The operating room minute is often thought of as the most expensive unit in healthcare (link), and ongoing workforce shortages in anesthesia have pushed OR-staffing and coordination issues to the center of ASCs’ struggles.
Leaders have told Becker’s that the true cost of misalignment between ASCs and their anesthesia provider teams can extend beyond a straightforward dollar amount, rippling into other facility workflows and disrupting case selection processes.
Here are five notes on what anesthesia misalignment looks like and what it costs ASCs:
1. The economics of the issue. From a purely financial perspective, anesthesia is already one of the ASC industry’s steepest cost issues as provider compensation demands rise and reimbursement from both government and private payers continues to drop. Over the past 23 years, inflation-adjusted Medicare reimbursement for select pain management procedures has decreased an average of 2.81% annually, according to the American Association of Physician Leadership.
Advertised W-2 base pay for physician anesthesiologists jumped sharply in the first quarter of 2026, with peak offers reaching seven figures for the first time. The cost of hiring locums and certified-registered nurse anesthetists are not much lower — as CRNAs gain broader legal authority to practice independently in many states and as the anesthesia workforce shortage deepens, many leaders are seeing ASCs adopting CRNA-only anesthesia models.
As reimbursements fall and demand remains high, many ASCs have become locked into agreements to subsidize anesthesia coverage. From 2024 to 2025, the share of centers expecting to pay stipends rose from 28% to 44%.
“In most ASCs today, the expense that is most out of sync with reimbursement is labor cost — especially licensed nursing staff, anesthesia staff and surgical tech staffing,” Charlene Cioe, RN, MSN, chief nursing officer of Summit Center for Surgery in Oakbrook Terrace, Ill., told Becker’s.
“Anesthesia contracts are often the single line item that shocks leadership, but nursing labor is the continuous daily bleed that erodes margins,” she said, noting that there are little to no payment levers that can be used to make up for the sometimes unpredictable nature of surgical workflows.
“A 90-minute ase reimburses the same regardless of how many staff are required,” she said. “Longer turnovers, [social determinants of health]-related delays and higher acuity patients increase staff time but not payment.”
2. A lack of reliability causing coverage gaps. Megan Friedman, DO, chair and medical director of Los Angeles-based Pacific Coast Anesthesia, told Becker’s that too many ASCs treat anesthesia like a commodity to be shopped around rather than a fixed operational pillar. They cycle through coverage providers in search of lower per-case costs, and pay for it in cancellations, coverage gaps and surgeon frustration.
“The highest-performing ASCs do the opposite,” she said. “They align with a reliable anesthesia partner and build staffing around their schedule, driving on-time starts, fewer cancellations and sustainable growth.”
3. Overbooked rooms cause similar inefficiencies. Brett Maxfield, CRNA, president and CEO of Rigby, Idaho-based Maxfield Healthcare Solutions, told Becker’s the most damaging mistake he sees is centers running four operating rooms with four separate anesthesia providers, one for each physician owner, even when each room has only a single case.
“Most anesthesia providers are requiring a daily minimum and possibly a stipend, so four operating rooms with four anesthesia providers and one case for each surgeon is going to kill the financials of that ASC,” he said.
The fix, he argues, is consolidating coverage so one or two providers handle all four surgeons, but it requires physician owner buy-in on schedule flexibility.
4. Physician turnover costs add fuel to existing pay-related flames for ASCs. In a 2025 report, AMN Healthcare found that each office-based physician generates an average economic output of $3.1 million. While not directly comparable to the costs of contracted anesthesiologists or CRNAs, the study highlights the increasingly high stakes of staffing inconsistencies and turnover.
“Without a doubt, the most out-of-sync expense to reimbursement is anesthesia. Specifically, the government programs of Medicare and Medicaid,” Jeffrey Flynn, administrator and chief operating officer of New York City-based Gramercy Surgery Center told Becker’s. “It is nearly impossible to support an anesthesiologist on these payments and has forced us through the past three years to supplement with the facility fee. This stands as the number one danger to ASCs that we face today.”
5. Anesthesia bottlenecks preventing future growth. Facility’s inability to consistently secure and sustain anesthesia coverage may prevent future ASC growth, especially as more procedures in higher-acuity specialties become approved for outpatient settings.
For example, In its 2026 final rule published Nov. 21, CMS approved four cardiovascular codes for electrophysiology studies and ablations and three codes for percutaneous coronary intervention. But as more ablations and PCI cases head outpatient, operators and anesthesia groups are warning that staffing shortages may slow the pace of expansion.
Kristen Richards, vice president of ambulatory care at Lafayette, La.-based Cardiovascular Logistics, told Becker’s that anesthesia coverage is quickly becoming one of the key operational hurdles, particularly for EP procedures.
“We are currently seeing a national shortage of anesthesiologists and CRNAs,” she said. “Cardiovascular ASCs should already be pursuing anesthesia coverage for their facility in preparation for cardiac ablations, along with acquiring the appropriate anesthesia equipment, EP mapping equipment, developing anesthesia protocols and revising their patient selection criteria to ensure the right patient, for the right procedure at the right facility.”