Anesthesia groups are increasingly insisting on contracts built on revenue guarantees. The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report, a 57% increase in a single year.
“It seems almost counterintuitive for both parties long term since essentially the anesthesia groups are asking the ASC’s to take on 100% of the anesthesia financial risk without the upside potential,” Monte Goldstein, MD, chief medical officer of Virtua Health ASC Joint Ventures in Ramsey, N.J., told Becker’s. “Long-term I believe the principles of the ASC will demand control of all aspects of anesthesia operations if they are taking on all of the financial risk of anesthesia coverage.”
Peter Bravos, MD, chief medical officer of Sutter Health Surgery Center Division in Sacramento, Calif., said subsidies should come with conditions.
“Paying stipends without changing the operating model only accepts that leverage as permanent,” Dr. Bravos said.
He recommended tying subsidies to “block utilization, guaranteed hours, on time starts, and reliability,” and said those agreements carry more weight when negotiated regionally instead of center by center.
Other leaders are tying the stipend directly to volume.
“The higher the volume for the day, the lower the stipends.” Tammy Smittle, RN, COO and chief nursing officer of Northwest Hills Surgical Hospital in Austin, proposed a hybrid subsidy based on patients per day or payer mix.
“I do not believe that this issue can be fixed by paying a bigger stipend, we will need to partner to redesign the OR schedule so we pay for productive capacity, not idle time,” Ms. Smittle said.
Jamison Pearlman, vice president of managed care at Brentwood, Tenn.-based Fresenius Medical Care North America, told Becker’s that formal RFPs, regional benchmarking and “appropriate exit protections can also bring greater discipline to stipend arrangements.”
The fine print matters as well. Michelle Punshon, CEO of Charleston (S.C.) Surgery Center, said her anesthesia group requires a second physician on site beyond four rooms, endoscopy included, so the center cannot run all four ORs alongside GI cases without paying for an additional MD. At Lake George Surgery Center in Coldwater, Mich., nurse administrator Kathy Meccia said overtime disputes were resolved by moving to a 40-hour week with overtime paid only after 40 hours.
Maher Kodsy, MD, chair of anesthesiology at University Hospitals Elyria (Ohio) Medical Center, said stability is its own negotiating strategy.
He advised centers to negotiate better minimum hour guarantees and avoid frequent group changes, which “are often perceived as instability and an opportunity for higher bidding.”
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.
