Anesthesia departments are being challenged to deliver the same level of safety and excellence with dwindling resources as hospitals face mounting financial strain. Across the country, anesthesia leaders are innovating to align high-quality care with operational efficiency — proving that cost control and clinical excellence don’t necessarily have to be in opposition.
Question: How do you balance providing high-quality anesthesia care with the growing pressure to cut costs in your department?
Editor’s note: These responses have been lightly edited for clarity and length.
Moeed Azam, MD. Head of Innovation at U.S. Anesthesia Partners (Dallas): Anesthesia practices came together under U.S. Anesthesia Partners to invest in shared goals, with perioperative quality as the core foundation. We have a quality structure with local clinician governance over all medical care and committees that meet monthly at local, regional and national levels to collaborate on best practices. Cost pressures are not a clinical challenge but an operational one. The real savings come from improving OR utilization and efficiency through data analytics and business insights that help clinicians work collaboratively with facility partners and surgical leaders.
Brian Cohen, MD. Administrative Chief at Miami Anesthesia Services: Over 90% of anesthesia costs are clinician salaries, limiting opportunities for significant cuts in today’s competitive market. The key to high-quality, lower-cost care is optimizing team deployment — collaborating with surgical departments on case scheduling, consolidating service locations and reducing downtime. As anesthesia costs increasingly shift to hospitals and ASCs, leaders must balance staffing “needs” versus “wants.” At no point should anesthesia quality be compromised — the stakes are too high.
Katy Dean, CRNA. Chief Nurse Anesthetist at TKM Anesthesia (Newport News, Va.): Balancing quality care with cost pressures requires aligning clinical excellence and operational efficiency. Cost stewardship and patient safety are not competing priorities — they reinforce each other. Through evidence-based practice, workflow optimization and smart resource use, cost savings follow naturally. For example, multimodal anesthesia reduces reliance on any single drug, decreases complications and shortens PACU stays. Standardized ERAS pathways, efficient communication and data-driven collaboration also improve outcomes and financial performance. Safe, individualized care should always come first — efficiency follows.
Alex Gorecki. President of CCI Anesthesia (Pensacola, Fla.): At CCI Anesthesia, cost management and quality care go hand in hand. By empowering clinicians with autonomy, performance metrics and accountable leadership, we foster environments that prioritize patient-centered care. As a family-owned company without private equity investors, our focus remains on patients, clinicians and hospital partners — not shareholders. That independence supports transparency, stability and long-term excellence over short-term financial gains.
Robert Johnstone, MD. Professor of Anesthesiology at West Virginia University (Morgantown): We promote a culture of quality by publicly recognizing clinicians and technicians for their achievements. Cost control is achieved through quick case turnovers and maintaining the right number and mix of anesthesia staff, reallocating team members as needed to sustain efficiency.
Cory Koenig, DO. Vice President of Operations at Providence Anesthesiology Associates (Charlotte, N.C.): Finding creative, cost-effective ways to maintain high-quality anesthesia has become a major challenge. With payer reimbursement declines and staffing shortages, flexibility is essential. Every aspect — from patient screening to OR scheduling — must adapt.
Facilities are implementing cost-control measures through policies that limit use of expensive equipment and drugs when cheaper alternatives exist. Efficiency and communication across multiple sites are key. Ultimately, anesthesia personnel must be used efficiently, and staffing decisions should align with potential revenue benefits of expanded OR capacity.
Evan Lebovitz, MD. Anesthesiologist in Alexandria (Va.): Delivering high-quality care doesn’t conflict with cost efficiency. When safety and outcomes drive decisions, financial value follows. Evidence-based protocols, efficient OR management and thoughtful innovation shorten recovery times, reduce length of stay and improve throughput. Clinical innovation — such as advanced monitoring and multimodal analgesia — enhances both outcomes and efficiency, creating a high-value model for patients and hospitals alike.
Tim McAdams, CRNA. Amnestic Anesthesia (Charleston, S.C.): In a small ASC, accountability is key. Being accurate in billing and mindful of supply use should never compromise care. Safe, effective anesthesia can be delivered while maintaining awareness of time, resources and efficiency.
Kathy Piotrowski, DNP, CRNA. Former Chief CRNA at The Ohio State University Wexner Medical Center (Columbus): At the endoscopy center where I now work, staffing shortages often require contracting with local groups. While this raises labor costs, it ensures cases continue safely under anesthesia providers rather than sedation nurses. Quality of care remains high, though operations can be affected by inconsistent staffing and unfamiliarity with workflows.
Justin Routman, MD. Vice Chair of Anesthesiology & Perioperative Medicine and Division Director of Multispecialty Anesthesiology at UAB Medicine (Birmingham, Ala.): High-quality care and cost control are not opposing goals — they align when systems are well designed. Reducing idle and overtime hours is essential, so resource deployment must be thoughtful. Sometimes that means pooling service lines and focusing limited resources where they yield the greatest value. The most expensive anesthetics are often inefficient ones — unplanned cancellations, late starts or long turnovers. Focusing on patient readiness, workflow efficiency and right-siting cases improves predictability and safety while conserving resources.
Jacob Schaff, MD. Division Chief of Cardiac Anesthesiology at White Plains (N.Y.) Hospital: Balancing cost pressures with quality care depends on system design and culture. The goal isn’t to “do more with less” but to “do better with purpose.” By aligning staffing, scheduling and perioperative workflows, we promote both fiscal responsibility and clinical excellence. Integrating anesthesia into new areas — like perioperative echocardiography and structural heart programs — creates value that benefits patients, providers and institutions alike.
Mark Vojtko, APRN, CRNA. Delta Wave Anesthesia: Simple steps can significantly reduce costs. Labeling supply prices promotes awareness and reduces waste. Reusing leftover materials when appropriate, optimizing needle inventory, avoiding unnecessary high-cost drugs and using spinal anesthesia for certain procedures all save money without sacrificing quality.
Efficiency and thoughtful resource management ensure safe, effective anesthesia care while conserving limited resources.
Zev Wachtel, MD. Anesthesiologist at St. Joseph’s Health (Paterson, N.J.): Anesthesia departments can maintain quality while managing costs by embracing value-based care principles, optimizing operations and leveraging data. Focusing on safety, efficiency and evidence-based protocols maximizes outcomes and reduces waste. Optimizing OR schedules, staffing and block allocations also improves both quality and cost performance, while real-time dashboards and analytics enhance utilization and help prevent burnout.
Balancing standardization with individualized care remains essential, as excessive uniformity can compromise safety. Transitioning to value-based models requires collaboration, accurate data and strong leadership. The key takeaway: financial pressure shouldn’t mean cutting anesthesia budgets. Instead, anesthesia should be viewed as a strategic partner in achieving clinical and operational success.