As anesthesia leaders settle into 2026, the big questions aren’t just about hiring; they’re about how ASCs pay for coverage, how tightly schedules depend on staffing stability and whether technology and partnership models can offset rising costs.
Here are five predictions leaders shared with Becker’s about where anesthesia is headed next:
1. AI and new tools will rewrite anesthesia workflows
Vijay Sudheendra, MD, president of Providence, R.I.-based Narragansett Bay Anesthesia, told Becker’s that “AI-driven decision support and automation — especially in monitoring, dosing and workflow — are poised to be the most transformative innovations in anesthesia, enabling more precise, personalized and safer anesthetic care.”
In particular, ultrasound guidance and virtual reality will further professional skill and patient experience, and the shift to more personalized medicine and data-driven systems marks a fundamental change in how anesthesia will be practiced, he said.
“These innovations will not replace anesthesiologists but will augment their capabilities and allow for greater focus on complex and critical care,” he said. “The integration of these technologies, along with standardized protocols and continuous education, is expected to substantially improve outcomes, safety, and efficiency in anesthesia over the next five years.”
2. Fee-for-service will continue to erode as ASCs pay for readiness, not volume
Across the country, anesthesia groups are shifting from traditional fee-for-service arrangements to hourly or salaried models, Megan Friedman, DO, chair and medical director of Los Angeles-based Pacific Coast Anesthesia Consultants, told Becker’s.
Dr. Friedman said that for many ASCs, the shift has been abrupt. Before the shortage, the market was oversaturated, and ASCs had no problem finding providers. Historically, anesthesia groups operated on a fee-for-service model, anesthesiologists billed per case, and ASCs rarely needed to subsidize coverage. That model has unraveled.
“It used to be all fee-for-service, but anesthesiologists have realized they should function more like ER staffing — you have physicians and [other] providers available to handle whatever comes in,” she said. “Anesthesia is similar: anesthesiologists and CRNAs don’t schedule their own cases or choose patients based on insurance. They’re at the mercy of the surgeons and the center.”
Now, many facilities are paying anesthesia providers on an hourly basis to ensure consistent coverage. Facilities need anesthesia available as a constant resource, whereas “in the past, you could get an anesthesiologist to do a case, wait a few hours, then do another,” she said. That shift has been difficult for many administrators and physician-owners.
“A lot of centers are relying on subsidies or switching to hourly models,” she said. “But that’s been hard for some administrators and joint venture partners to accept — they want to go back to how things were 10 years ago.”
Small and independent ASCs are feeling the strain most acutely because they don’t have “hospital-level resources,” she said. In some cases, consolidation might be critical.
“ASCs might need to consolidate,” Dr. Friedman said. “While surgeons might not like it at first, they can’t argue with data. No one can really argue with data.”
3. Coverage will become a high risk for multisite ASC operators
Peter Bravos, MD, chief medical officer of Sacramento, Calif.-based Sutter Health’s Surgery Center Division, told Becker’s his biggest anesthesia-related concern in 2026 is “maintaining stable coverage across our sites in an increasingly competitive Northern California market.”
“Recruitment is difficult; compensation expectations keep rising, and even a single anesthesia vacancy can disrupt multiple centers,” Dr. Bravos said.
At the same time, he added, “anesthesia costs continue to climb while ASC margins stay tight,” forcing leaders to walk a narrow line between financial sustainability and consistent, high-quality staffing.
The dynamic is pushing systems to treat anesthesia coverage less like a plug-and-play contract and more like an operational dependency, one that can determine whether blocks run, surgeons stay loyal and schedules hold.
4. Reimbursement pressure will deepen, and the subsidy era expand
Brian Evans, chief operating officer of Savannah, Ga.-based Optim Health System, told Becker’s that anesthesia reimbursement remains “well below the cost of providing care.”
“Additional cuts will only worsen this issue,” Mr. Evans said, “increasing the subsidies hospitals and ASCs pay anesthesia providers to ensure coverage.”
That cost squeeze is showing up in negotiations, where facilities are increasingly paying for readiness, not just production, and leaders are forced to weigh anesthesia coverage against other margin-critical investments. The risk, ASC operators say, is that reimbursement decisions made far from the OR floor can quickly become access problems on the ground.
5. Anesthesia’s identity will shift from contracted necessity to strategic partner
Brian Cohen, MD, administrative chief of Miami Anesthesia Services, told Becker’s he hopes that solving the staffing and cost crisis of 2024-2025 doesn’t cause anesthesia to become “a forgettable asset in 2026.”
“For example, normal blood pressure doesn’t mean you can stop the medicine…it means the medicine is working,” Dr. Cohen said. He warned that when systems believe they can manage staffing and cost challenges “independent of any collaboration with the anesthesia team,” it’s tantamount stopping the blood pressure medication, thus fueling the cycle. His hope for 2026? “We continue to move forward together and appreciate the impact of teamwork.”
Yusuf Ahmad, MD, an anesthesiologist in Berkeley, Calif., echoed the broader shift, telling Becker’s that outpatient facilities need to “mature in their way of thinking” because the old model of anesthesia as a third-party, contracted necessity was built for a market where groups competed with one another to gain ASC contracts.
That supply-demand curve has “shifted dramatically,” he said, as hospitals deploy “supportive stipends” and reimbursement declines.
In the emerging model, Dr. Ahmad said, anesthesia teams must be treated as “essential, productive partners that contribute value,” with economic alignment to drive efficiency and outcomes. “Ultimately,” he said, “the best operating suites are the ones where anesthesia has a central role in medical directorship, quality control, and outcomes management.”
