As labor costs climb and federal reimbursement lags, anesthesia coverage has become one of the fastest-growing financial pressures on ASCs.
ASC leaders told Becker’s the gap between what anesthesia services cost and what payers reimburse has widened significantly.
Many ASCs are forced to subsidize coverage to keep operating rooms running. The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report published Oct. 9.
“ASCs increasingly must offer anesthesia subsidies just to keep coverage intact due to workforce shortages and declining anesthesia reimbursement,” Scott Kulstad, CEO of St. Paul (Minn.) Eye Clinic, said. “These subsidies were rare a few years ago but are now becoming material operating expenses that commercial contracts do not account for.”
Several leaders said the issue is no longer a marginal operational challenge, but a structural threat to ASC economics. Vijay Bachani, president and chief growth officer of New York Bariatric Group in Roslyn Heights, N.Y., said the disconnect is particularly severe for government payers.
“Anesthesia reimbursement as it relates to government payers, especially Medicaid, is most out of sync,” he said. “Anesthesiologists are in high demand and unless your center has a healthy amount of commercial cases, you will either end up losing money if you hire your own anesthesiologists or you may have to provide a subsidy if you outsource it.”
The supply-and-demand imbalance is compounded by reimbursement systems that have not kept pace with workforce realities.
According to a 2025 Medicus Healthcare Solutions white paper, the projected shortage of anesthesiologists will reach 6,300 by 2036. At the same time, 59% of practicing anesthesiologists are 55 or older, with 17% nearing retirement age.
Anesthesiologists also report some of the highest levels of career dissatisfaction among physician specialists. About 40.6% said they are considering leaving their current roles within the next two years, according to a June report from the American Medical Association.
Over the past several years, anesthesia compensation has climbed significantly as health systems and ASCs compete for a limited pool of clinicians, leaders said.
Jeffrey Flynn, administrator and COO of Gramercy Surgery Center in New York City, told Becker’s the reimbursement gap has intensified over the past several years.
“Without a doubt, the most out-of-sync expense to reimbursement is anesthesia,” he said. “Specifically, the government programs of Medicare and Medicaid. It is nearly impossible to support an anesthesiologist on these payments and has forced us through the past three years to supplement with the facility fee.”
For his center, the imbalance represents a major risk.
“This stands as the number one danger to ASCs that we face today,” Mr. Flynn said.
Part of the challenge stems from how anesthesia services are reimbursed. Payments are typically tied to billable case time, meaning the minutes spent actively providing anesthesia during procedures. But the operational reality of anesthesia staffing is more complex.
Megan Friedman, DO, chair and medical director of Pacific Coast Anesthesia in Los Angeles, said staffing must account for variability in surgical schedules, patient acuity and unexpected delays.
“Anesthesia coverage is still reimbursed as if it can be turned on and off by the case, but the expense structure no longer works that way,” she said. “Anesthesiologists must be physically present, immediately deployable, and staffed for variability, delays, add-ons and rising acuity, regardless of whether a room is actively generating billable minutes.”
Jessica Lam, PhD, practice manager of Pacific Coast Anesthesia, said the disconnect makes anesthesia one of the most difficult service lines to budget under traditional reimbursement models.
“Reimbursement is tied to billable case time, but staffing costs are driven by coverage requirements, fixed schedules and the need to have anesthesiologists on site and available regardless of daily volume variability,” she said. “That mismatch makes anesthesia one of the hardest service lines to budget accurately.”
Patrick Haley, principal of Physicians Surgery Centers in Woodland Hills, Calif., said anesthesia costs represent a fundamental shift for the ASC industry.
“Anesthesia is absolutely the biggest line-item expense that has changed in recent times,” he said. “There has never been consideration for anesthesia expense in payer reimbursement to a standalone ASC as it has historically been a non-issue, but the market has shifted.”
The systems governing ASC reimbursement were not designed for facilities to shoulder the cost of anesthesia staffing, he said.
“The anesthesia stipends required today for reliable coverage are a paradigm shift for the industry,” Mr. Haley said. “The systems we work within were not designed to account for anesthesia expenses borne by a facility.”
