Anesthesia plays a critical role in ASCs, particularly as anesthesia challenges continue to rise across the healthcare ecosystem.
Here are the top five mistakes in ASC and anesthesia partnerships, according to leaders:
1. View anesthesia as a service, not a partner
A common and costly error is treating anesthesia as a “plug-and-play” service rather than a clinical and operational partner, Megan Friedman, DO, anesthesiologist and Director of Pacific Coast Anesthesia Consultants, told Becker’s.
“Not all anesthesia groups bring the same level of quality, alignment or engagement,” she said.
Luc Corriveau, CRNA, chief nurse anesthetist at Androscoggin Valley Hospital in Gorham, N.H., echoed that sentiment.
“A common and costly mistake is hiring an anesthesia group simply to fill a slot, treating it like hiring a body to administer anesthesia for the day rather than securing a well-managed anesthesia service,” he said. “Anesthesia should be viewed as a strategic clinical partner, not a line-item expense. When you reduce it to ‘just coverage,’ you forfeit leadership, quality oversight and operational value that come from a fully engaged anesthesia team.
These problems are especially common when groups are selected based solely on cost.
“This mindset can result in transactional relationships focused only on price, rather than collaborative efforts to improve quality, efficiency and patient outcomes,” said Vijay Sudheendra, MD, president of Narragansett Bay Anesthesia in Providence, R.I. “Strong anesthesia partners bring leadership, analytics and innovation — qualities often overlooked when decisions are made solely on price or coverage.”
2. Failing to align anesthesia with the ASC model
Many anesthesiologists come from hospital-based training, which doesn’t always translate to the more efficient, fast-paced ASC setting.
“While ASCs often cater to surgeons to improve their experience compared to the local hospital, today there is an increasing need to maximize their OR utilization,” Eric Callan, CRNA, CEO of Memphis, Tenn.-based LifeLinc Anesthesia, told Becker’s “This leads to less surgeon convenience in terms of guaranteed work times that are best for the surgeons.”
George Anastasian, MD, chief of anesthesiology at White Plains (N.Y.) Hospital, emphasized the importance of connection to the community in the ASC setting.
“There is a certain level of pride, connectivity and extra care taken when you are providing anesthesia and perioperative care to outpatients who reside in your own local community,” he said.
3. Blindly trusting big anesthesia groups
Not all large, private equity-backed anesthesia groups live up to their promises, some leaders warned.
“Another misstep is trusting large private equity-backed groups that overpromise and underdeliver,” Mr. Corriveau said. “Many of these groups are more focused on meeting quarterly projections than on building a reliable, lasting partnership with the ASC or supporting the local community. They often lack the staff to follow through on their commitments, which can erode trust and compromise performance.”
4. Underestimating the financial realities
Anesthesia reimbursement is evolving — and not always in ways ASC leaders anticipate.
“Many ASC leaders fail to understand the evolving financial model of anesthesia services fully,” Mr. Sudheendra continued. “With a growing proportion of Medicare patients and decreasing anesthesia reimbursement rates, especially from Medicare, ASCs often do not account for the fact that anesthesia reimbursement may only cover a fraction of provider costs. This leads to financial shortfalls and the need for direct subsidies from the ASC or its physician owners.
“Leaders who ignore this shift or believe switching anesthesia groups will solve the problem often face repeated operational disruptions and strained relationships,” he said.
5. Ongoing communication
One of the most overlooked components of a successful ASC-anesthesia relationship is regular, structured communication.
“One of the most critical and often overlooked components of a successful ASC-anesthesia partnership is clear, ongoing communication,” said Jeffrey Tieder, MSN, CRNA, clinical assistant professor at the University of Tennessee at Chattanooga. “ASC leaders and anesthesia providers must work collaboratively to define appropriate patient selection criteria, ensuring alignment on which patients are safe and suitable for the outpatient setting. Without clear boundaries, anesthesia teams may face last-minute surprises or unsafe situations, leading to case cancellations or unexpected transfers to the hospital — outcomes that are frustrating, costly and potentially damaging to the ASC’s reputation. Continued dialogue around case complexity, comorbidities and escalation protocols is essential to minimize disruption and ensure a smooth, efficient workflow that prioritizes patient safety.”
Ms. Friedman added that anesthesia leaders should be involved early in key operational decisions.
“Anesthesiologists have a unique, systemwide view of workflow and patient flow — excluding them from these conversations limits the ASCs ability to run efficiently and grow sustainably. Strong anesthesia partnerships start with shared goals, open communication and mutual respect,” she said.
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