Becker’s ASC Review
Anesthesiology is heading into a pivotal year, as workforce volatility, reimbursement pressure and policy shifts collide with rising surgical demand and expanding outpatient care.
After a period of partial stabilization, leaders say the structural forces reshaping how anesthesia is staffed, paid and deployed are intensifying, with direct implications for hospitals, ASCs and perioperative access. Five disruptions in particular are poised to reshape anesthesia care delivery in 2026:
1. Physician employment is making the anesthesia workforce more transient and less predictable: As physician employment and locums use expand, anesthesia leaders say workforce instability is increasingly driven by structural shifts rather than clinical shortages. Anesthesia groups are navigating a growing mix of employed roles, stipend-supported contracts, hourly arrangements and exclusive facility agreements, creating more complex compensation and staffing models than in prior independent practice structures.
Leaders say the move toward employment has made the anesthesia workforce more mobile, allowing providers to leave positions with shorter notice and disrupting regional coverage patterns. They also warned employed models can accelerate burnout and attrition when physicians have less control over workload intensity. Heading into 2026, leaders expect workforce transience, not just provider supply, to remain a central challenge shaping coverage reliability, recruitment costs and long-term sustainability.
2. Reimbursement compression collides with rising labor and subsidy costs: Anesthesia practices are facing some of the steepest reimbursement pressure in healthcare, driven by years of CMS cuts, tighter payer policies and new federal rules. Average professional anesthesia reimbursement has fallen since 2019, with Medicare rates following the same downward trajectory, even as demand for services and labor costs continue to rise.
The financial squeeze intensified in 2025 with CMS finalizing a cut to the anesthesia conversion factor, while commercial payers increased denials, bundled previously billable services and pulled back payments through reprocessing and modifier disputes. These pressures are accelerating subsidy growth for hospitals and ASCs and leaving some anesthesia groups and facilities, particularly smaller and rural operations, struggling to sustain coverage and remain financially viable heading into 2026.
3. Legislative and regulatory shifts add new uncertainty to anesthesia operations: From reimbursement rules to scope-of-practice debates, a growing wave of state and federal legislation is reshaping the anesthesia landscape and adding operational complexity for providers. In 2025, multiple states introduced or passed bills addressing anesthesia time limits, with some lawmakers moving to ban insurer-imposed caps on anesthesia coverage while others proposed language that would allow time limits to be imposed.
At the same time, scope-of-practice legislation continues to evolve. Federal lawmakers introduced bills that would allow anesthesiologists and CRNAs to provide anesthesia autonomously at the Veterans Health Administration, while several states advanced proposals affecting CRNA and certified anesthesiologist assistant practice authority. Heading into 2026, anesthesia leaders expect continued policy volatility, requiring close monitoring of legislative changes that can directly affect coverage models, reimbursement and workforce deployment.
4. ASC growth is increasingly constrained by anesthesia capacity, not demand: For ASC leaders, anesthesia has become one of the most consequential limits on growth. Persistent shortages of anesthesiologists and CRNAs, driven by rising surgical demand and training bottlenecks, continue to strain coverage, particularly in rural and hard-to-staff markets. At the same time, reimbursement declines and rising labor costs are pushing more ASCs toward stipends, forcing difficult tradeoffs between expansion, staffing models and financial sustainability.
Heading into 2026, leaders expect anesthesia availability to remain the defining constraint on ASC capacity, making site selection, coverage strategy and OR efficiency critical to maintaining access and viability.
5. Control of perioperative operations is shifting toward anesthesia-led models: Anesthesia leaders say 2026 will accelerate a break from surgeon-driven scheduling and legacy coverage models as workforce pressure and margin compression intensify. They point to a shift toward anesthesia-led scheduling, flexible staffing structures and AI-supported tools that align coverage with real-time OR capacity, rather than individual surgeon preference.
At the same time, anesthesia’s role is expanding beyond intraoperative coverage into preoperative optimization, multimodal and regional-first care and team-based workforce redesign. Heading into 2026, leaders expect this redistribution of control and responsibility to fundamentally reshape how hospitals and ASCs plan throughput, staffing and surgical growth.