As ASCs face workforce shortages, reimbursement pressure and rising expectations around access and efficiency from patients and regulators alike, maintaining stable anesthesia coverage is emerging as a major operational priority.
ASC leaders across the U.S. cite reliable anesthesia staffing as one of their biggest operational risks. The percentage of healthcare facilities reporting anesthesia staffing shortages rose from 35% before the COVID-19 pandemic to 78% by late 2022, according to workforce research from the American Society of Anesthesiologists.
At the same time, surgical demand continues to rise while the supply of clinicians struggles to keep pace. Nearly 59% of practicing anesthesiologists are 55 or older, and projections suggest the U.S. could face a shortage of more than 6,000 anesthesiologists by 2036.
ASC leaders told Becker’s that, against that backdrop, their anesthesia strategies for 2026 center on reliability, continuity and operational alignment.
Reliable coverage as a performance driver
For many ASCs, dependable anesthesia coverage has become the most critical factor in maintaining surgical throughput.
Peter Bravos, MD, chief medical officer of Sutter Surgery Center Division in Sacramento, Calif., said guaranteed coverage is now essential to protecting both patient access and ASC performance.
“My non-negotiable 2026 anesthesia coverage strategy is guaranteed, dependable coverage that protects patient safety and access to care while maintaining a sustainable cost structure,” he said.
Variability in anesthesia coverage can quickly erode operating room utilization, surgeon confidence and the patient experience, he added.
“As a result, anesthesia coverage reliability must be treated as a core ‘non-negotiable’ operating requirement rather than a discretionary cost lever.”
The stakes are growing as ASCs take on a larger share of surgical volume — with more procedures shifting outpatient, anesthesia availability increasingly determines how many cases can be performed each day.
Alignment with block scheduling
Unpredictable coverage can undermine the innate efficiencies of the block scheduling method in specialties with high procedural volumeJohn Beauchamp, senior director of administration, revenue cycle and data analytics at GI Associates in Milwaukee, said aligning reliable monitored anesthesia care with GI block schedules is a top priority.
Many GI centers rely on independent-contractor anesthesiologists and CRNAs who balance ASC work with other clinical commitments. Without advance commitments tied to block schedules, that model can introduce recurring coverage risk.
When monitored anesthesia care is unavailable, cases may shift to IV sedation, a clinically appropriate option in some cases, but one that can reduce efficiency and procedure throughput.
“The downstream effects are immediate and measurable,” Mr. Beauchamp said, pointing to longer turnover times, underutilized procedure rooms and delayed patient care.
Those operational inefficiencies can ripple into financial pressure for ASCs already operating on thin margins.
The payoff of continuity and clinical alignment
Several leaders emphasized the importance of establishing a familiar anesthesia team.
Raghu Reddy, chief administrative officer of MiOrtho Surgery Center in Southfield, Mich., said centers increasingly prioritize regular providers who understand surgeons’ preferences, workflows and clinical standards.
“This continuity is critical to reducing quality issues and avoiding unnecessary day-to-day variability,” he said.
Continuity can improve efficiency especially in high-volume surgical environments, where small variations in workflow can compound across dozens of daily cases.
Quality remains a hard line
For some centers, clinical standards remain the chief nonnegotiable.
Chuck Schwab, RN, executive director for ASC Ventures at Illinois Bone and Joint Institute in Des Plaines, said maintaining best-practice anesthesia protocols and strong patient outcomes outweighs potential cost savings.
A few years ago, the organization explored alternative anesthesia models aimed at reducing stipends. Ultimately, leadership chose to prioritize safety and quality over lower-cost approaches: “We demand clinically sound and safe protocols,” Mr. Schwab said.
Flexibility in a tightening workforce
Other leaders say flexibility will be essential as workforce constraints persist.
Charles “Chuck” Tabbert, CRNA, anesthesia department chief at Mercy Health – Defiance (Ohio) Hospital, said sustainable coverage models must allow both facilities and providers to adapt to changing staffing realities.
“Flexibility with our facility partner to collaboratively adjust points of service,” he said. “Flexibility in staffing to design roles that work for real people.”
Without that adaptability, he said, inefficiencies accumulate, clinician morale declines and costs rise.
