The continuous escalation of staffing challenges and the financial complexities of anesthesia care are squeezing ASCs’ bottom lines.
Labor costs
While staffing and retention are often cited as significant workforce challenges for ASCs, the cost of maintaining fair compensation for clinicians is also rising as hospitals and health systems expand their presence in the ASC market.
“The most significant financial challenge is keeping up with the labor market,” Michael Cournyea, CEO of University at Buffalo Neurosurgery, told Becker’s “Most ASCs are competing with hospitals and health systems for RNs and surgical techs, and this is driving up the costs for these positions.”
The level of investment required to support a physician practice — measured as median investment per physician full-time equivalent — rose to $322,490 in the second quarter of 2025, according to data from Strata. Total expense per physician FTE climbed to nearly $1.2 million in the second quarter, an 11.4% increase compared with the same period in 2024.
Cost of anesthesia
The anesthesia cost squeeze is intensifying as Medicare’s conversion factor declined 2.8% for 2025 while provider wages continue to rise amid workforce shortages, prompting many ASCs to reevaluate their anesthesia delivery models.
“There’s going to be a breaking point for smaller companies like mine. … Unless things change, this entire system will likely hit a breaking point within five years,” Brian Cross, CRNA, owner of Youngstown, Ohio-based CS Anesthesia, told Becker’s.
In addition to the cost of anesthesia, ASC leaders are also struggling with the financial management of anesthesia stipends and scheduling issues. “ASCs often enter into stipend agreements with anesthesia providers based on a projected minimum number of cases,” Phyllis Norton, administrator of Central New York Eye Center in Poughkeepsie, N.Y., told Becker’s. “However, when surgeons fail to meet these minimum case thresholds, the center is still obligated to pay the anesthesia stipend, resulting in a financial loss for time and services that were never utilized.”
Payer tactics to cut anesthesia pay
While ASC leaders work to address the costs of anesthesia services, payers are developing new methods to limit anesthesia reimbursements, including delayed payments, bundling, denials over coding technicalities and so-called “silent PPOs” that apply reduced rates without provider consent. These strategies can significantly undercut expected revenue, even in cases with clean claims.
“The cost of running a functional anesthesia group from 2001 to 2025 has risen 39% whereas Medicare has only increased anesthesia reimbursement by 11% over this time frame,” Andy Briggs, a CRNA in Colorado Springs, Colo., told Becker’s. “The lifeblood of our specialty, aside from vigilant patient safety, is our ability to understand a multitude of conditions and interventions across a vast playing field. The future of our profession will depend on our willingness to evolve that skill set further into the business world and educate the several moving parts of healthcare about the long-term implications of short-sighted strategy.”
