Rising labor costs, persistent workforce shortages and growing pressure on ASC margins are forcing leaders to rethink how they procure and manage anesthesia services.
While traditional group coverage models become increasingly difficult to sustain, many organizations are shifting toward contractor arrangements, performance-based stipends and CRNA-forward care teams.
Scott Freer, a clinical administrator of ASC Bala Cynwyd (Pa.) joined Becker’s to discuss his views on how ASC anesthesia management is likely to change over the next five years.
Editor’s note: This response has been lightly edited for clarity and length.
Question: What models or methods for anesthesia procurement and team management do you think will be the most highly-utilized over the next 5 years?
Scott Freer. Clinical Administrator of ASC Bala Cynwyd (Pa.): ASCs used to have it easy with anesthesia. The case mix was favorable, payer mix was decent and groups would cover a busy ASC at no cost because they could live off collections. That era is ending, and the next five years belong to the centers that adapt fastest.
[No. 1], Procurement: The independent contractor model is taking over. Surveys of ASC leaders heading into 2026 found roughly 44% planning to use contractor arrangements with stipends and another 36% using contractors without them, leaving employed and traditional group-coverage models a shrinking minority. The real change is the stipend itself. Coverage that was cost-neutral five years ago now often requires a subsidy, because provider compensation has surged while reimbursement hasn’t. Smart ASCs will stop treating the stipend as a ransom payment and start treating it like any other negotiated contract, tied to coverage guarantees, on-time starts, and turnover metrics. Expect more centers to run formal RFPs, benchmark subsidy requests against regional data and build exit clauses that protect them if a group can’t staff the schedule.
On team management, the math points one direction: fewer physician-heavy models, more CRNAs. With nearly 30% of anesthesiologists projected to leave practice by 2033 and CRNA pay up 59% since 2019, physician-only coverage is becoming a luxury most ASCs can’t justify for routine ambulatory cases. CRNA-only and hybrid care team models fit the ASC setting well since the acuity is lower and the case volume rewards efficiency. Centers in states with CRNA independent practice will lean into that; others will stretch medical direction ratios and add anesthesiologist assistants where licensure allows.
The operational piece ties it together. An ASC’s anesthesia cost problem is often really a scheduling problem, with blocks built around surgeon preference instead of actual utilization. Expect wider use of scheduling and AI-based forecasting tools that match anesthesia staffing to realistic daily volume, because every over-scheduled anesthetist hour now shows up directly in the stipend.
The winning ASC model for 2026 through 2030 looks like this: contracted coverage under a benchmarked, performance-tied stipend, a CRNA-forward care team and tight schedule discipline. Centers that keep waiting for free coverage to come back will pay more than everyone else.
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