We find you the real numbers.
Independent anesthesia consulting for hospital leadershipOn the hospital’s side of the table.
The anesthesia group across the table negotiates for a living. We give your leadership team its own model, its own benchmarks and its own advisor, whether your rooms are staffed by physician anesthesiologists, CRNAs, anesthesiologist assistants or all three.
A threat is not a number.
Don’t let an anesthesia group push you into a bigger subsidy without an independent review.
The pattern is familiar: a deadline, a warning about coverage gaps and a line that ends “or we’ll just leave.” Some groups bring it to every renewal, because it works.
Leaving is expensive for a group too. Before you sign, have someone on your side rebuild the numbers, read the contract and build the fallback plan. Then negotiate.
7:30 a.m.
The first case of the day.
Every room, every minute.
Six rooms on the board. One sits empty.
An idle room still costs money.
The clinicians are paid whether a case is running or not.
Four parties at the table.
One of them is on yours.
The subsidy keeps rising. The revenue behind it doesn’t.
- $185,000Average annual subsidy per anesthetizing location, contracts signed in the last three years.1Up 30% from $132,000 in the three years before.
- $66 / minAverage OR revenue per minute in California hospitals, about $4,000 an hour.2Against an average cost of $58 per minute.
- +54%Rise in the cost of one OR minute in California hospitals, FY 2014 to FY 2022.2Every staffed hour costs more than it did.
- +37%Rise in average CRNA pay, May 2019 to May 2025.34$181,040 to $248,320 a year.
- +6%Rise in average anesthesiologist compensation, 2024 to 2025.56$523,277 to $557,131 a year, in one year.
- −8%Change in Medicare’s anesthesia payment per unit, 2019 to 2026.78$22.27 to $20.50. Group revenue falls; subsidy requests rise.
Anesthesiologists, CRNAs and CAAs. Every model, no favorites.
Whoever staffs your operating rooms, the economics work the same way: coverage, collections and the gap between them. We advise hospitals on every arrangement.
- Physician anesthesiologist groups
- Anesthesiologists personally performing each case, one room at a time.
- CRNA groups
- Certified registered nurse anesthetists practicing independently or under surgeon or anesthesiologist supervision, as federal rules and state law allow.
- Care teams with CRNAs and CAAs
- Physician anesthesiologists directing CRNAs or certified anesthesiologist assistants across several rooms at once.
- National management companies
- Large anesthesia companies that staff, bill and manage the department under one contract.
- Hospital-employed departments
- Your own anesthesiologists, CRNAs and CAAs on the hospital payroll, or a hybrid of employed and contracted staff.
Seven services. Each answers one question your board will ask.
- 01
Coverage and subsidy review
“Are we paying the right amount for what we get?”
- 02
Care-team model design
“Is our anesthesiologist, CRNA and AA mix right for our case mix and OR hours?”
- 03
Group RFP and transition
“Should we change groups, and how do we do it without a coverage gap?”
- 04
Contract negotiation support
“What should we accept, and where should we hold firm?”
- 05
Performance monitoring
“Are we getting what the contract promised, quarter by quarter?”
- 06
Hospital-employed anesthesia
“Should we take anesthesia staffing in-house?”
- 07
Anesthesia billing review
“Is the group collecting what the work should earn?”
Savings that don’t cost you coverage.
Pay for the rooms you actually run
Match staffed hours to the hours your rooms are really used.
Price nights and obstetrics on purpose
Round-the-clock coverage is often the largest line in the subsidy.
Pay for the real gap, not a guess
An open-book, rolling subsidy reconciled to what the group actually collects.
Collect what the work earns
Anesthesia-specific billing, because every uncollected dollar comes back as subsidy.
Cap the locum ramp
Don’t fund a new group’s open-ended locum bill.
Price the whole contract, not year one
Test the bid that looks too good to be true.
Three things to catch before a new group walks in.
- Red flag 1
Locums on your tab
A new group asks you to pay for locum coverage for six, twelve or eighteen months while it recruits. With no cap and no milestones, the ramp drains the budget, and the “actual costs” come back as a bigger subsidy.
Read more → - Red flag 2
Savings that look too good to be true
Some bids are built to win the contract, not to run it. The low number arrives first. The request for a larger subsidy arrives once the incumbent is gone, and then another.
Read more → - Red flag 3
Books you cannot see
A subsidy you cannot reconcile is a subsidy you cannot control. We recommend an open-book, rolling subsidy: you see the group’s books, understand its billing and pay for the real gap.
Read more →
Two practicing anesthetists, working for hospital administration.
Fifth Party was founded by two doctorally prepared nurse anesthetists who continue to practice. We understand how an anesthesia department operates from the inside, and we build the financial model alongside your leadership team.
Matthew Harmon
DNP, CRNA, MBA · Co-founder
Dr. Matthew Harmon is a nurse anesthetist and healthcare executive. He has practiced anesthesia at The Medical Center at Bowling Green since 2017, with experience in independent, medically directed and medically supervised practice models. He is founder and chief executive officer of Synesthesia LLC and has held program leadership roles in nurse anesthesia education at three universities.
Full bio →
Zachary Stewart
DNAP, CRNA · Co-founder
Dr. Zachary Stewart is a nurse anesthetist and operations executive. He has practiced anesthesia at The Medical Center at Bowling Green since 2018, where he coordinates the clinical education of resident nurse anesthetists. He is chief operating officer of Synesthesia LLC, where he leads business operations and software development, and lead consultant for its accreditation practice.
Full bio →
Decision first. Evidence behind it.
- Step 1
Listen
A 30-minute call with your leadership team.
- Step 2
Measure
We build the model from your own OR, billing and contract data.
- Step 3
Decide
Options, trade-offs and one clear recommendation.
- Step 4
Deliver
Negotiation, RFP or transition support through signature.
Your next anesthesia contract starts before the group’s letter arrives.
Confidential. No obligation. For hospital and health-system leaders.
Sources
- 1Enhance Healthcare Consulting, “Anesthesia Subsidies: Putting It All on the Table,” first published September 2022, updated July 2025. Database of 120+ hospitals.
- 2Ashrafi, Maggard-Gibbons, Childers. “Costs, Charges, and Revenue of Hospital Operating Rooms in California.” JAMA Surgery, July 2026. 278 California hospitals, FY 2022.
- 3U.S. Bureau of Labor Statistics, “Occupational Employment and Wages, May 2019: 29-1151 Nurse Anesthetists.” Annual mean wage.
- 4U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025 national estimates, nurse anesthetists. Annual mean wage.
- 5Doximity, “Doximity 2025 Physician Compensation Report,” July 2025. Average anesthesiology compensation, 2024.
- 6Doximity, “Doximity 2026 Physician Compensation Report,” August 2026. Average anesthesiology compensation, 2025.
- 7Centers for Medicare & Medicaid Services, CY 2019 Physician Fee Schedule final rule, Federal Register, November 2018. Anesthesia conversion factor $22.2730.
- 8Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, Federal Register, November 2025. Anesthesia conversion factor $20.4976 for most clinicians.