The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report. Some ASC leaders said the bigger fix is changing the relationship, not the check.
“Anesthesia coverage is one of the most expensive line items in ASC operations, but the real problem isn’t the cost — it’s that the anesthesia economic model and the ASC operating model were never built to align,” Kristen Richards, vice president of ambulatory care at Cardiovascular Logistics in Phoenix, told Becker’s. “We spend so much energy negotiating stipends that we lose sight of the actual fix: a true partnership structured around coverage commitments, case productivity, clinical acuity, and shared financial performance.”
She said this matters most in cardiovascular ASCs, where case complexity requires anesthesia partners “who are invested in the center’s growth, not just its schedule.”
Kevin Youmans, CEO of Central Wyoming Outpatient Surgical Center in Casper, said treating anesthesia as a partnership has worked for his center.
“Rather than viewing anesthesia simply as a coverage expense, we’ve benefited from treating our anesthesia providers as long-term clinical partners,” he said. “That stability has significant operational and financial value to our center.”
Other ASC leaders want to make that partnership formal. Bruce Feldman, former administrator of Eastern Orange Ambulatory Surgery Center and founder of an ASC consulting firm in Cornwall, N.Y., told Becker’s that centers should consider “offering anesthesia groups an equity stake in the ASC.”
“We need to be looking at anesthesia coverage no longer as a service/vendor but rather a partner no different than our surgeon investors who have an equity stake in our facility,” Mr. Feldman said.
Some centers are building that alignment into their governance instead of their ownership. Amanda Ryan, DO, an interventional cardiologist and CEO of the Advanced Heart and Vascular Center of New Mexico in Carlsbad, said her center gives anesthesia leaders a formal role in decision-making.
“Our model at Current Clinic includes internal anesthesia leadership who serve as active, strategic participants across our core committees,” Dr. Ryan said. “This integrated governance structure aligns clinical excellence with operational efficiency, ensuring anesthesia insights directly inform our quality, safety and utilization initiatives.”
Anesthesia leaders are making the same case. Randy Robbins, MD, president of Valiant Anesthesia Associates in Southlake, Texas, cautioned anesthesia practices against “taking advantage of the current situation in order to provide short-term increased revenue.”
“We should all be looking for long term stable partnerships that allow both facilities and anesthesia practices to continue working together for the foreseeable future,” Dr. Robbins said.
Ms. Richards said the cost would follow from that alignment.
“Get the incentives aligned, and the cost conversation takes care of itself,” she 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.
