Dr. Lee Anne Carlisle, Medical Director of UMA Anesthesia, University Health Systems

Summary

Becker’s Healthcare Podcast Summary

Episode: Dr. Lee Anne Carlisle, Medical Director of UMA Anesthesia, University Health Systems
Release Date: August 2, 2025
Host: Grace Lynn Keller

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Introduction

Grace Lynn Keller welcomes listeners to the 22nd Annual Spine, Orthopedic, and Pain Management Conference recording. She introduces Dr. Lee Anne Carlisle, the Medical Director of UMA Anesthesia Services at University Health Systems, a nonprofit multispecialty group serving Bexar County, home to San Antonio.

Notable Quote:

"Bexar County actually houses San Antonio and San Antonio, if you didn't know, is one of the seven. It's the seventh largest city in the United States." (01:31)

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Industry Trends and Shifts in Anesthesia and Ambulatory Surgery Centers (ASCs)

Dr. Carlisle highlights significant changes in the anesthesia landscape, particularly within ambulatory surgery centers (ASCs). She notes a shift towards treating a sicker patient population in outpatient settings, driven by insurance companies' preferences for lower-cost care centers.

Key Points:

• Patient Population: Increasingly complex cases managed in ASCs require thorough patient assessments to maintain hospital-level care standards.
• Patient Volume: A substantial rise in patient numbers presents challenges in staffing and resource allocation.
• Anesthesia Shortages: Ongoing shortages in anesthesia professionals pose significant hurdles, expected to persist for years.

Notable Quote:

"Patients are much sicker in being cared for in an ambulatory outpatient setting... the anesthesia shortages... is something I see on the front line." (02:02 – 03:36)

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Staffing and Workforce Challenges: Strategies and Solutions

Addressing workforce shortages, Dr. Carlisle discusses innovative strategies implemented by University Health. In response to anesthesia shortages, University Health introduced a delegation of privileges for Certified Registered Nurse Anesthetists (CRNAs), allowing them to practice to the full extent of their licenses.

Key Strategies:

• Delegation of Privileges: Enabled CRNAs to operate more autonomously, enhancing team efficiency.
• Team Model Transformation: Shifted from requiring multiple MDs and CRNAs to a more streamlined staffing approach, resulting in cost savings and increased efficiency.
• Impact on Patient Care: These changes led to a 13% increase in patient care over two quarters and reduced same-day cancellation rates.

Notable Quotes:

"We saw a 13% increase in patients that we cared for... a reduction in salary costs." (03:47 – 06:35)
"This has a multifold benefit... maximize the revenue for our institution." (05:50)

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The Evolving Role of Orthopedics and ASCs in Healthcare

Dr. Carlisle emphasizes the expanding role of orthopedics within ASCs, particularly through the implementation of regional anesthesia and multimodal pain management techniques. These practices facilitate same-day discharges and reduce reliance on narcotics, aligning with CMS initiatives.

Key Developments:

• Regional Anesthesia Services: Established robust regional anesthesia programs managed by experienced CRNAs, enhancing pain management and patient throughput.
• Narcotic Reduction: Significant decrease in postoperative pain medication usage, with less than 10% of patients requiring narcotics in the recovery room.
• CMS Reimbursement: Medicare incentives for multimodal pain management approaches bolster the financial viability of these programs.
• Patient and Provider Satisfaction: Improved patient outcomes and satisfaction, along with reduced postoperative complications and nighttime pain medication calls.

Notable Quotes:

"Less than 10% are receiving pain medications there. The impact on PACU stays... frees up PACU space to allow more patients to flow through our facility." (06:45 – 10:31)
"Patient satisfaction, as you can imagine, is wonderful... They usually hear Good news." (10:00)

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Conclusion and Final Thoughts

In her closing remarks, Dr. Carlisle underscores the importance of team culture and the unique composition of her anesthesia team, which largely consists of retired military CRNAs. Their autonomy, experience, and commitment to teamwork are pivotal in sustaining the innovative staffing model and ensuring long-term stability for University Health.

