Anesthesia providers are closely eyeing the future of the ASC industry as it is increasingly consolidated by national management services organizations, hospitals and health systems and private equity groups.
Three leaders in anesthesia joined Becker’s to share their thoughts on how the increased consolidation of ASCs will impact anesthesia providers and practices.
Editor’s note: Responses have been lightly edited for clarity and length.
Megan Friedman, DO. Anesthesiologist and Director of Pacific Coast Anesthesia Consultants (Los Angeles): Consolidation is the dominant trend in the ASC space today, largely driven by rising labor costs, supply chain disruptions and mounting pressure on reimbursement. For many centers, partnering with health systems or national platforms appears to be a practical response to financial and operational complexity.
But over time, the limitations of many large-scale models have become increasingly clear. Cost savings are typically achieved through staffing cuts, rigid protocols, and centralized control — often at the expense of quality and operational flexibility. In anesthesiology specifically, we have seen national groups take over contracts, reduce coverage to bare minimums, and struggle to recruit or retain experienced clinicians. When that model inevitably breaks down, facilities are forced to pay inflated rates or bring in emergency coverage just to keep rooms open — wiping out any supposed savings and destabilizing care.
Independent, physician-led anesthesia groups offer a different path. They are not driven by investor returns or corporate mandates. We are focused on reliability, adaptability and aligning with the long-term goals of each ASC and hospital partner. That flexibility and accountability becomes especially important when surgical schedules are full and every room matters.
Anesthesia departments also bring a unique operational perspective that has been underutilized until recently. While surgeons typically focus on their own service lines, anesthesiologists work across all specialties and are embedded in day-to-day operations. Involving anesthesia leadership in planning — whether for case flow, staffing models or efficiency strategies — often reveals systemwide improvements that might otherwise be missed. This collaboration is no longer optional in today’s climate.
Consolidation is not going away — but as the ASC space matures, there will be a growing distinction between thoughtful integration and margin-driven rollups. The most successful models will be those that invest in clinical infrastructure, maintain local agility and value true partnership — especially with anesthesia departments.
Over the next five years, we will likely continue to see consolidation — but with a more strategic focus. Transactions will become increasingly selective, aimed at creating synergy, expanding service lines, and integrating care across the continuum. ASCs that demonstrate strong clinical outcomes, operational efficiency and physician alignment will be best positioned — whether they choose to remain independent or enter into a partnership.
Narasimhan “Sim” Jagannathan, MD. Professor at the University of Arizona College of Medicine in Phoenix, Division Chief of Anesthesiology at Phoenix Children’s Hospital: Over the next five years, mergers and acquisitions will continue to reshape the ASC landscape, with anesthesia groups under growing pressure to scale or affiliate. As health systems and private equity firms acquire ASCs, they will favor anesthesia partners who can demonstrate consistency, efficiency, and alignment with broader operational goals. This may lead to fewer but larger anesthesia groups, with centralized management and standardized protocols. While this can drive efficiency, it risks diminishing provider flexibility and engagement. Groups that can offer tailored, high-quality care while navigating this consolidation trend will be best positioned to thrive.
Brett Maxfield, CRNA. Director of Anesthesia and Surgical Services at Teton Valley Health Care (Driggs, Idaho): Acquisitions and mergers will definitely change the landscape of the ASC world going forward. Based on several encounters I have personally had, I think many hospitals and hospital systems are realizing that they may have made an error during the pandemic era decision-making, and are now realizing that letting some of the lower performing specialties leave the hospital didn’t hurt their bottom line from a revenue generation standpoint, but it did hurt their bottom line in terms of loss of staff and especially loss of anesthesia providers. I think you’ll see several hospital systems actively pursuing opportunities within the ASC market to try to bring some of that revenue and cost savings back in house over the next few years.
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