As ophthalmic ASCs navigate staffing shortages, reimbursement pressures, and rising expectations around patient experience, anesthesia has emerged as one of the most strategically important components of surgical operations. At the Outpatient Ophthalmic Surgery Society’s “OOSS Perspective 2026” symposium in Washington, DC, a panel discussion titled, “Anesthesia Services: Models, Challenges, and Solutions,” explored how ASCs can build sustainable anesthesia programs while maintaining quality, efficiency, and financial viability.
Panelists William Wiley, MD, Diana Buck, RN, BSN, CNOR, Nikki Hurley, RN, MBA, and Ami Grube, and moderator Todd Albertz, CASC, acknowledged the growing role of certified registered nurse anesthetists (CRNAs) in outpatient surgery centers. Panelists challenged longstanding assumptions that anesthesiologists are inherently necessary for routine ophthalmic procedures, noting that many ASCs have successfully transitioned to CRNA-led models without compromising patient outcomes. Several speakers argued that CRNAs often provide a level of patient engagement and attentiveness that aligns particularly well with the needs of cataract and other ophthalmic patients, and they are well suited to fast-paced ophthalmology clinics.
Financial Considerations
The conversation also addressed reimbursement misconceptions. Although some payers may offer modest payment differentials between anesthesiologists and CRNAs, the panelists emphasized that anesthesia reimbursement is generally tied to the same billing codes regardless of provider type. The more significant distinction lies in compensation costs.
“CRNAs are a much more economical option in the ophthalmology ASC for sure,” while still delivering comparable care, said Ami Grube, chief financial officer of Aurora, Colorado–based practice CPR Anesthesia, Inc.
As for provider pay, panelists distinguished between subsidies, which cover revenue shortfalls against a guaranteed compensation target, and stipends, which are fixed payments provided in exchange for coverage or availability. Speakers acknowledged that requests for both arrangements are becoming increasingly common as anesthesia providers gain leverage in a competitive labor market. Ophthalmology centers are competing not only with one another for providers but also with higher-revenue specialties such as orthopedics. Private-equity-backed organizations and aggressive recruitment practices have further intensified compensation pressures.
Employment Models
The panel also discussed the 3 primary anesthesia delivery models being adopted across the ASC landscape: employed providers, contracted providers, and hybrid partnership arrangements. For centers considering direct employment, Nikki Hurley, RN, MBA, director of surgical services at Key-Whitman Eye Center in Dallas, described a model built around recruiting multiple CRNAs and creating internal staffing flexibility. She noted that advantages include continuity of care, scheduling consistency, and the opportunity to capture professional fees when providers are employed through the practice.
“The biggest advantage of it, with physician reimbursement cuts in the clinic: We're employing [CRNAs] on the clinic side because we're collecting that professional fee,” said Hurley. “That’s infusing another $300,000 to $400,000 into your clinic each year.”
Patients may also benefit from seeing the same anesthesia provider during sequential eye surgeries, helping reduce anxiety and improve the overall experience, she said. However, direct employment places scheduling responsibilities squarely on the ASC, requiring careful coordination to avoid paying guaranteed hours on days when cases are unexpectedly cancelled.
Diana Buck, RN, BSN, CNOR, nurse consultant with Medical Consulting Group in Springfield, Missouri, discussed the contracted-provider model, which remains common among ASCs. In this approach, ASCs typically partner exclusively with an anesthesia group. Buck encouraged administrators to evaluate not only provider availability but also the broader value an anesthesia group can deliver. Beyond case coverage, strong partners can assist with policy reviews, emergency preparedness drills, code cart management, and other operational responsibilities. She emphasized the importance of consistency, encouraging centers to negotiate for recurring provider assignments whenever possible to strengthen team familiarity and workflow efficiency. Buck also observed that some facilities that once insisted on anesthesiologist-only coverage have successfully transitioned to CRNA groups without experiencing any decline in quality of care.
The panel also explored emerging hybrid partnership models. In some cases, anesthesia groups are becoming equity partners in ASCs or taking on broader leadership responsibilities through medical directorship roles. Advocates of these arrangements cited improved continuity, long-term commitment, and more reliable staffing coverage. At the same time, speakers cautioned attendees to work closely with legal counsel when structuring such relationships.
To address growing staffing shortages, panelists also noted growing interest in RN-based sedation models. These approaches may be particularly useful when anesthesia coverage is unavailable due to call-offs or workforce shortages. However, speakers emphasized that such models require careful attention to state regulations, credentialing requirements, sedation training, and competency assessments.
Supervision Requirements
Regulatory and liability considerations must be addressed regarding CRNA supervision. Panelists stressed that many surgeons misunderstand the nature of supervision requirements. According to the panelists, CMS supervision provisions are primarily billing-related conditions of coverage rather than licensure or malpractice mandates. In practical terms, surgeons are already performing many of the required activities, including assessing patients before surgery and confirming readiness for discharge afterward. Speakers emphasized that CRNAs should maintain their own professional liability coverage and remain responsible for anesthesia management within their scope of practice.
Conclusion
Anesthesia has become a strategic business issue that influences staffing, scheduling, patient experience, and financial performance in the ophthalmic ASC. For ASCs seeking long-term stability, the panelists agreed that success will depend on understanding the full range of anesthesia delivery models and choosing the approach that best aligns with each organization’s goals and resources. OASC