - needs, of the patient and and where care
• 14:13
  - is being provided and what type of care
• 14:15
  - is being provided and and what what has
• 14:18
  - historically worked is is likely not going to
• 14:20
  - work in the future if you don't flex
• 14:22
  - with that. So,
• 14:24
  - there's definitely a need to look ahead and
• 14:26
  - and to plan for that and to stay
• 14:27
  - out in front of it as much as
• 14:29
  - possible.
• 14:30
  - I would also point to partnerships that are
• 14:32
  - successful or ones where there's real transparency of
• 14:35
  - data, and the data will tell a story.
• 14:37
  - And we just wanna make sure that everybody's
• 14:39
  - looking at it the same way and and
• 14:41
  - that there's collaboration
• 14:42
  - to make adjustments
• 14:43
  - based on what the data's sharing.
• 14:45
  - And, really, while it's sometimes is an overused
• 14:49
  - phrase, alignment is is really important,
• 14:52
  - because when the anesthesia group and the facility
• 14:54
  - understand each other's priorities
• 14:56
  - and can work towards that common goal, that's
• 14:58
  - where you have really strong foundation for not
• 15:01
  - just success today, but long term success and
• 15:05
  - and good partnering.
• 15:07
  - Mhmm.
• 15:08
  - Now, Steve, and and you're touching on what
• 15:10
  - I was hoping to close this out on
• 15:12
  - as well, which is, you know, you mentioned
• 15:15
  - that the field and the challenges are are...
• 15:18
  - They're evolving. And so
• 15:20
  - I'm curious as organizations
• 15:22
  - are looking out a few years from now,
• 15:25
  - how do you see anesthesia staffing and coverage
• 15:28
  - models
• 15:29
  - changing, especially as more cases move to the
• 15:32
  - ambulatory setting? Are there specific things that groups
• 15:35
  - should be thinking about now? I I know
• 15:37
  - you mentioned data, but we'd love to hear
• 15:39
  - any other, best practices or strategies for the
• 15:42
  - years ahead.
• 15:43
  - Yeah. Absolutely. And I I think you hit
• 15:45
  - the nail on the head is is evolution,
• 15:48
  - how anesthesia is provided needs to continually evolve,
• 15:51
  - and and you gave a great example as
• 15:53
  - more procedures move into ambulatory settings. It's not
• 15:56
  - just any procedure, but it's more complex procedures.
• 16:00
  - Organizations and practices are going to need to
• 16:03
  - have greater flexibility in how they deploy their
• 16:05
  - providers,
• 16:06
  - to meet those needs.
• 16:08
  - A hospital based program can be very, very
• 16:10
  - different from an ambulatory
• 16:12
  - surgery center program.
• 16:14
  - And even within that environment, there's... You know,
• 16:17
  - we're already seeing significant variation in in case
• 16:20
  - mix and volume in, you know, historically hours
• 16:24
  - of operation and and how it's staffed. So
• 16:27
  - I I think groups will,
• 16:29
  - need to continue
• 16:31
  - to move away from a kind of a
• 16:33
  - one size fits all approach and really be
• 16:35
  - more deliberate with site specific coverage models,
• 16:38
  - providers that understand that,
• 16:41
  - and what that means to the group both
• 16:43
  - clinically, operationally, financially.
• 16:46
  - All of those things,
• 16:48
  - need to be considered as as the model
• 16:50
  - changes and evolves.
• 16:51
  - We touched on data.
• 16:53
  - Hand in hand with data would be technology.
• 16:56
  - They're gonna continue to play a really important
• 16:58
  - role. We need to be able to look
• 16:59
  - at what the plan is and how we
• 17:01
  - execute it against the plan from a from
• 17:03
  - a coverage model and availability model, a financial
• 17:06
  - model.
• 17:07
  - Organizations really need visibility
• 17:10
  - into how providers are being utilized, not just
• 17:13
  - how they're being scheduled, but how they're being
• 17:15
  - utilized,
• 17:16
  - because I think at its core,
• 17:18
  - there's a lot of alignment that already exists
• 17:20
  - between, say, a facility, whether it's a hospital
• 17:22
  - or an ASC in an anesthesia practice.
• 17:26
  - Efficiency is is already there. The the desire
• 17:29
  - for efficiency is already there.
• 17:31
  - So you need to have the data that
• 17:33
  - informs that so that,
• 17:35
  - misses or or variation from an efficient model
• 17:38
  - can be
• 17:39
  - addressed and quantified and move towards better performance.
• 17:43
  - By bringing all those pieces together, the leaders
• 17:45
  - both on the clinical side and on the
• 17:47
  - on the hospital or ASC or business side,
• 17:50
  - if you will, will make more informed decisions
• 17:52
  - when they have the the right data. We'll
• 17:54
  - tell them where where they need resources and
• 17:57
  - how to structure their operations.
