Savings
Where hospitals save on anesthesia
Most anesthesia savings do not come from cutting pay or coverage. They come from paying for the coverage you use, collecting what the work earns and signing contracts that don’t reset upward every renewal.
These are the twelve places we look first. Each applies whether your rooms are covered by a physician anesthesiologist group, a CRNA group, a care team with CAAs, a national company or your own staff.
The examples below are illustrative arithmetic with round numbers, not client results or benchmarks. Every hospital’s numbers are different. That is why we build the model from yours.
Pay for the rooms you actually run
Coverage grids drift. Rooms stay staffed until five that empty out by two. Off-site locations are covered all day for a handful of cases.
What we do. We line up staffed hours against used hours, by location and hour, from your own OR data. Then we show which sites could be consolidated, flexed or moved to a different schedule without hurting access.
Coverage and subsidy review →Match the care team to the case mix
Many hospitals inherit a staffing ratio from their group and never see the arithmetic behind it. The mix of physician anesthesiologists, CRNAs and anesthesiologist assistants decides how many clinicians you pay for.
What we do. We model two or three care-team options from your case mix, acuity, obstetric and trauma needs and state scope-of-practice rules, with the cost and the trade-offs of each. We favor no profession.
Care team models explained →Price nights and obstetrics on purpose
Labor floors, trauma and emergency surgery need someone available at all hours, whatever the volume. That coverage is usually bundled into one subsidy number, so nobody sees what it costs or whether its structure still fits the delivery volume.
What we do. We price in-house and home call separately in the coverage grid, compare obstetric coverage models against your delivery volume and your state’s rules, and write response times into the contract.
Obstetric anesthesia coverage →Match coverage to the procedure, outside the OR
Anesthesia outside the operating room often runs by habit: short cases, scattered rooms and schedules set by each proceduralist. Those sites cost more per billable hour than the main OR.
What we do. We map every site outside the OR by hour and case type, then help your medical staff and anesthesia leaders decide where anesthesia care is needed, where your sedation policy applies and which sites can share rooms and schedules.
Anesthesia outside the OR →Pay for the real gap, not a guess
A fixed stipend set at renewal is a forecast. If collections beat the forecast, the hospital never sees it. If they miss, the group asks for more.
What we do. We help you move to an open-book, rolling subsidy: an agreed budget, the group’s books open to you, and periodic reconciliation against actual collections and actual coverage, with incentives that keep the group billing well.
The open-book anesthesia subsidy →Collect what the work earns
Anesthesia is billed in base units, time units and modifiers that general medical billing often gets wrong. Under a subsidy, what the group fails to collect tends to come back to you as a request.
What we do. We review the group’s billing and collections against your own case and time data: units per case, payer mix, denials, charge lag and medical direction documentation.
Anesthesia billing review →Look at the rates, not just the subsidy
Two groups doing the same work can be paid very differently by commercial insurers. Weak rates show up as a bigger subsidy request.
What we do. We show how much of the group’s shortfall comes from its commercial rates and payer mix, so leadership can see whether part of the answer sits with payers rather than with the hospital’s budget.
What to ask about anesthesia billing →Cap the locum ramp
A new group asks the hospital to pay for locum coverage until it is fully staffed. With no cap, no end date and no milestones, the ramp runs long and the costs become the case for a larger subsidy.
What we do. We write the ramp into the deal: a recruiting plan by role, a declining cap on locum funding, pass-through at cost with invoices, monthly reporting and credits for missed milestones.
New group asking you to fund locums? →Price the whole contract, not year one
Some bids are built to win the contract, not to run it. A low first-year number is followed by a request for more once the incumbent is gone and your fallback has disappeared.
What we do. We rebuild each bid’s math: collections by payer, staffing by role, pay against the market, locum assumptions, escalators and reopeners. Then we compare bids over the whole term, not the first year.
Proposals that look too good to be true →Phase it, don’t just pay it
Subsidy requests arrive with a deadline, a warning about coverage and, sometimes, “or we’ll leave.” Paying in full on day one sets the floor for the next renewal.
What we do. We test the request line by line, then structure any increase against coverage delivered and staffing milestones, with a shorter term and a reopener.
Review the request before you say yes →Don’t pay for coverage you didn’t get
Many agreements promise coverage in general terms. When a room goes unstaffed or first cases start late, the subsidy stays the same.
What we do. We turn coverage into an exhibit: every location, its hours and its call, with reporting and a credit for each unstaffed room-day. Then we track it quarter by quarter.
Performance monitoring →Employ where it pays
A contracted group’s price includes its management, overhead and margin. For some hospitals, employing the anesthesia team, or part of it, costs less. For others it adds risk they don’t need.
What we do. We model employed, contracted and hybrid options side by side, including recruiting, benefits, malpractice, billing and leadership, and plan the transition if the numbers support it.
Hospital-employed anesthesia →Your next anesthesia contract starts before the group’s letter arrives.
Book a 30-minute callSources
- 1Nathan Kaufman, “Nathan Kaufman: Hospital-based anesthesia and radiology operate in a broken financial model,” HFMA, January 2026.
- 2Richard H. Epstein and Franklin Dexter, “Influence of Supervision Ratios by Anesthesiologists on First-Case Starts and Critical Portions of Anesthetics,” Anesthesiology, March 2012.