Key Takeaways:

• Team Composition: Predominantly retired military CRNAs bring high skill levels and autonomous practice readiness.
• Team Culture: Emphasis on mutual support and collaboration ensures a stable and efficient workforce.
• Future Outlook: The delegation of privileges model is expected to continue benefiting University Health by enhancing care delivery and operational efficiency.

Notable Quote:

"A strong team culture on an anesthesia team is vital. Looking out for each other... so we can create a very stable staffing model for university health currently and for years to come." (10:38 – 12:07)

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Grace Lynn Keller wraps up the episode, thanking Dr. Carlisle for her insightful contributions and providing a comprehensive overview of the evolving landscape in anesthesia services within ASCs.

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This summary encapsulates the key discussions from the podcast episode, providing valuable insights into the challenges and innovations in anesthesia services and ambulatory surgery centers.

Transcript

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[Grace Lynn Keller]

Is Grace Lynn Keller with the Beckers Healthcare Podcast and we are recording live at the 22nd annual Spine, Orthopedic and Pain Management Conference. I'm currently joined by Dr. Leanne Carlile, who is the Medical Director of UMA Anesthesia at University health systems. So Dr. Carlisle, thank you for being here. Let's start off by having you introduce yourself and tell us a little bit more about your role in organization.

[Dr. Leanne Carlile]

Absolutely. Yes. And good morning to you, Grace. My name is Dr. Lee Carlisle. I am the Medical Director of UMA Anesthesia Services. UMA is University Medical Associates, which is a nonprofit multispecialty group practice that provides healthcare services to University Health. Now University Health is the public health and hospital system for Bexar County. And how good are you with Texas geography? Do you know where Bexar county is?

[Grace Lynn Keller]

I do not. I've only been to Texas once.

[Dr. Leanne Carlile]

Okay, so Bexar county actually houses San Antonio and San Antonio, if you didn't know, is one of the seven. It's the seventh largest city in the United States. So lots of people in the county, lots of opportunity for patient care. So that's where I work and live.

[Grace Lynn Keller]

Wonderful. Well, thank you for joining me. And I'd love to start off with what trends or shifts that you're currently seeing in the industry that you specifically think are important for leaders to be paying attention to.

[Dr. Leanne Carlile]

Absolutely. So I've been in the field of anesthesia, primarily in ambulatory surgery centers. One of the major shifts that I've seen in a change of patient population. Patients are much sicker in being cared for in an ambulatory outpatient setting. Variety of reasons for that. Certainly the insurance companies have a vested interest in finding a low cost center, which ambulatory surgery centers are. The challenge of that always is to make sure that we assess the patient adequately and provide the same level of care we would within the hospital in San Antonio. Like I mentioned, patient population is growing by leaps and bounds, so increased patient volumes is what we're seeing. And again being the challenges that come with that staffing, throughput resources, those are some of the challenges that we see with the increasing patient population. And the other one is a, the third one is one that's near and dear to my heart, that I pay great attention to is the challenges within the world of anesthesia, the anesthesia shortages. This has been growing for the last several years and is projected to last years into the future. Becker's does a wonderful job of highlighting the challenges in anesthesia and certainly I see it on the front line.

[Grace Lynn Keller]

Absolutely. And let's touch on staffing and workforce challenges too as these continue to be a concern across healthcare. So how's your organization navigating these pressures and what strategies have you seen work?

[Dr. Leanne Carlile]

Well, back In February of 2023, the Bexar County Hospital District Board of Managers tasked Ed Banis, who is the president and CEO of University Health, to address these ongoing anesthesia shortages. What he came up with was a really innovative plan of a delegation of privileges for CRNAs. This has flipped our staffing model, our team model that we practice at the surgery center and has allowed the CRNAs to practice to the fullest extent of their license. We implemented this in June of last year, so June of 2024 and it has been a wonderful experience for me to work within a team of highly trained CRNAs. We've realized increased patient throughput. When you compare at our institution, the patient population that we cared for in the last two quarters of 2023 compared to the last two quarters of 2024, we saw a 13% increase in patients that we cared for. And I attribute this to the experienced team, to the process that allows me to act as a consulting physician on the team. I am no longer doing direct patient care. My responsibility as the medical director of the Surgery centers under University Health is to focus on strategic goals for the facilities as well as pre screening all patients before they show up for the date of surgery. This has decreased our same day cancellation rate. So when the patients do make it on the schedule, they they stick and we get to care for them. So a multifold benefit of this staffing model, delegation of CRNAs, delegation of privileges. The cost savings for the institution is also something we used to practice medical direction at the surgery center which required 2 MDs and 6 CRNAs. We now have one MD myself at the surgery center where I'm based out of, and seven CRNAs. So we have a reduction in salary costs. So a great combination of factors have increased the Efficiency and maximize the revenue for our institution.

