Anesthesia costs have become the biggest financial surprise hitting ASCs, and four surgery center leaders say the shift happened faster than most expected.
Before 2022, most ASCs paid nothing for anesthesia coverage. Today, stipends and daily guarantees have turned anesthesia into one of the largest and least predictable cost centers on the balance sheet, arriving at the same time reimbursement is falling. Becker’s asked four ASC leaders which cost category surprised them most in the past 12 months. Three named anesthesia. The fourth flagged supply costs on new cardiac procedures.
Question: Which ASC cost category surprised you most in the past 12 months — supplies, anesthesia, staffing or payer denials? Why?
Tiara Dennison, RN. Anesthesia. Director of Nursing at Fayetteville (N.C.) Ambulatory Surgery Center: Though we have seen a continued increase in anesthesia cost over the past couple of years, the spike in anesthesia cost is shocking. Understanding that the demand is far greater than the supply for anesthesia staff and still being competitive with other local competitors can be detrimental to ASCs. All of this while anesthesia reimbursement is on the decline, so many anesthesia companies are requiring the differential cost to come from the ASC, causing more difficulty in maintaining profitability. To combat the rise in cost, ASCs are having to become creative in operating room schedules, staffing, hours of operation etc.
Megan Friedman, MD. Chair and Medical Director of Pacific Coast Anesthesia Consultants (Los Angeles): Anesthesia has changed the most, not simply because reimbursement has shifted, but because the financial responsibility for inefficiency has shifted.
Historically, anesthesia groups often absorbed the cost of underutilized operating rooms, schedule gaps, and low volume days. Today, with the widespread use of daily guarantees and stipends to secure anesthesia coverage, much of that financial risk has shifted to the ASC.
That has fundamentally changed the economics of running a surgery center. Every idle operating room, fragmented schedule, or underutilized block now has a direct financial impact on the facility. As a result, operational efficiency has become more important than ever. The highest performing ASCs are not just managing costs. They are optimizing scheduling, consolidating volume when appropriate, and ensuring anesthesia resources are aligned with surgical demand.
Patrick Garman. Administrator of Spartan Health (Monongahela Pa.): For my ASC, the number one challenge is the anesthesia contract labor cost and it continues to be an issue. Anesthesia is a necessary vendor that is able to govern its own process — bill for its own revenues, compensate for its own professional staff. But the argument that anesthesia makes is that their own reimbursement continues to decrease or stagnate while the cost of hiring professional staff (particularly CRNA’s) increases annually within highly competitive markets. So, it falls on the ASC to support this shortfall with a stipend and reconciliation shortfall. This is now a very serious additional cost center. Prior to 2022-2023, most ASCs did not need to pay anything for anesthesia.
Thomas Hutchinson. Administrator of the Surgery Center of Central Florida (Ocala): In the past 12 months we started doing electrophysiology procedures (ablations) in the ASC. As a cardiac ASC we typically do not use any reprocessed supplies, however with the high cost of ablation cases we decided to use some reprocessed products. In doing so I learned that the cost of reprocessing is not as cost effective as initially thought. There is a savings but the availability of the specific items and cost was a surprise.
Lauren Phillips. Director of Invasive Services at the Cardiac and Vascular Institute (Chiefland, Fla.): Supply costs are always changing in the ASC world, lately I feel like the costs have increased more drastically than prior before with any cost changes. Our center has great working relationships with our vendors and always strives to get the best price possible. This is becoming a tedious process for all involved and creative ways of cost savings are having to be used like tired rebate programs or bulk orders in order to get the pricing to an acceptable price point. I feel like this is due to just the ever changing and rising cost of anything and everything and suppliers also know that the demand is increasing.
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.
