ASC leaders and anesthesia executives say the flat annual subsidy, which long has been treated as the cost of keeping ORs covered, is being replaced by structured deals that tie financial support to room-hour minimums, guaranteed coverage, block utilization and performance metrics.
“Flat stipends are dying; there are already negotiations ongoing that head toward volume-tied performance and high acuity patients,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker’s.
The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report, marking a 57% increase in a single year. Additionally, more than 80% of ASCs anticipate relying on contractor-based anesthesia coverage in 2026, with 44% planning to use independent contractors with stipends and another 36% without. Only 9% of ASC leaders said they plan to staff anesthesia through a traditional employment agreement.
Jack Dillon, CEO of Grand Rapids, Mich.-based Anesthesia Practice Consultants, said the financial structures themselves — not just the amounts — are evolving.
“Rather than broad subsidies, ASCs and anesthesia groups will likely move toward more defined support models tied to room coverage, guaranteed hours, underutilized blocks and staffing expectations,” Mr. Dillon said. “In many cases, the issue is not whether a stipend exists, but whether the structure clearly aligns incentives between the facility, surgeons and anesthesia providers.”
Raghu Reddy, chief administrative officer of Southfield, Mich.-based MiOrtho Surgery Center and secretary of the Ambulatory Surgery Center Association’s board, expects “the days of ‘free anesthesia coverage’ to become less common, especially for ASCs with variable volume, inefficient block utilization, late cancellations or heavy add-on expectations.”
Anesthesia groups, he said, will want some combination of:
- Guaranteed daily coverage payments
- Room-hour minimums
- Call or add-on stipends
- Medical director stipends
- Performance-based subsidy models tied to utilization, quality and coverage reliability
The flip side, Mr. Reddy said, is accountability.
“If we are financially supporting anesthesia coverage, then we should expect reliable room coverage, flexibility for trauma and add-ons, consistent regional anesthesia capabilities, surgeon satisfaction, patient safety metrics, on-time starts, and participation in operational improvement,” he said.
Megan Friedman, DO, chair and medical director of Los Angeles-based Pacific Coast Anesthesia, said the old model relied on anesthesia groups quietly eating the cost of ASC inefficiency.
“Historically, anesthesia groups absorbed inefficiencies such as late starts, underutilized rooms, fragmented schedules, cancellations and add-ons. That model is no longer sustainable,” Dr. Friedman said. “Reliable coverage requires alignment between scheduling discipline, block utilization and financial support.”
CMS’ anesthesia-specific conversion factor fell 2.2% in 2025, following a broader 2.83% cut to the overall PFS conversion factor. Additionally anesthesia reimbursement averaged $21.88 per unit in 2023, a 5.5% drop from 2019. Medicare rates show the same pattern, falling from $22.27 in 2019 to $21.12 in 2023.
Sean Gipson, CEO and ASC division president of Houston-based Remedy Surgery Center, said the shift is permanent.
“What was once viewed as a temporary response to staffing challenges is becoming a permanent component of ASC financial planning,” Mr. Gipson said. “As hospitals continue to compete aggressively for anesthesia providers, ASCs will need to offer increasingly competitive arrangements to ensure reliable coverage.”
Centers with disciplined block utilization and predictable volumes will negotiate from strength; centers with empty rooms and late starts will pay a premium for the same coverage.
“Empty rooms, late starts and underutilized blocks will become harder to defend,” Mr. Reddy said. “If surgeons want premium coverage, we need disciplined schedules.”
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.