[Grace Lynn Keller]

And as outpatient care continues to grow, how do you see the role of orthopedics and ASCs evolving within the broader healthcare ecosystem?

[Dr. Leanne Carlile]

I think it's a really exciting time again to see these cases being outsourced from the hospitals into the ASCs. The challenge always is to make sure that they are able to go home at the end of the day. Regional anesthesia or a multimodal approach for pain care management postoperatively is an absolute necessity. This is also something that I'm really excited about at the institution where I am the mark, which is where the surgery center where I am and downtown, the other ambulatory surgery center of uh, the Robert B. Green ambulatory Surgery center, have a robust regional anesthesia service. We started this in February of 2025. This is all run by the CRNAs who are completely adept in regional anesthesia and created a great working network with the orthopedic surgeons as well as other physicians who are interested in post op pain blocks, but primarily ortho to provide their patients with after care that enables them to go home at the end of the day. What we've seen since February is patients who arrive in the recovery room and less than 10% are receiving pain medications there. The impact on PACU stays the post anesthesia care unit has been tremendous. It shortens the amount of time that patients are recovering. It doesn't create a stop for or cases coming out of the operating rooms, but quite the contrary, it frees up PACU space to allow more patients to flow through our facility. So less than 10% are receiving pain meds. The average block lasts two to three days. So the reliance on narcotics is dramatic. It has changed how we manage pain. We don't use narcotics like we used to and in fact CMS introduced a no pain act that is reimbursing for modalities that help to reduce the reliance on narcotics. These are for Medicare patients. So for example, they're reimbursing for exparel, reimbursing for the cost of the vial as well as a 6% bonus added to that to try to focus on multimodal approaches instead of our traditional reliance on narcotics. Patient satisfaction, as you can imagine, is wonderful. Imagine having an ankle reconstruction and going home and never needing any pain medication and your block lasts for 3, 4 days. Again. The CRNA Regional Anesthesia Program that we've developed there has been a wonderful source of revenue for uh, the exparel reimbursement where it pays for the vial as well as a 6% increase of revenue of that cost. The patients are happy. The surgeons are very happy. They don't get calls in the middle of the night for pain meds and when they show up back in clinic for their post op visit, they usually, I can't say always. They usually hear Good news.

[Grace Lynn Keller]

Well Dr. Carlisle, thank you so much for sharing these thoughts today. Is there anything else you'd like to share that we didn't touch on?

[Dr. Leanne Carlile]

I would like to Like I mentioned before, I'm from San Antonio and live and work there. The team that I work with is primary, primarily retired CRNAs. We talked about this innovative staffing model, delegation of privileges within the medical staff for CRNAs to practice to the fullest extent of their license. This requires that the CRNA understands and is comfortable in working autonomously. Military CRNAs are the ones who are comfortable practicing autonomously as well as other experienced CRNAs. Another fun fact about San Antonio, it's known as Military City usa. We have a large military presence. We have a large population of retired military. So my current team is probably 90% retired military CRNAs, highly skilled. They also promote a team culture. I think a strong team culture on an anesthesia team is vital. Looking out for each other, not just focusing on your own or and your own cases, but looking out for your teammates so we can create a very stable staffing model for university health currently and for years to come.

[Grace Lynn Keller]

Wonderful. Well, thank you so much for joining me today on the Beckers Healthcare Podcast. Again, we're recording live at the 22nd annual Spine, Orthopedic and Pain Management Conference.