Anesthesia stipends have become a nearly unavoidable part of ASC operations as a high demand for surgical services and a low supply of both anesthesiologists and certified registered nurse anesthetists has greatly shifted the power dynamics in the space.
The share of ASCs paying anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to VMG Health data. Sixty-seven percent of ASC leaders now name anesthesia coverage among their top three financial challenges heading into 2026. Independent contractor arrangements, many paired with a stipend, are projected to be the dominant anesthesia staffing model this year: 44% of ASC leaders expect to use contractors with stipends and another 36% expect to use contractors without one. Traditional employment, by contrast, is expected at just 9% of centers.
Charlene Cioe, RN, MSN, chief nursing officer of Summit Center for Surgery in Oakbrook Terrace, Ill., said the gap between labor costs and what payers cover has widened sharply since the COVID-19 pandemic and has not been matched by Medicare or commercial rate increases. Anesthesia contracts, she said, are the expense that most often shocks leadership, while nursing labor is “the continuous daily bleed that erodes margins,” Ms. Cioe told Becker’s.
Vijay Bachani, president and chief growth officer of New York Bariatric Group in Roslyn Heights, N.Y., told Becker’s that the anesthesiologist shortage has left centers without a healthy volume of commercial cases facing an uncomfortable choice of whether to absorb losses by employing anesthesiologists directly, or pay a subsidy to outsource coverage.
The subsidy math would be easier to justify if reimbursement were holding steady, but Medicare anesthesia reimbursement fell 8.2% from 2019 to 2024, then absorbed another 2.83% cut in 2025. UnitedHealthcare has layered on its own pressure, cutting payments 15% for independently practicing certified registered nurse anesthetists in select states and eliminating payment for key modifiers. On the facility side, the 2026 ASC payment conversion factor sits at $56.322, compared with $91.415 for hospital outpatient departments — a structural gap ASC leaders have flagged for years, even as CMS acknowledges surgery centers can safely handle a broader range of procedures.
The pressure isn’t only financial. When coverage falls short, some centers have had to close rooms or cancel cases outright. Tina Driggers, administrator of DSC Day Surgery Center in Winter Haven, Fla., said the nationwide anesthesia staffing shortage leads directly to room closures and canceled cases, creating “economic stresses to the surgery center,” she told Becker’s. Nathan Garner, director of area operations at Sutter Surgery Center Division in Sacramento, Calif., said the shortage has been “greatly challenging for many ASCs,” not just centers with thin margins to begin with.
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.
