Anesthesia coverage is turning into the most expensive line item on many ASCs’ books, and the real cost rarely shows up in the contract’s headline number.
The share of ASCs paying anesthesia stipends jumped from 28% in 2024 to 44% in 2025, a 57% increase in one year, according to a VMG Health survey. Sixty percent of ASC leaders now rank anesthesia coverage among their top three financial challenges for 2026, and more than 80% expect to rely on contractor-based anesthesia coverage this year rather than traditional employment agreements.
“ASCs increasingly must offer anesthesia subsidies just to keep coverage intact due to workforce shortages and declining anesthesia reimbursement,” Scott Kulstad, CEO of St. Paul (Minn.) Eye Clinic, said. “These subsidies were rare a few years ago but are now becoming material operating expenses that commercial contracts do not account for.”
Professional anesthesia reimbursement has fallen 5.5% since 2019, from $22.27 to $21.12 per unit by 2023, even as the cost of covering a room has climbed. Vijay Bachani, president and chief growth officer of New York Bariatric Group in Roslyn Heights, N.Y., said anesthesia reimbursement as it relates to government payers, especially Medicaid, is most out of sync.
The mismatch isn’t just about rates, it’s about how anesthesia gets paid versus how it gets staffed. Reimbursement is tied to billable case time, while staffing costs are driven by fixed coverage requirements that keep an anesthesiologist on-site regardless of how the day’s volume shakes out.
“Expense and reimbursement are most out of sync in anesthesia staffing. Anesthesia coverage is still reimbursed as if it can be turned on and off by the case, but the expense structure no longer works that way,” Megan Friedman, DO, of Pacific Coast Anesthesia, told Becker’s. “Anesthesiologists must be physically present, immediately deployable, and staffed for variability, delays, add-ons, and rising acuity, regardless of whether a room is actively generating billable minutes.”
That gap is what a stipend is designed to close.
“Without a doubt, the most out-of-sync expense to reimbursement is anesthesia,” said Jeffrey Flynn, administrator and chief operating officer of Gramercy Surgery Center in New York City. “Specifically, the government programs of Medicare and Medicaid. It is nearly impossible to support an anesthesiologist on these payments and has forced us through the past three years to supplement with the facility fee.”
Behind the rate mismatch is a shrinking, aging workforce. Fifty-nine percent of practicing anesthesiologists are 55 or older, 17% are nearing retirement, and roughly 41% say they’d consider leaving their current role within two years, the highest share of any physician specialty. Nationally, the field is projected to be short 6,300 anesthesiologists by 2036.
That scarcity shows up directly in pay. Average CRNA salaries grew 59% from 2019 to 2026, rising from about $181,000 to $288,000.
Physician anesthesiologist recruiting has moved even faster. Postings that typically advertised $400,000 to $650,000-plus in base pay in the fourth quarter of 2025 were advertising seven-figure base pay for some roles by the first quarter of 2026.
“Anesthesia contracts are often the single line item that shocks leadership, but nursing labor is the continuous daily bleed that erodes margins,” Charlene Cioe, RN, MSN, chief nursing officer at Summit Center for Surgery, said.
With stipends now closer to standard than exceptional, ASC leaders are rethinking how coverage is structured rather than whether to pay for it. Among ASCs planning 2026 anesthesia staffing, 44% expect to use independent contractors paired with a stipend, 36% expect contractor coverage without one, and just 9% plan to stick with traditional employment agreements.
Some operators are testing “cascading stipend” arrangements, which tie the subsidy to volume. As a facility’s case volume grows past an agreed baseline within a fixed coverage window, the stipend owed shrinks accordingly, aligning the health system’s and the anesthesia group’s incentives around productivity rather than guaranteed pay.
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.
