Anesthesia is one of the most emerging threats to ASC profitability. While supply costs, staffing shortages and payer negotiations often dominate executive discussions, anesthesia-related expenses and reimbursement challenges are eroding margins.
Here are five things to know about the current state of anesthesiology as it pertains to ASCs:
1. Rising costs meet stagnant reimbursement
The anesthesia cost squeeze is intensifying as Medicare’s conversion factor has declined 2.8% for 2025 while provider wages rise amid workforce shortages, prompting many ASCs to reevaluate their anesthesia delivery models.
“There’s going to be a breaking point for smaller companies like mine …. Unless things change, this entire system will likely hit a breaking point within five years,” Brian Cross, CRNA, owner of Youngstown, Ohio-based CS Anesthesia, told Becker’s.
2. Payer tactics intensify
Insurers are using aggressive tactics to limit anesthesia reimbursements, including delayed payments, bundling, denials over coding technicalities, and so-called “silent PPOs” that apply reduced rates without provider consent. These strategies can significantly undercut expected revenue, even in cases with clean claims.
“This cut singles out CRNAs despite using the same techniques as other anesthesia providers. It’s unacceptable, especially amid a national shortage of anesthesia providers,” Janet Setnor, CRNA, president of the AANA, told Becker’s.
3. Operational inefficiencies add to the drain
Beyond reimbursement, operational inefficiencies — such as underutilized block time, slow room turnover and suboptimal scheduling — can increase anesthesia costs per case. When cases are delayed or canceled, anesthesia providers still incur staffing expenses, further diminishing profitability. Anesthesia inefficiencies often go unaddressed in broader cost-containment strategies.
“One of the most overlooked cost factors threatening ASCs is the inefficient use of OR time, specifically, underutilization or poor scheduling practices,” Heather Combs, RN, ASC administrator at Austin (Texas) Regional Clinic, told Becker’s. “Whether a room is in use or not, the center is paying for it.”
4. Alternative anesthesia models come with trade-offs
More and more ASCs are experimenting with alternative anesthesia models to regain control over costs. CRNA-only coverage is expanding in lower-risk specialties, while some centers are insourcing anesthesia to eliminate third-party markups. Others are forming equity partnerships with anesthesia groups to align incentives. While these models can reduce expenses, they also introduce staffing, training and compliance challenges.
“These demands are driving a transition toward CRNA-led and CRNA-only models, which align more closely with the clinical and financial objectives of these facilities,” Jeff Tieder, MSN, CRNA, and a clinical assistant professor at the University of Tennessee at Chattanooga, told Becker’s.
5. Strategic anesthesia planning is essential to long-term sustainability
Anesthesia cost control requires the same strategic oversight as supply chain management. As consolidation reshapes the ASC landscape, facilities that regularly evaluate their anesthesia model, track key metrics and negotiate transparent payer contracts will be better positioned to protect margins while maintaining uninterrupted coverage.
“This new way of engaging anesthesia services resembles how ASCs have engaged surgeons: they must be seen and treated as essential, productive partners that contribute value,” Yusuf Ahmad, MD, an anesthesiologist in Berkeley, Calif., told Becker’s.
