Anesthesia costs squeeze ASCs as staffing shortages, reimbursement gaps widen

Editor's Note

Ambulatory surgery centers (ASCs) continue to face a mounting anesthesia crisis: costs are rising, staffing is tightening, and reimbursement is failing to keep pace. Anesthesia payments have dropped 8.2% over the past decade, while provider salaries have risen by as much as 40%, creating a growing financial burden on ASCs, Ambulatory Surgery Center News July 8 reports.

According to the outlet, a modest 2.25% CMS reimbursement bump is expected in September. However, an expert quoted—Randy Quinn, chief compliance officer and chief integration officer at Guide Anesthesia, cautioned it will not meaningfully offset long-term financial pressure. Meanwhile, the American Medical Association projects a 30% reduction in anesthesiologists by 2033 and a shortage of nearly 8,000 CRNAs by 2028. Quinn believes the situation is worse than those forecasts suggest, citing rapidly increasing procedure volume and over 200 CRNA job postings in Arizona alone.

To cope, ASC leaders need a firm grasp of anesthesia billing. As explained in the article, revenue depends not on long, complex procedures, but on shorter cases that can be performed in greater volume. A quick procedure like an umbilical hernia repair might bring in $180 under Medicare or $630 from a commercial payer, depending on contracted rates. As Quinn noted, “You can do five Medicare cases and still not make what you would on a single commercial case.”

Stipends, once rare, are becoming essential. Guide Anesthesia did not historically require them, but the outlet notes that model is no longer sustainable. Quinn urged ASC leaders to explore flat-rate and collection-based stipend structures and be prepared to adapt as staffing costs rise and reimbursement stagnates. Quinn also emphasized that surgeons must use their full block time and minimize room turnover delays and cancellations. Missed or underutilized cases quickly erode financial performance.

In Arizona, CRNAs can legally practice without supervision. Quinn reminded ASC leaders that concerns about surgeon liability are largely unfounded due to the state's physician immunity clause. The article further outlines various anesthesia staffing models, from physician-only (most expensive) to CRNA-only (least), each with different cost implications. With solo anesthesia providers declining, ASCs are increasingly contracting with larger groups, but those come with more administrative overhead and complex contract terms. Quinn advised including clear expectations, exit clauses, and regular contract reviews.