Anesthesia stipends are becoming a cost of doing business for ASCs. One Pittsburgh-area administrator said the best way to keep them in check is to know what the anesthesia group should be collecting.
The share of ASC leaders expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, according to a VMG Health survey of ASC leaders. Sixty percent of the leaders ranked anesthesia coverage among their top three financial challenges for 2026. Among ASCs that NorthStar Anesthesia serves, about 80% now pay stipends, up from 10% to 15% before COVID-19, CEO Adam Spiegel told Becker’s.
Patrick Garman, executive administrator of Spartan Health Surgicenter in Monongahela, Pa., spoke Oct. 29 at Becker’s 32nd Annual Meeting: The Business and Operations of ASCs in Chicago. The third-party anesthesia group that covers his center bills it by the hour, and he checks those bills against the group’s own revenue.
“If there are any administrators in this room, you need to know what anesthesia is supposed to be paid,” Mr. Garman said.
Because he knows the billing units, Mr. Garman said, he can estimate what the group should be billing and collecting. He reconciles that against what the group reports every quarter or every six months.
He said anesthesia should be no different from other suppliers.
“I can’t tell Zimmer or Arthrex, ‘Hey, we’re not getting paid very much right now from Aetna. Can I pay you in 60, 90 days?’” he said. “It doesn’t work that way. They’ll cut us off.”
Stan Plavin, MD, an anesthesiologist and owner of Ambulatory Anesthesia Partners, agreed. His practice works mainly in ASCs and office-based settings. Three of his group’s facility agreements include reconciliation terms.
“I am exceedingly transparent,” Dr. Plavin said. He said he shares the group’s expected allowables, percentage of net collections, bad debt, hourly rates and sign-in sheets with the centers it works with.
He also pressed Mr. Garman on what a fair margin is. Dr. Plavin said his group’s profit is usually 8% to 10% a year or less, after costs including scheduling and liability coverage.
“If your docs are not getting anything out of it, they wouldn’t do their cases there either,” he said.
He said a $500,000 stipend sounds large but is smaller once divided among providers, working out to about $150,000 per provider a year.
Mr. Garman said the goal is to fill schedules and cover any gap without letting it grow.
“We have to come up with whatever the shortage is in the form of a stipend or a reconciliation,” he said. “So we just don’t want it to escalate.”
Reconciliation is built into some contract models. Contracts with a collections guarantee require regular reconciliation of collections and stipends, attorneys at McDonald Hopkins wrote in 2025. They added that anesthesia groups requesting stipends should expect to commit to regular financial reporting and allow audits.
Mr. Garman said administrators also need guardrails on payer mix. Workers’ compensation is slow to pay, and Medicaid anesthesia reimbursement can leave a center “upside down.” When physicians have hospital privileges, his center encourages them to take some Medicaid cases there.
“Knowing what anesthesia is capable of billing and getting paid is very, very crucial,” he said. “It’s part of my budget process.”
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.
