Reimbursement changes and margin pressure are pushing more surgical volume out of the hospital operating room and into ASCs at rapid pace.
For health systems chasing lower costs and new growth, the shift looks like an obvious win. But for anesthesiologists, surgery center administrators and anesthesia group leaders the success of health system perioperative strategies depends greatly on the availability and alignment of anesthesia teams.
“Ambulatory care is reshaping perioperative strategy by shifting appropriate procedures to ambulatory surgery centers and hospital outpatient departments, allowing hospitals to focus on higher-acuity cases,” Courtney Pearson, assistant vice president of operations for the perioperative service line at MedStar Health in Columbia, Md, told Becker’s. “Ultimately, success depends on delivering the right care in the right setting while balancing quality, patient experience and financial performance.”
Nikki Washington, DNP, RN, director of surgical services at St. Joseph’s Medical Center in Stockton, Calif., described the same shift in blunter terms.
“Ambulatory migration, along with changes in reimbursement models, is significantly changing hospital perioperative strategies,” she said. “Organizations that will thrive are those that can anticipate these market changes, adapt their surgical offerings, and balance growth across both hospital and ambulatory environments.”
Stephen Estime, MD, associate chair of anesthesiology and critical care at University of Chicago Medicine, said that continuum runs directly through anesthesia — and that ASCs only capture the efficiency they’re chasing when they respect its limits.
“Ambulatory surgery centers can make procedural services significantly more efficient when offloading the right patients, surgeons, and procedures from the main OR,” Dr. Estime said. “The efficiency gains disappear quickly when that selection discipline breaks down or is less rigorous.”
He added a caveat that’s becoming the central story in ASC anesthesia: “Anesthesia is one of the most expensive resources in any procedural setting, and the ASC is no different.”
That expense has grown sharply. The average certified registered nurse anesthetist, or CRNA, earned $291,396 in total compensation as of July, according to Marit Health’s compilation of peer-reported salaries — but the fully loaded cost of employing one, after payroll taxes, malpractice insurance, benefits, retirement matching and continuing education, runs closer to $342,812 before any stipend, a gap of roughly $51,000. The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, even as average professional anesthesia reimbursement fell 5.5% from 2019 to 2023.
Ben Childers, MD, a plastic surgeon and president of Premier Outpatient Surgery Center in Colton, Calif., told Becker’s the shift comes down to a shrinking labor pool with pricing power.
“It’s supply and demand,” Dr. Childers said. “The price of nurse anesthetists has gone up because they can demand it — because there’s not as many. We can get $1,600 down the street. So you’ve got to raise your rate.”
“What’s happened is they’re now putting it on the hospitals, and they’re putting it on the surgery centers, to subsidize their payments,” he said.
Traci Albers, CEO of Sioux Falls, S.D.-based Surgical Management Professionals, said that subsidy burden is landing on centers that never budgeted for it.
“Anesthesia is now a cost for many ASCs that previously did not have to subsidize their providers,” she told Becker’s. “With increasing anesthesia shortages, increasing salaries and stagnant reimbursement, ASCs are now subsidizing anesthesia.”
Scott Freer, clinical administrator of ASC Bala Cynwyd (Pa.), said the old assumptions about free anesthesia coverage no longer hold.
“ASCs used to have it easy with anesthesia,” Mr. Freer said. “The case mix was favorable, payer mix was decent and groups would cover a busy ASC at no cost because they could live off collections. That era is ending, and the next five years belong to the centers that adapt fastest.”
His prescription is to negotiate rather than absorb the cost. “Smart ASCs will stop treating the stipend as a ransom payment and start treating it like any other negotiated contract, tied to coverage guarantees, on-time starts, and turnover metrics,” he said. With nearly 30% of anesthesiologists projected to leave practice by 2033 and CRNA pay up 59% since 2019, he added, “physician-only coverage is becoming a luxury most ASCs can’t justify for routine ambulatory cases.”
Suzi Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif., is already rethinking the staffing structure itself, not just the price of it.
“In my opinion, we need to move toward a model that is focused more on alignment rather than coverage,” she said, predicting that ASCs will move away from contracting independent anesthesia groups altogether. “Instead of relying exclusively on independent anesthesia groups, more physician groups, health systems, and ASC ownership entities may need to directly employ anesthesiologists and CRNAs.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.