Becker’s ASC Review
Fifteen anesthesia leaders — anesthesiologists and certified registered nurse anesthetists — recently joined Becker’s to discuss the future of anesthesia.
Question: If you had to describe the future of anesthesia in one word, what would it be?
Editor’s note: Responses were edited lightly for clarity and length.
Aaron Chyfetz, MD. Assistant Professor of Medicine at Montefiore Health System (New York City): Mutualistic. Anesthesia is going to have to work with the hospital and surgeons to optimize patient care and results. I also predict there will be some ethics and administrative component to healthcare delivery preventing futile care and procedures.
Corey Collins, DO. Medical Director at Anesthesia Consults of Massachusetts (Boston): Unsustainable. Salaries for anesthesiologists and CRNA are increasing at a pace that is unsustainable based on decreasing reimbursement. This will create a need for the dramatic shift in service delivery. Insurers have tried already to change the landscape (e.g. endoscopy, fixed fees based on procedure codes) but it will likely be the healthcare systems that implement these changes.
Robert Fabich, DNP. CRNA at SSM Healthcare of Oklahoma (Edmond): Complicated, because there are multiple issues facing the field. These include policy and scope questions for CRNAs nationwide and other policy debates facing the field of anesthesia. Additionally, there is a risk of decreasing reimbursements, more demands on anesthesia within systems and an ever-looming provider shortage. We will also see an increasing rise in technological advancements in healthcare, like AI integration, that have yet to be seen in how they will genuinely affect anesthesia practice.
Marco Fernandez, MD. Anesthesiologist at Chicago Anesthesia Leaders: Opportunity. Most have a tendency to be very reactive and address problems as they come up. We have built a culture in our organization to see problems as opportunities. We look for opportunities to add to our value proposition. This approach allows us to be proactive in the relationships with our nursing and surgical colleagues.
Chris Hackney, MD. Anesthesiologist at Emory Specialty Associates Anesthesia (Johns Creek, Ga.): Change. Throughout healthcare, we have seen demonstrable changes to the way physicians are managed and how they practice. Anesthesia is no exception, given the influx of private equity and the loss of private anesthesia practices. But with an aging workforce of anesthesiologists and limited number of graduating residents, there will need to be change in order to meet the demands of the expanding surgery schedules of hospitals and outpatient surgery centers.
Matthew Hulse, MD. Chief of the Division of Critical Care Medicine at Medical University of South Carolina (Charleston): Adaptive. No other medical specialty works more closely with technological innovations than anesthesiology. The field is evolving rapidly in response to advancements in AI-driven monitoring, automation and novel drug delivery systems. At the same time, workforce dynamics and healthcare economics are shifting, requiring us to rethink care models. The key to the future of anesthesia is adaptability — leveraging these changes to enhance patient safety, optimize perioperative outcomes and improve efficiency across diverse practice settings.
Christopher Hoeman, MSN. CEO of ICON Anesthesia of New England (Middleton, Mass.): Transparency. I feel that transparency is a direct goal in communicating with the centers constantly. All of our ICON Anesthesia contracts are designed to be non-punitive. Those centers where a subsidy is needed we share our expenses and returns in an effort to build trust and cooperation to make necessary changes where possible within the system. It cannot be where one side demands at the expense of the other without some level of transparency.
We have about three to five years before there is a more stable anesthesia market for staffing, but that won’t change the relationship that is demanded between the ASC and anesthesia.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children’s: Adaptive. With evolving technology, workforce dynamics and shifting care models anesthesia will continue to transform to meet patient and system needs.
Cory Koenig, DO. Vice President of Operations at Providence Anesthesiology Associates (Charlotte, N.C.): Uncertainty. Where should we start to break it down further? Staffing shortages, rampant increases in staffing costs, burnout, workforce shifts to 1099 and locums work, vertical integration by insurers and large healthcare systems and more layers of administrators and increasing red tape. At the same time, we have decreasing reimbursements by CMS, commercial payers not being held accountable by anyone and the No Surprises Act implementation failures.
From an employment perspective, private equity and hospital employment remain challenges to private practice groups. Worsening payer mixes, increased out of OR anesthesia requirements and ever increasing poor efficiency and OR utilization by facilities add to the problems on a day-to-day basis. It seems to be continuing to approach a tipping point for many in our field. I actually don’t think we are alone as a specialty. Most data and surveys would show that a vast majority of physicians would not advise our youth to pursue medicine which is very sad for a once well-respected career.
John Kezele, MSN. CRNA at Franklin County Medical Center (Preston, Idaho): Vulnerable. A recent example of the games insurance companies are playing to cut costs is Anthem Blue Cross Blue Shield reversed its plan to limit anesthesia payments in certain states, had it not been for the tremendous pushback by many in opposition. The explanation by the company for why was lame and pathetic to say the least.
