For ASCs with heavy Medicaid and Medicare volume, anesthesia stipends are often a government payment gap passed down to the facility.
“California’s Medicaid program values an anesthesiologist’s time at between $40 and $50/hour, leaving the burden of the delta between $45 and the market rate on the facility to cover,” Patrick Haley, vice president of Aptos (Calif.) Surgery Center, told Becker’s. “The disparity in reimbursement between governmental and commercial payers exacerbates the problem by shifting the cost to facilities least able to afford large subsidies.”
Federal rates are moving in the wrong direction too. CMS anesthesia payments fell 8.2% from 2019 to 2024, then took an additional 2.83% cut in 2025.
Randy Robbins, MD, president of Valiant Anesthesia Associates in Southlake, Texas, said an aging patient population is making the math worse.
“Unlike our procedural counterparts, the reimbursement from Medicare is roughly 20% of their commercial counterparts and that gap will continue to widen unless congress addresses the issue,” Dr. Robbins said. Without that fix, he said, anesthesia providers have two options: demand higher commercial rates or ask facilities for subsidies.
The pressure is sharpest for centers whose case mix leaves little room to absorb it. Mr. Pearlman said Azura Vascular Care’s “Medicare and Medicare Advantage-heavy payer mix” and its focus on essential vascular access procedures mean “the reimbursement associated with these services provides limited flexibility to absorb escalating anesthesia costs.”
Deena Edwards, RN, administrator of The Surgery Center of Southwest Ohio in Moraine, said CMS rates need an upward adjustment to reduce facilities’ reliance on coverage stipends. Nyleen Flores, administrator and COO of Lake Oconee Orthopedics in Greensboro, Ga., agreed.
“The real solution is meaningful increases in anesthesia reimbursement, not continued annual reductions or reduced reimbursements with continued limitations and scrutiny,” Ms. Flores said.
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.
