As anesthesia workforce shortages persist nationwide, more hospitals and ASCs are paying stipends to secure anesthesia coverage.
About 80% of hospitals now offer some form of anesthesia stipend, citing factors such as unfavorable payer mix, irregular OR schedules, low facility utilization and administrative responsibilities that fall on anesthesia groups. The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report, a 57% increase in a single year.
Hospitals have historically used stipends to offset inadequate insurance payment for uninsured and underinsured patients, while ASCs, which work primarily with private insurers and have traditionally limited case complexity, largely avoided the practice, Christina Menor, MD, president of the California Society of Anesthesiologists, told Becker’s.
That is changing. Fragmented surgeon schedules — cases running from 7 to 11 a.m., for example, with nothing again until 3 p.m. — push anesthesiologists to leave for other facilities and not return, Dr. Menor said.
ASCs are increasingly guaranteeing stipends to prevent that loss of coverage. CMS has also expanded which procedures ASCs can perform. Outpatient total shoulder replacement, for instance, was not allowed 1 1/2 years ago and is now, Dr. Menor said, adding to the demand for reliable anesthesia staffing.
Competition for coverage extends beyond one-off stipend deals. A growing number of ASCs are directly employing anesthesiologists with higher salaries and expanded benefits rather than relying solely on facility-based stipend arrangements. Smaller centers are the most exposed to the resulting cost pressure, Ashley Hilliard, administrator of Deerpath Ambulatory Surgery Center, told Becker’s, describing the need for ASCs to offer stipends while still maintaining a healthy bottom line. The shortage is compounding staffing gaps in other OR-dependent roles, including business office functions and surgical technicians, Andrew Lovewell, CEO of Columbia Orthopedic Group, told Becker’s.
Dollar figures vary widely by arrangement, and they’ve grown substantially over time. Among California hospitals that paid an anesthesiology stipend, the mean annual amount rose from $647,985 in 2002 to $2.9 million in 2021, according to a Health Affairs study published in June 2025; the share of hospitals paying any anesthesiology stipend also grew from 35.5% to 57.4% over that period. Volume-adjusted, the 2021 stipend averaged $40.11 per 15 minutes of anesthesia services — nearly double the $21.56 Medicare paid for the same time increment, the study found.
A separate model tied to OR efficiency, outlined by consulting firm Surgical Directions, ties stipend costs to a hospital’s “adjusted utilization” rate against a 75% target; most hospitals run between 50% and 65%. Fixed anesthesia overhead can run about $2,300 per operating room per day, and stipends often exceed $100,000 per anesthesia provider, according to the firm, which cited one hospital where unused capacity across 23 operating rooms totaled $4 million over a year.
Hospitals are increasingly attaching performance metrics to that money rather than paying it unconditionally. Common benchmarks include first-case, on-time starts, turnover times and patient satisfaction scores, law firm McDonald Hopkins reported in an August 2025 analysis of anesthesia contracting trends. A separate review cited merit-based incentive payment system quality measures, anesthesia-related case cancellations and on-time first-case starts as increasingly standard conditions for continued stipend support, Coronis Health reported in April 2024.
Beyond the facility-anesthesia group relationship, a 2022 study conducted by researchers at Columbia University’s Mailman School of Public Health and Weill Cornell Medical College in JAMA Internal Medicine found that anesthesiology practices affiliated with physician management companies, particularly those backed by private equity, command higher payment than independent practices. Facilities with management-company contracts saw allowed amounts rise 16.5% and unit prices climb 18.7%, while private equity-backed companies saw steeper gains of 26% and 25.6%, respectively, according to the study, which examined more than 2.2 million privately insured patients’ claims from 2012 to 2017.
Some hospitals have restructured stipends to recapture money as volume grows. Under a cascading model, the total subsidy decreases as a facility’s case volume rises within a fixed coverage window, with anesthesia providers offsetting the smaller stipend through revenue from the additional cases.
Whether stipend dollars ultimately land with individual clinicians, group leadership or a management company’s investors depends on how a given anesthesia practice is structured.
“That model is not likely sustainable if they don’t want to pay stipends,” Dr. Menor told Becker’s, referring to ASCs relying on unstructured, on-call arrangements.
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