Image by kalhh from PixabayAnesthesia remains one of the biggest pain points for ambulatory surgery centers (ASCs).
Anesthesia reimbursement has dropped 8.2% over the past decade while provider salaries have climbed as much as 40%. In turn, that has contributed to creating a growing financial strain on ASC operators.
Randy Quinn, chief compliance officer and chief integration officer at Guide Anesthesia, said the widening gap is unsustainable, and likely to get worse.
“There’s nothing coming up in the future that looks like anesthesia collections are going to increase anytime soon,” Quinn said last month at the Arizona Ambulatory Surgery Center Association’s 2025 Annual Conference.
Although a 2.25% increase from CMS is expected in September, he said it will do little to reverse the downward trend.
Guide Anesthesia is a physician-owned anesthesia services provider specializing in ASCs and office-based procedures.
Shortages outpacing demand
Anesthesia providers are also becoming harder to find. The American Medical Association has projected a 30% reduction in the anesthesiologist workforce by 2033 and a shortage of nearly 8,000 CRNAs by 2028, Quinn said at the event.
In his view, those numbers understate the problem.
“It seems like every street corner has a new surgery center going up, and the number of procedures requiring anesthesia is growing faster than we can train new providers,” Quinn said.
And job postings for CRNAs have grown more than 90% over the last decade, with over 200 CRNA job ads in Arizona alone, he said.
To manage anesthesia expenses, ASC operators need to understand how billing works, Quinn advised.
Reimbursement depends on a combination of base units assigned to a procedure and time units based on 15-minute increments, he noted. But it is not long, complex surgeries that generate the most revenue.
“Anesthesia makes money on the quick, short, simple cases because you can do more of them in a day,” Quinn said.
He gave the example of an umbilical hernia repair, which might generate $180 from a government payer or $630 from a commercial payer, depending on contracted rates.
“You can do five Medicare cases and still not make what you would on a single commercial case,” Quinn said.
Where facilities can make a difference
For many years, Guide Anesthesia did not require facility stipends, Quinn said. That is no longer the case.
“Salaries are not going to come down, and reimbursement is not going to go up,” Quinn said. “If you’re not paying a stipend now, it’s likely you will be soon.”
He urged ASC leaders to educate themselves on stipend models, including flat-pay structures and collection guarantees. The latter can be unpredictable, since they depend heavily on case volume, payer mix and room utilization, Quinn said.
ASC leaders can also reduce anesthesia costs by running more efficient facilities, Quinn said. That starts with surgeons consistently using their full block time.
“If a provider is guaranteed eight hours of pay and only works three or four hours, that difference adds up quickly,” Quinn said.
Other costly inefficiencies include slow room turnover, surgeons operating out of two rooms with downtime between cases, and case cancellations due to poor patient screening or scheduling issues, he said. Each missed case can mean the difference between a profitable and non-profitable day.
“Surgeons may not love it, but filling their blocks and keeping cases moving is critical,” Quinn said.
Understanding models and contracts
There are several anesthesia staffing models, including physician-only, supervision-based, mixed and CRNA-only models. Each has different cost implications, according to Quinn.
“The physician-only model is typically the most expensive,” he said.
Solo anesthesia providers are rapidly disappearing due to lack of negotiating power with insurance companies, Quinn said. Larger groups can often secure better rates but also carry more administrative overhead, he said.
When entering contracts with anesthesia groups, ASC leaders should look for clarity around expectations, cancellation terms, invoicing and mutual responsibilities, Quinn said. Contracts should include both immediate termination and 90-day exit clauses and should be reviewed and potentially amended every one to two years, he said.
“These contracts are not meant to last forever,” Quinn said.
CRNA scope and liability clarity
Arizona is an opt-out state, which means CRNAs can practice without supervision, Quinn said. Still, many surgeons remain wary of working with CRNAs due to misinformation about liability.
“It is not true that supervision is required in Arizona,” Quinn said. “That law was changed.”
He also pointed to Arizona’s physician immunity clause, which protects surgeons from liability in cases involving CRNA errors.
“If something goes wrong and the CRNA was at fault, the surgeon is excluded from the case,” Quinn said.
ASC leaders must be careful to avoid Stark Law and anti-kickback violations, Quinn said. Facilities cannot profit from anesthesia services, and physicians cannot own anesthesia groups unless they are certified anesthesia providers themselves, he said.
“Ownership arrangements need to be carefully structured,” Quinn said.
He also cautioned against arrangements where anesthesia groups buy equipment, pay for EMR access or rent office space above fair market value.
“If money is changing hands, you need to know exactly why and ensure it is compliant,” Quinn said.
Groups should also help develop policies and procedures, support quality improvement efforts, participate in staff training, and ensure compliance with safety and HIPAA standards, he said.
“This is not just about pushing drugs and going home,” Quinn said. “You need a partner who helps maintain efficient services, avoids unnecessary cancellations, and supports your goals.”
He also encouraged facilities to make full use of anesthesia providers’ knowledge when reviewing staffing needs, compliance issues, or survey preparation.
“We all have to be good stewards,” Quinn said. “This is a partnership, and we all need to be part of the solution.”
