Physician owners at an Illinois orthopedic ASC said ownership gives them something many hospital-based surgeons lack amid the anesthesia shortage: the ability to negotiate directly with their anesthesia providers.
Surgeons at Oswego, Ill.-based Kendall Pointe Surgery Center, which recently completed a more than $3.5 million expansion that added a fourth OR, told Becker’s that direct talks have helped them build a more efficient working relationship with anesthesia as the center grows.
“We’ve all been beaten by that,” Xavier Simcock, MD, an orthopedic surgeon at the center, said of the shortage.
Dr. Simcock pointed to fewer trainees entering the field, which he said left a gap in advanced practice providers, along with pressure from Medicare reimbursement.
The U.S. is projected to face a shortage of 6,300 anesthesiologists by 2036 and roughly 12,500 CRNAs by 2033, and nearly 57% of practicing anesthesiologists are 55 or older, according to a 2025 Medicus Healthcare Solutions white paper. Anesthesia reimbursement averaged $21.88 per unit in 2023, a 5.5% drop from 2019, and Medicare rates fell from $22.27 in 2019 to $21.12 in 2023.
When anesthesia groups feel shut out, they have less reason to work efficiently with surgeons, Dr. Simcock said. He said that happens in hospitals.
“Since we’re part of the ownership, we negotiate with the anesthesia staff, saying, ‘OK, do you need a stipend? What do you need to do this? How are we going to work together to make this efficient, as opposed to working against each other?’” he said. “That’s been very fruitful for us.”
Nearly one-third of ASCs offer financial assistance in their contracts with anesthesia providers or groups, according to the Ambulatory Surgery Center Association’s third-quarter 2026 60-Second Survey, published Oct. 16. Among ASCs that offer assistance, stipend contracts remain the most common form, cited by 51%, followed by collections guarantees at 29%. Both figures are in line with 2024. Flat subsidies, however, fell to 15% from 27% in 2023.
The surgeons said improvements in regional anesthesia have made it possible to send larger orthopedic cases home the same day.
“General anesthesia is almost something of a bygone era now,” Dr. Simcock said. “The vast majority of cases we’re doing [use] regional anesthesia with sedation, which is safer for the patient and well tolerated.”
Over the last 15 years, he said, nerve blocks have gotten longer-lasting, from about eight hours to as long as two or three days if a patient wants that. That has eased worries that patients will go home with uncontrolled pain and come back. “That is an incredibly rare event these days,” he said.
Jorge Chahla, MD, an orthopedic surgeon and vice chair of the Kendall Pointe board, said anesthesia teams can now control pain “from minute one” after surgery. Even patients having multiligament reconstructions can recover at home and start outpatient physical therapy the next day, he said. Being out of the hospital may also lower their infection risk, he said.
Anesthesia is one of the pieces physician ownership lets surgeons control, said Scott Sporer, MD, an orthopedic surgeon and chair of the Kendall Pointe board. That includes how patients are communicated with before, during and after surgery, “and everything in the recovery room and anesthesia care.”
It also matters for where NueHealth, which manages the center, wants to take its payer contracts. Daniel Tasset, the company’s founder, CEO and executive chairman, said the next phase of value-based care in surgery will bring the surgery center, surgeon, anesthesia provider and physical therapy into one episodic bundle that guarantees quality, cost and patient satisfaction.
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.