• 17:59
  - Just to add on to Steve's comments, I
• 18:01
  - I wanna dig into the the role of
• 18:03
  - the administrative
• 18:04
  - teams just a little bit. We think that
• 18:07
  - that infrastructure is gonna be paramount in the
• 18:10
  - path forward for facilities and groups alike as
• 18:13
  - the relationships become
• 18:15
  - more dynamic and the needs change in light
• 18:18
  - of the workforce shortage and the reimbursement pressures
• 18:21
  - that we've talked about.
• 18:22
  - Those capabilities
• 18:24
  - to manage the complexity
• 18:25
  - and do so without creating additional burden for
• 18:28
  - clinicians is really gonna be important here. So
• 18:31
  - our advice to groups
• 18:32
  - is to start thinking about scalability now rather
• 18:36
  - than waiting until growth or staffing challenges
• 18:39
  - force that change.
• 18:40
  - So some questions for facilities and groups alike
• 18:43
  - would be,
• 18:44
  - is the right leadership structure in place?
• 18:47
  - Do we have reliable
• 18:48
  - data?
• 18:49
  - Are our contracts aligned with the services that
• 18:52
  - are being provided?
• 18:54
  - Do we understand the economics, and do we
• 18:56
  - have flexibility to adapt as the market changes?
• 18:59
  - Those are the kinds of questions that can
• 19:01
  - help organizations
• 19:03
  - build a more sustainable model for the future.
• 19:06
  - Absolutely.
• 19:07
  - Well, it's been such a great conversation with
• 19:10
  - you both. I wanna thank you again for
• 19:12
  - for sharing with our listeners how they can
• 19:14
  - better prepare their anesthesia staff and and teams
• 19:17
  - and operational approach. Before we end our time
• 19:21
  - together, any final thoughts or maybe anything we
• 19:23
  - didn't touch on that you wanted to leave
• 19:24
  - our listeners with?
• 19:26
  - Yeah. I think,
• 19:27
  - the biggest,
• 19:29
  - final thought or message I'd leave for listeners
• 19:32
  - with anesthesia is is simply understanding it's a
• 19:35
  - very complex and nuanced business, and there's no
• 19:37
  - really one single solution that's going to work
• 19:40
  - for every organization.
• 19:42
  - But I do think that frequently there are
• 19:45
  - opportunities that... To make improvements,
• 19:47
  - to strengthen relationships, and to build a more
• 19:50
  - sustainable business that aren't being tackled.
• 19:53
  - I think the starting point to to tackling
• 19:55
  - those issues is really being willing to take
• 19:57
  - an honest look at at the organization, at
• 19:59
  - the situation, and understand what's working and what
• 20:02
  - isn't,
• 20:03
  - and being open to changing the things that
• 20:05
  - need to change. And I would encourage all
• 20:07
  - anesthesia stakeholders
• 20:09
  - really not to wait until there's a crisis
• 20:11
  - to have those conversations and to be forward
• 20:13
  - thinking and planning.
• 20:15
  - And, Erica, thank you again for
• 20:18
  - this conversation. We're certainly grateful for for the
• 20:21
  - time here. And one final thought for the
• 20:23
  - listeners from my perspective is really as Steve
• 20:26
  - alluded to, a proactive approach is key here.
• 20:29
  - So if you're starting to see recurring challenges
• 20:32
  - on the staffing front or
• 20:34
  - increased financial pressure
• 20:36
  - or difficulty maintaining consistent coverage,
• 20:40
  - those are the kinds of signals that are
• 20:41
  - worth paying attention to. And the earlier that
• 20:44
  - those signals are identified,
• 20:46
  - the more options that are typically on the
• 20:49
  - table to address those issues.
• 20:51
  - And at the end of the day, it's
• 20:53
  - about building a model that works for both
• 20:55
  - clinicians and facilities,
• 20:57
  - but mainly supports reliable access to quality anesthesia
• 21:00
  - care for patients.
• 21:02
  - That's what creates a foundation for long term
• 21:04
  - success.
• 21:06
  - Well, Zach, Steve, it's been great having you
• 21:08
  - with us today. Thank you so much for
• 21:10
  - your time and your insights. It's been great
• 21:12
  - having you on the podcast.
• 21:13
  - Erica, thank you for the opportunity to to
• 21:15
  - speak with you on this important topic.
• 21:18
  - Thank you very much.
• 21:19
  - And listeners, you can be sure to tune
• 21:21
  - in to more podcasts from Becker's by visiting
• 21:23
  - our podcast page at beckershospitalreview.com.