Issue 003 · Tuesday, March 17, 2026 · OR Edge Morning Report

Good Morning,

Two weeks ago, we discussed the pre-op call and the 4-minute protocol that prevents same-day cancellations.

Last week, we covered the revenue math behind preventable cancellations and what the corrected numbers actually look like when you run them against a real ASC baseline.

This week, we move upstream! Before a patient ever reaches your pre-op suite, before the pre-op call happens, before the schedule gets built, someone has to be available to provide anesthesia. And for a growing number of independent ASCs in 2026, that someone is increasingly hard to find, harder to keep, and more expensive than your current contract anticipated.

Let's get into it!

Your CRNA Just Retired. Now What? A Survival Guide for ASC Anesthesia Coverage in 2026

Here is the scenario that keeps independent ASCs administrators awake at night.

Your CRNA of 20 years gives you notice. They're retiring, and they've earned it. You thank them, celebrate their service, and then, sitting at your desk, you realize: you have no succession plan.

You post the position. You call agencies. You work your network. Weeks become months. Cases get compressed. Surgeons start asking questions. Your best pre-op nurse is fielding calls she was never trained to handle.

This is not a hypothetical.

A case study in Becker's ASC Review last year detailed this very scenario at an ASC in Yakima, Washington. Their CRNA, with 20 years of service, retired in April 2025. After a year of active recruitment, they were still unable to find a replacement. Their solution? They restructured their entire sedation model from the ground up, not as a first choice, but as the only viable option.

That story was published as a single case study. The data suggests it belongs in a trend report.

Per VMG Health's October 2025 survey of 97 ASC leaders, 67% cited anesthesia coverage as a top-three financial challenge for 2026, the number-one operational concern for the second consecutive year. [1] The share of ASCs expecting to pay anesthesia stipends above billing revenue jumped from 28% in 2024 to 44% in 2025. [1] That is not a staffing blip. That is a structural shift.

The numbers behind the crisis

The stipend pressure tells the same story from a different angle. According to CMS, the anesthesia conversion factor was cut by 2.83% for 2025, further widening the gap between what payers reimburse and what it costs to recruit and retain providers. [2] On the supply side, the American Association of Nurse Anesthetists projects a shortage of approximately 12,500 anesthesia providers by 2033. Average CRNA compensation climbed from $181,000 to $232,000 between 2018 and 2024, a 28% increase in six years, driven entirely by demand outpacing supply. [3]

The math is structural, not cyclical. Demand is rising. Supply is constrained. Costs are climbing. Reimbursement is flat. And independent ASCs are operating without a hospital system's recruiting infrastructure, compensation flexibility, or backup coverage pool, and are absorbing this pressure alone.

What this means operationally for your ASC

The ASCs successfully navigating this crisis aren't those with the largest recruiting budgets; they're the ones who stopped waiting for the problem to resolve itself and built systems to manage it before a vacancy forced their hand.

Here is what the high performers are doing differently.

1. Building anesthesia succession plans before the vacancy hits

Most independent ASCs lack formal anesthesia succession plans. When a CRNA retires or leaves, the response is reactive, posting the job, calling agencies, and scrambling. By the time a replacement is found, schedules have been compressed, cases canceled, and surgeon relationships strained.

The centers managing this well treat anesthesia coverage as a strategic asset, not an operational assumption. That means annual conversations with your current anesthesia providers about their retirement timeline. It means maintaining a short list of vetted locum CRNA contacts before you need them, not an agency number, but actual individuals you have worked with or screened. It means knowing your state's regulations around AA credentialing and whether cross-credentialing expands your coverage options.

None of this is complicated. All of it requires doing it before the phone call that changes your week.

2. Restructuring contracts before you negotiate from desperation

The worst time to renegotiate an anesthesia contract is when you have no coverage and a surgeon is threatening to take cases elsewhere. Your leverage disappears the moment the vacancy becomes known.

ASC administrators who negotiated stipend structures into their contracts before the current shortage peaked are in a fundamentally different position than those now negotiating against a backdrop of CRNA leverage and rising market rates. If your current anesthesia contract is within 18 months of renewal, start those conversations now before a retirement or departure forces your hand.

