About a year ago, the Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., flipped the traditional anesthesia payment model on its head. Instead of the facility paying anesthesia stipends, surgeons are now required to pay a fee if they fail to meet the minimum number of cases for their assigned operating block.
Bruce Feldman, former administrator of the center and now head of his own ASC consulting firm, told Becker’s the change became a “win-win” for the surgery center and the anesthesia group, even motivating surgeons to find creative ways to improve operating room efficiency.
Initially, the anesthesia group approached the center requesting stipends because operating rooms were not being fully utilized.
“They were providing anesthesiologists, but ORs were sitting empty — so they weren’t making enough revenue to justify coverage,” Mr. Feldman said.
More ASCs are being forced to pay anesthesia stipends as staffing shortages deepen and coverage gaps threaten daily operations. The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report published Oct. 9.
To address the problem, the anesthesia group and ASC leadership created a new model: If a surgeon does not use their full block, that surgeon pays the anesthesia group $300 per unused hour.
According to Mr. Feldman, this solved two problems. It compensated anesthesia providers fairly while pushing surgeons to maximize their operating time, because leaving block time unused now came with a direct cost.
“It became a win-win,” he said. “The facility no longer carried the financial burden, and the surgeons were incentivized to maximize utilization. It’s kind of a risk-sharing model: Surgeons take on ownership for underused time instead of the facility absorbing all the impact.”
At first, surgeons balked at the policy, Mr. Feldman said. But once they saw the data, they realized that paying for guaranteed anesthesia coverage was better than losing it altogether.
“They started to see it was actually to their advantage,” he said. “By fulfilling their block time, they brought in more revenue to the facility, and that translated into higher quarterly bonuses for them.”
The ASC team tracked block-time utilization and calculated the actual costs incurred by each surgeon. The biggest challenge, according to Mr. Feldman, was communicating why the change was necessary.
“Each surgeon’s block was based on expected patient volume, but when that volume dropped, anesthesia revenue plummeted too,” he said. “Everything was on a downward spiral. This model solved both problems simultaneously.”
The model also sparked collaboration among surgeons. They began sharing blocks to avoid penalties.
“For example, if a physician had an eight-hour block but only wanted to fill four hours, they could ask a colleague to combine schedules,” Mr. Feldman said. “That way, one works in the morning, the other in the afternoon, and neither has to pay for unused anesthesia coverage.”
This approach not only improved utilization but fostered teamwork across specialties.
Mr. Feldman believes the model is scalable, but most effective in multispecialty centers where case mix and scheduling flexibility allow for better redistribution of OR time.
“It’s really the lesser of two evils,” he said. “Most models have at least one loser. I have colleagues at centers that have had to cut operating days because they couldn’t afford anesthesia stipends.”
As anesthesiologist coverage issues continue to plague ASC operations, creative solutions are necessary.
“We live in a world today where you have to be creative and strategic,” Mr. Feldman said. “The old days of just paying anesthesia stipends don’t solve the problem anymore, especially as the acuity level of ASC cases increases.”
With more hospital-level procedures moving into ASCs, anesthesia requirements have intensified. Longer sedation times and extended recovery periods make anesthesiologists essential, yet the shortage continues to grow.
“You have to ask: Would you rather pay $1,200 out of pocket for anesthesia coverage, or pay nothing because you can’t get cases done due to not having anesthesia providers at all?” he said.
