Many ASCs are paying anesthesia groups coverage subsidies to keep their ORs staffed. Casper (Wyo.) Surgical Center has never paid one in its 26 years.
The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health survey. Sixty percent of ASC leaders ranked anesthesia coverage among their top three financial challenges for 2026, and only 9% plan to staff anesthesia through traditional employment agreements.
Becker’s spoke with 34 ASC leaders and anesthesia providers about anesthesia coverage. Kevin Youmans, CEO and administrator of Casper Surgical Center, was the only one who described his center’s coverage as stable.
The anesthesia group has worked at the center since it opened. The same group also covers the local hospital, so many of the center’s surgeons work with the same anesthesiologists in both settings.
“Over time, I think the relationship has been less about providing coverage and more about establishing a long-term partnership,” Mr. Youmans told Becker’s.
The financial arrangement is simple. The ASC bills the facility fee and the anesthesia group bills its own professional fees. Mr. Youmans said no single factor explains why that has been enough.
“I can’t point to one factor and say why we’ve never needed a coverage subsidy,” he said. “Historically, we’ve been able to maintain that model that works for both without the center subsidizing coverage.”
In exchange for consistent coverage, the center commits to running efficiently, working closely with anesthesia on schedules and focusing on clinical quality. Mr. Youmans said the deal holds up only if both sides benefit. An ASC with unpredictable schedules and poor communication could eventually become “an economic issue for anesthesia,” he said.
Mr. Youmans said scheduling is what matters most to the anesthesia group. Its clinicians split their time between the hospital and the ASC, and they need to know when an ASC day will end.
The center sends anesthesia any schedule changes the day before. That includes cancellations that will shorten a room’s day and surgeon add-ons that will lengthen it.
“It’s communicating that the day before to give them an opportunity to plan for the next day,” he said.
The anesthesia group is constantly recruiting, Mr. Youmans said. New anesthesiologists work at the hospital for a year before they can work at the ASC. The center has credentialed several of them over the past year and a half, which has strengthened its coverage as volume grows.
Case volume has grown every year since 2022. The center has hired more staff, runs more rooms and has brought on more anesthesiologists. It is a multispecialty center covering gastroenterology, ENT, general surgery, pediatric dental, urology, orthopedics, ophthalmology and gynecology. It recently added Inspire therapy for sleep apnea, a service it launched in partnership with the anesthesia group.
Mr. Youmans said the center’s anesthesia model is not necessarily a fix for the subsidy pressure other centers face.
“I wouldn’t suggest that our model eliminates the need for subsidies in other places,” he said. “I think the markets are different.”
What he can say is what has worked in Casper: predictable schedules, steady communication and a relationship that has lasted.
“It’s a relationship that was established 26 years ago,” he said, “and it works.”
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.
