ASCs are taking on more cases, expanding service lines and pushing into higher-acuity procedures, but many are hemorrhaging money on the one department that touches every single case on the schedule.
The problem, according to anesthesia leaders, is operational. Centers are structuring anesthesia coverage around surgeon convenience rather than financial reality, and the daily losses add up fast.
Brett Maxfield, CRNA, president and CEO of Rigby, Idaho-based Maxfield Healthcare Solutions, told Becker’s the most damaging mistake he sees is centers running four operating rooms with four separate anesthesia providers, one for each physician owner, even when each room has only a single case.
“Most anesthesia providers are requiring a daily minimum and possibly a stipend, so four operating rooms with four anesthesia providers and one case for each surgeon is going to kill the financials of that ASC,” he said.
The fix, he argues, is consolidating coverage so one or two providers handle all four surgeons, but it requires physician owner buy-in on schedule flexibility.
That scheduling dysfunction compounds a deeper strategic error, according to Megan Friedman, DO, chair and medical director of Los Angeles-based Pacific Coast Anesthesia.
She said too many ASCs treat anesthesia like a commodity to be shopped around rather than a fixed operational pillar. They cycle through coverage providers in search of lower per-case costs, and pay for it in cancellations, coverage gaps and surgeon frustration.
“The highest-performing ASCs do the opposite,” she said. “They align with a reliable anesthesia partner and build staffing around their schedule, driving on-time starts, fewer cancellations and sustainable growth.”
Narasimhan Jagannathan, MD, division chief of anesthesiology at Phoenix Children’s, frames the same problem from a throughput perspective. Understaffing anesthesia, or leaning on locum coverage to plug holes, generates downstream costs through delays, last-minute cancellations and lost utilization that never shows up on the anesthesia line item, but hits the P&L just the same.
“ASCs should invest in stable anesthesia teams and optimized perioperative workflows,” he said, pointing to preoperative screening and demand-aligned staffing as two levers most centers underutilize.
For Thomas Jeneby, MD, CEO of Palm Tree Surgicenters, Chrysalis Cosmetic Surgicenter and Maximus Plastic Surgicenter in San Antonio, the anesthesia workforce shortage on the horizon makes getting this right even more urgent.
His approach is to treat recruiting as a permanent, never-off function.
“I have found my Indeed account and headhunters open 24/7 to try and find good single anesthesia providers and CRNAs to add for part-time help,” he said.
He applies the same discipline to broader staffing decisions, using salary benchmarks from sources like Salary.com and MGMA data to anchor compensation conversations rather than letting market rumors or staff pressure set the rate.
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.