Key contract elements to address: stipend floors and escalation clauses, coverage minimums by day and specialty, locum rates and pre-authorization provisions, and cross-coverage agreements with nearby ASCs to address emergency scheduling gaps.

3. Expanding the provider pipeline through scope-of-practice awareness

The CRNA scope-of-practice landscape shifted significantly in 2025. The American Medical Association tracked 32 bills in 19 states related to anesthesia scope of practice during the 2025 legislative session. [4] Several states expanded CRNA independent practice authority, which directly affects the pool of providers willing to work in ASC settings where physician oversight arrangements vary.

Understanding your state's current scope-of-practice law goes beyond compliance; it's a key recruitment differentiator. In states with full practice authority, CRNAs have greater flexibility, making independent ASC positions more attractive. Conversely, states with supervision requirements necessitate a recruitment pitch that clearly and specifically outlines the oversight structure. The scope-of-practice map is changing state by state. Knowing where your state stands and how that compares to neighboring states directly shapes your recruiting territory and your negotiating position.

4. Running the honest math on your sedation model

The Yakima administrator's transition to RN-administered sedation was not her first choice. But it kept her cases running while a longer-term solution was built.

For independent ASCs performing procedures that qualify for moderate sedation under RN protocols, such as selected GI cases, certain pain management procedures, and orthopedic injections, a structured moderate sedation program with trained RNs can maintain volume while anesthesia coverage is rebuilt. This is not appropriate for all case types, and it requires investment in RN training, updated policies, and physician backup protocols.

But for some centers, it is the difference between operating and not operating while the market corrects.

The key question: what percentage of your current case mix could be performed under moderate sedation with appropriate RN training and physician backup? If that number is meaningful, it deserves a formal analysis before you are forced into it reactively.

→ Want to calculate how anesthesia-related cancellations are affecting your ACS’s revenue? The free Pre-Op Cancellation Cost Calculator runs your real figures in under 60 seconds: Pre-op Cancellation Cost-Calculator

The ASC Anesthesia Coverage Audit: 5 Questions to Ask This Week

Before your next leadership meeting, review these five questions. The answers will reveal your center's vulnerabilities and highlight your priority areas.

Question 1) Succession timeline: What is your current anesthesia provider's anticipated practice timeline? If you don't know, you don't have a succession plan. Schedule that conversation this week, not next quarter.

Question 2) Contract expiration: When does your current anesthesia contract expire? If it's within 18 months, start renewal discussions now, before leverage shifts away from you.

Question 3) Locum readiness: Do you have at least two vetted locum CRNA contacts in your network right now, not just an agency number, but actual individuals you've worked with or screened? If not, start building that list before you need it.

Question 4) Scope-of-practice position: What is your state's current CRNA scope-of-practice law? Is physician supervision required, or does your state allow independent practice? Does your current anesthesia arrangement reflect the current law — or is it structured around regulations that may have changed since your last contract was signed?

Question 5) Moderate sedation capacity: What percentage of your case mix is eligible for moderate sedation protocols with trained RNs? Do you have a written moderate sedation policy and a training pathway for your nursing staff?

If you can answer all five with confidence, your center is better positioned than most. If any of these surfaces have a gap, you now know exactly where to focus before a vacancy forces you to.

Curated intelligence from the perioperative space this week.

The CMS prior authorization demonstration for ASCs is now live in 7 states. Effective January 19, 2026, CMS launched a 5-year prior authorization requirement for five procedures: blepharoplasty, botulinum toxin (Botox) injections, panniculectomy, rhinoplasty, and vein ablation in California, Florida, Tennessee, Pennsylvania, Maryland, Georgia, and New York. Texas, Arizona, and Ohio follow on February 16, 2026. If your ASC performs any of these procedures, your billing workflow needs to be updated before your next applicable case. We will cover the full compliance breakdown, including the action checklist and False Claims Act exposure analysis, in a future issue. [5]

Surgical smoke evacuation legislation is accelerating. As of early 2026, 20 states have enacted surgical smoke evacuation laws, with 11 more states carrying active bills in their current legislative sessions. AORN's Go Clear Award program has enrolled more than 800 surgical teams in compliance recognition. If your state is not yet enacted, it is likely on the 2026 legislative calendar. A full breakdown of state-by-state status, compliance steps, and equipment selection guidance is coming in a future issue. [6]