This kind of disconnect between payers, patients and providers appears to be increasing and is one reason I see the future of anesthesia services as we now know it to be vulnerable to similar misguided policy or attacks. The time I spend chasing the revenue cycle issues with payers is discouraging.
I have personally seen reimbursement go down, especially in the last 5 years. Not a single company has offered a payment increase. If I go asking, I get ignored. In the case of CMS reimbursement, current payments are on par with 2011 actual payments. 2011 CMS anesthesia conversion factors for my State of Idaho was $20.17 and for 2025 $19.30. Yet anesthesia provider wages are up 45% since 2011. The cost to process anesthesia billing and credentialing has gone up in a similar fashion.
There is a principle called “cost shifting” where big insurance companies pay 3-5 times CMS rates. These rates are needed to help anesthesia practices stay afloat. Some cost shifting has been placed upon the surgical facilities to make up the difference. CMS’ own studies claim it isn’t happening because of their low reimbursement. I question their data.
Julie Staczek-Marx, MSN, CRNA. Federal Political Director for the Michigan Association of Nurse Anesthetists: Adaptive. CRNAs deliver over 50 million anesthetics annually and serve as the primary anesthesia providers in 80% of rural communities and health systems. Their ability to continuously adjust and adapt is critical to increasing access to safe, efficient anesthesia care where it is most needed.
CRNAs adapt to provide independent coverage in states that have exercised the federal opt-out, ensuring anesthesia services in OB departments, freestanding ASCs, dental offices, GI suites, IVF clinics, plastic/cosmetic surgery offices and critical access hospitals. In Michigan, where 80% of the state is rural, health systems rely on the adaptive, skillful, and efficient care of independent CRNAs.
CRNAs also navigate legislative and reimbursement variations, particularly with Medicaid, Medicare and private insurance. However, they now face open discrimination from certain private insurers, such as Anthem BCBS, Cigna and Medical Mutual who reimburse CRNAs 15% less for anesthesia services solely based on their licensure as “nurse” anesthesiologist — a blatant disregard for their expertise and contributions.
The adaptive nature of CRNAs was especially evident during the COVID-19 crisis, when the CMS temporarily lifted supervision requirements, allowing CRNAs to practice at their full scope without unnecessary barriers. Anticipating workforce challenges, CRNA educational programs proactively expanded, adding 14 new programs nationwide and graduating over 3,000 doctoral-prepared CRNAs annually, a testament to the forward-thinking, adaptive nature of the profession. CRNAs are essential, highly skilled and adaptive professionals, ensuring patients in both rural and urban areas receive safe, high-quality anesthesia care, no matter the challenges they face.
Samuel Smith, MSN. CRNA at Richmond (Va.) VA Medical Center: Value. As healthcare systems push for more value-driven care, CRNAs will play a key role in optimizing the perioperative experience for patients and key stakeholders. Utilizing technology such as AI and pharmacogenomics to achieve these aims are being prototyped across health systems now, and it is imperative we remain agile as providers to incorporate these efforts as they prove cost-efficient. As anesthesia experts with the ability to function without anesthesiologist supervision, CRNAs can drive the conversation in the C-suite about the most cost-effective and safe anesthesia care model, one where we work in parallel with our physician colleagues.
Ron Tharp. CRNA at Akron (Ohio) Children’s Hospital: I would describe the future of anesthesia as promising due to advancements in technology (ultrasound, better high-quality video laryngoscopes), newer and safer medications (Suggamadex, Precedex). Additionally, advances in surgical techniques and patient monitoring all are promising in that it improves patient safety and outcomes.
Jeff Tieder, MSN, CRNA. Clinical Assistant Professor at the University of Tennessee at Chattanooga: Efficiency. As anesthesia providers, we must continually enhance the level of service we provide to patients, surgeons, hospitals and surgery centers. This means a reduction in opioid use and increase in regional anesthesia techniques.
Reuben Wechsler, MD. Anesthesiologist at Wellstar MCG Health (Kennesaw, Ga.): Challenging. More than 2,200 anesthesiologists retired in 2022. Between that and natural attrition due to an aging population, we will not be able to fill that hole for years. The workforce is aging, and the inability to fill the shortfall created by COVID-19, because we don’t graduate enough anesthesiologists per year, makes it difficult to envision how we can evolve. Literature recommends older practitioners should cut back if they wish to keep working, but in the real world are rarely allowed to, which forces them to retire because of the stress created, and for safety’s sake. This of course adds to the shortage. A true catch-22.