With 44% of ASCs expecting to pay anesthesia stipends and 27 states opted out of federal CRNA supervision, the staffing model a center picks has become a strategic bet.
The share of ASCs expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, according to VMG Health data. The workforce behind every model continues to face significant obstacles, with the U.S. projected to be short 12,500 CRNAs by 2033, and CRNA programs accept 24% of applicants on average.
Here are the five models ASC leaders have weighed in recent months, and where each fits.
1) Contracted coverage: More than 80% of ASCs expect to rely on contractors in 2026, but a stipend does not guarantee stability. Suzi Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif., is on her fourth anesthesia provider arrangement and still searching for one that lasts.
“When I came into the ASC market 11 or 12 years ago, we didn’t pay for anesthesia at all,” Ms. Cunningham told Becker’s.
Her center has since moved from free hospital-provided coverage to a stipend-supported anesthesiologist group. That group lost $350,000 in a single year despite the stipend her center paid, then exited.
Brian Cohen, MD, administrative chief of Miami Anesthesia Services, told Becker’s that centers often go wrong by treating a contract as the finish line.
“The biggest mistake is treating anesthesia as a procurement decision rather than an operational one,” he said. “If you contract with an anesthesia company, the proven component of success is transparency in both directions.”
2) Direct employment. Only 9% of ASCs plan to staff anesthesia this way. Employment buys control, but Aaron Hayes, administrative director of North Pointe Surgery Center in Lancaster, Pa., told Becker’s it “does not make anesthesia inexpensive.” Dr. Cohen said it fits high-volume centers with predictable schedules and strong payer contracts.
“You are committed to those salaries, which means you lose the ability to scale costs down on lighter days, weeks or months,” he said.
3) CRNA-only. This model starts with state law. Twenty-seven states have opted out of Medicare’s physician supervision requirement for CRNAUtah and Wyoming are partial opt-outs, and Vermont and Ohio joined in July. The opt-out removes only the federal condition; state law still applies, and facilities can still require supervision. It is also the model most exposed to the CRNA shortage.
“The math points in one direction: fewer physician-heavy models, more CRNAs,” Scott Freer, clinical administrator of ASC Bala Cynwyd (Pa.), told Becker’s.
4) Physician-led care team. Gary John Mullen, MD, CEO of Raleigh, N.C.-based Sovereign Anesthesiology Partners, said his group uses the model in nearly every center it covers and has not changed it despite workforce shortages: One anesthesiologist medically directs two to three anesthetists. Ms. Cunningham’s primary center uses a version of it — one physician and two CRNAs — and others pair a stable core team with per diem or locum support for peak demand. The model suits higher-acuity case mixes and states that have not opted out.
5) Acuity-matched sedation. Some centers are matching coverage to the case rather than the room. Dr. Mullen’s group has helped ASCs use non-anesthetist providers for minimal sedation in cases such as cataracts, which he said lowers costs and reduces delays. The approach fits high-volume, low-risk service lines.
“The answer isn’t simply hiring more anesthesiologists; it’s acuity-matched staffing,” said Scott Shapiro, MD, a cardiologist with AMS Cardiology in Horsham, Pa.
Whichever model a center chooses, Dr. Cohen said the choice is where the work begins.
“The red flag is assuming that once you’ve selected a model, the work is finished,” he 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.
