Twelve years ago, Suzi Cunningham did not pay for anesthesia coverage. Today, her ASC is on its fourth provider arrangement and still searching for one that sticks.
Ms. Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif., has watched the anesthesia market unravel. Each the ASC found a model that seemed workable, the economics shifted.
Her experience is less an outlier than a case study in what ASC leaders across the country are navigating, and why so many are rethinking not just their contracts, but the entire structure of how anesthesia coverage gets delivered.
Editor’s note: This interview was edited lightly for clarity and length.
Question: How has the increase in anesthesia prices shifted the way you structure anesthesia partnerships, and what does a sustainable arrangement actually look like?
Suzi Cunningham: When I came into the ASC market 11 or 12 years ago, we didn’t pay for anesthesia at all. We contracted with a local major hospital — they had an anesthesia department, all physicians, and they did their own billing. It was seamless. But they were losing money, even with a hospital’s buying power behind their contracts.
Fast-forward a few years and they came to us needing a stipend. We were floored — maybe eight years ago — thinking, ‘You want us to pay for anesthesia?’ We started paying it, frustrated the whole time. Eventually they served us termination notice because they couldn’t make money at the contracted rate. We had to go find new providers.
That group got bought by Optum, which eventually exited the anesthesia business. The anesthesiologists then formed their own group and contracted with us — and they lost $350,000 in a single year, even with the stipend we were paying. They couldn’t sustain it either, so they got out.
By late 2024 or early 2025, we transitioned to a CRNA-anesthesiologist hybrid model — one MD, two CRNAs — at our primary center. What I pay for one physician is roughly equivalent to what I pay for two CRNAs. I also manage another center that runs an all-CRNA model, and it does well. But now our current CRNA group has roughly doubled their pricing over the past year, so we’re back to searching for a sustainable model.
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