Tirzepatide is the GLP-1 medication most ASC pre-op screens are missing. Sold as Mounjaro and Zepbound, tirzepatide is a dual GIP/GLP-1 receptor agonist that produces more pronounced delayed gastric emptying than standard semaglutide-based medications. Per ASA 2023 guidance, all GLP-1 receptor agonists, including dual agonists, require perioperative management protocols beyond standard NPO guidelines. Most ASC intake forms screen for Ozempic currently by name. Mounjaro, Zepbound, and Tirzepatide carry the same aspiration risk under a different label. Your pre-op intake needs to ask for all of them. [7]

I remember the first time I realized how much of what happens in an operating room depends on relationships that exist entirely outside of it.

A CRNA I worked with for years left our facility for a more attractive position. Better hours, better benefits, closer to home. Nobody blamed her. But the day she left, something changed in the room. Not just logistically, though that was real. It was the loss of someone who knew our surgeons' preferences, our patient population, and our rhythms.

A replacement is not a replacement. It is a restart.

That is the part that doesn't show up in the workforce data. The 28% compensation increase, the shortage projections, and the stipend figures are the system-level story. The floor-level story is what it feels like when institutional knowledge walks out the door. When the person who knew to add five minutes to the room turnover for Dr. So-and-So is suddenly gone, and nobody thought to write that down.

I've thought about that a lot while building this OR Edge Morning Report Newsletter

The intelligence that matters most in perioperative care lives in people. It's the CRNA who knows which surgeon runs 15 minutes long. It's the charge nurse who knows which pre-op bay to avoid for anxious patients. It's the administrator who knows which locum to call at 5 AM on a Monday.

That knowledge is not in your policy manual. It is not in your EMR. It lives in relationships that took years to build and can walk out the door in a single conversation.

The 5-question audit in today's Protocol Box is not just a compliance exercise. It is a forcing function, a way to surface the gaps before a retirement notice forces them into the open.

Do the audit this week, before you need to!

The centers navigating 2026 are the ones that built their systems before the crisis arrived. Those that didn't are rebuilding them now, under pressure, with compromised leverage, and a full schedule on the board.

You have time right now. Use it!

Sources & Methodology

All data cited in OR Edge Morning Report is drawn from peer-reviewed literature, government reports, or professional association guidance. Calculations apply published ranges to illustrative ASC baseline figures.

[1] ASC anesthesia coverage as top financial challenge (67%) and stipend increase (28% to 44%): VMG Health/Becker's ASC Review, "The biggest ASC shifts to watch in 2026," October 2025. beckersasc.com

[2] CMS anesthesia conversion factor reduction (2.83% for 2025): CMS CY2025 Medicare Physician Fee Schedule Final Rule, November 2024. cms.gov

[3] CRNA shortage projection (~12,500 providers by 2033) and compensation data ($181K to $232K, 2018–2024): American Association of Nurse Anesthetists (AANA) workforce data; Becker's ASC Review, "The anesthesia workforce shortage demystified," 2025. beckersasc.com

[4] Scope-of-practice legislation (32 bills in 19 states, 2025): American Medical Association Scope of Practice Legislative Summary, 2025. ama-assn.org

[5] CMS prior authorization demonstration: CMS, "Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services," effective January 19 and February 16, 2026. cms.gov

[6] Surgical smoke evacuation legislation: AORN, "Surgical Smoke Evacuation Bills Across the Country in 2025"; AORN Go Clear Award Program. aorn.org

[7] Tirzepatide perioperative risk: American Society of Anesthesiologists, "Consensus-Based Guidance on Preoperative Management of Patients on GLP-1 Receptor Agonists," June 2023. asahq.org

If this landed with you — forward it to one independent ASC administrator or surgical director in your network who is navigating anesthesia coverage right now. They need this more than they know.

Reply with what you are seeing on the anesthesia front at your center. I read every response.

See you next Tuesday at 0700.

Yetsenia Tyson, RN, Founder, Haleris

Publisher, OR Edge Morning Report