Anesthesia has become one of the fastest-growing financial liabilities for ASCs amid what leaders call a structural mismatch between how ASCs operate and how anesthesia gets paid.
The costliest anesthesia issue is “misalignment between operational efficiency and the anesthesia delivery model,” Bronson Taylor, CRNA, executive vice president of clinical affairs at Pensacola, Fla.-based CCI Anesthesia, told Becker’s.
This is particularly important in ASCs, where Mr. Taylor said he sees a convenience-first mindset driving decisions that quietly erode the bottom line. Anesthesia reimbursement is no longer sufficient to offset scheduling gaps, low-acuity case mixes, inconsistent block utilization and rising labor costs, and ASCs are increasingly making up the difference themselves.
The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report published Oct. 9.
“When inefficiencies persist, ASCs often require ongoing anesthesia subsidies to maintain coverage,” he said. “These subsidies can become significant and, over time, erode the center’s financial performance.”
Several leaders said the issue is no longer a marginal operational challenge, but a structural threat to ASC economics. The problem is especially acute for centers with heavy government payer exposure.
“Anesthesia reimbursement as it relates to government payers, especially Medicaid, is most out of sync,” Vijay Bachani, president and chief growth officer of New York Bariatric Group in Roslyn Heights, N.Y., told Becker’s. “Anesthesiologists are in high demand and unless your center has a healthy amount of commercial cases, you will either end up losing money if you hire your own anesthesiologists or you may have to provide a subsidy if you outsource it.”
Beyond subsidies, revenue is also slipping through documentation gaps. Missed or incomplete capture of anesthesia cases, often driven by inadequate oversight of billing vendors, compounds the problem, according to Megan Friedman, DO, chair and medical director at Los Angeles-based Pacific Coast Anesthesia Consultants.
“Because revenue is unit-based, small documentation or reconciliation gaps compound quickly, and when vendors miss cases or fail to align with procedural logs, it results in significant, often unrecognized revenue leakage,” she said.
Mr. Taylor said the fix starts with visibility. ASC leaders need financial models that explicitly connect operational decisions to anesthesia costs, so the revenue impact of scheduling choices and payer mix is impossible to ignore.
“The most effective approach is to implement transparent financial models, such as revenue guarantee structures, that clearly connect operational performance (case volume, payer mix, block utilization) to anesthesia costs,” he said. “When ASC leadership has full visibility into these drivers, they can make informed decisions that reduce reliance on subsidies and improve overall margins.”