More ASCs are being forced to pay anesthesia stipends as staffing shortages deepen and coverage gaps threaten daily operations.
“Anesthesia is now a cost for many ASCs that previously did not have to subsidize their providers,” Traci Albers, CEO of Sioux Falls, S.D.-based Surgical Management Professionals, told Becker’s. “With increasing anesthesia shortages, increasing salaries and stagnant reimbursement, ASCs are now subsidizing anesthesia.”
The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report released Oct. 9.
But the growing reliance on stipends may have less to do with staffing shortages and more to do with an unsustainable business model, according to Christina Menor, MD, president of the California Society of Anesthesiologists.
“This is the model that pretty much exists in almost every hospital,” Dr. Menor told Becker’s. “In the ASC setting, this traditionally hasn’t been a problem because most ASCs don’t accept Medicaid insurers, usually don’t have lengthy cases and often work with private insurers who pay adequate rates.”
Dr. Menor said improving scheduling efficiency is one of the few levers ASCs can pull to offset rising costs. Even if anesthesia shortages disappeared, declining payment rates and payer tactics would still make the current setup difficult to sustain.
“In the past, ASCs bent over backwards to accommodate surgeons, because they wanted them to bring their business,” she said. “Now we’re seeing centers push back because of scheduling and access to safe, quality anesthesia services, which with the shortage will continue to be challenging.”
Payment data underscores the squeeze. The average anesthesia reimbursement rate fell to $21.88 per unit in 2023, down 5.5% from 2019, according to Coronis Health. Medicare reimbursement also declined from $22.27 per unit in 2019 to $21.12 in 2023, a trend highlighted by VMG Health.
Over the past 23 years, inflation-adjusted Medicare reimbursement for select pain management procedures has decreased an average of 2.81% annually, according to the American Association of Physician Leadership.
At the same time, payers are becoming more aggressive in denying or clawing back payments.
“Insurers are getting more aggressive, and more creative, in avoiding payment,” Katy Dean, CRNA, chief nurse anesthetist at Newport News, Va.-based TKMAnesthesia, told Becker’s. “We’re seeing more denials for time discrepancies, claims being reprocessed months later with money pulled back, and even outright rejections for technicalities like modifier confusion (the codes that show who provided care).”
Even if the workforce shortage were solved overnight, Dr. Menor said anesthesia stipends would still be a problem.
“The shortage makes it worse, but even without it, this would still be a problem,” she said. “So being more efficient — and not letting surgeons dictate the entire day — is probably where this has to go.”
Dr. Menor believes anesthesiologists should take a larger leadership role in ASC operations to drive efficiency and improve coordination. Anesthesiologists are uniquely suited for the role because of their experience in management of multiple hospital service areas and interfacing almost every aspect of care, she said.
But that shift faces cultural and structural resistance.
“The biggest barrier is that most ASCs are either partially or fully owned by surgeons … Most are still privately owned by surgeons, and most of those have one of the primary owners, a surgeon, as the medical director,” she said. “Surgeons are often not fully aware of everything going on in a surgery center or hospital operating room services. Anesthesiologists are in the OR and perioperative space all the time so we see and manage interactions between specialties, pre- and postop care, pain management, nurses, surgical technologists, laboratory, interventional radiology, gastroenterology, etc.”
For Dr. Menor, the rise in anesthesia stipends is not merely a symptom of the current labor market, it is a sign that ASC structures and expectations need to evolve.
“ASC’s have always been at the beck and call of surgeons, and that model is not likely sustainable if they don’t want to pay stipends,” she said.
Other leaders warn that the anesthesia stipend trend could push many ASCs to the brink.
“Facilities paying stipends have created an arms race between each other, and are doing so to keep grossly inefficient systems in place,” Mo Azam, MD, head of innovation at Orlando, Fla.-based US Anesthesia Partners, told Becker’s. “The long-term effect will be some winners and many losers … rural, financially strained facilities and some ASCs may not survive.”
