Anesthesia has become one of the most expensive line items on an ASC’s books.
Stipend payments are now standard. The share of ASCs paying anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to VMG Health data. Faced with that math, a small but growing number of ASC operators are skipping the stipend fight altogether and buying the anesthesia group instead.
Sean Gipson didn’t set out to become an anesthesia group owner. Mr. Gipson, CEO and ASC division president of Remedy Surgery Center, told Becker’s the decision followed months of watching hospital anesthesia stipends climb to levels he says no ASC could realistically match.
“At that point I knew I’d better make a run at an acquisition or something, because I wasn’t going to be able to afford that, and neither would any other ASC, given the margins we work on versus what a hospital works on,” Mr. Gipson said.
Mr. Gipson said he’d relied on a long-standing anesthesia group contract for years, but the calculus changed once he saw what hospitals were offering to pull providers away. He described interviewing the anesthesia providers he used about what was drawing them to hospital shifts, then confirming it himself.
“He pulled out a check that showed the stipend right there,” Mr. Gipson said of one provider.
That moment, more than any single financial model, is what pushed him from contracting toward ownership.
Other ASC leaders describe a similar logic, even if few frame it explicitly as “buy versus contract.” Suzi Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif., told Becker’s that “more physician groups, health systems and ASC ownership entities may need to directly employ anesthesiologists and CRNAs” as contracted coverage grows less reliable and more expensive. Megan Friedman, DO, director at Los Angeles-based Pacific Coast Anesthesia Consultants, pointed to the same underlying pressure driving consolidation across the specialty more broadly, citing “rising labor costs, supply chain disruptions and mounting pressure on reimbursement.”
As a contracted service, anesthesia billing is difficult to structure in a way that protects an ASC’s margin, according to Mr. Gipson, since case length varies too much for a straight per-unit approach to pencil out reliably. Before acquiring his group, he said the fix was a flat-fee contract, essentially bundled pricing by CPT code, that smoothed out the variability between a 15-minute case and one that runs an hour longer than expected.
Ownership changes that equation. Rather than paying a contracted group’s rate, or increasingly, a stipend on top of it, Mr. Gipson said owning the group let him capture the same inflated hospital-side stipend revenue his own providers were being offered elsewhere.
“To be quite honest, I’ll throw them over in hospital cases because we’re making those stipends now,” he said. “We pay our employees well, but it’s an exorbitant amount, more than twice of what we were paying anesthesia providers even three years ago.”
The underlying cost trend backs that up. CRNA salaries rose from a national median of $181,040 in 2019 to $231,700 in 2024 and $276,434 by April 2026, per Bureau of Labor Statistics. Over the same period, professional anesthesia reimbursement per unit actually declined 5.5%, from $22.27 in 2019 to $21.88 in 2023.
Mr. Gipson’s model lets him route anesthesia capacity toward whichever setting pays best, ASC cases or, now, hospital cases at stipend-inflated rates, rather than being stuck as a price-taker in either market.
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.
