Office Hours: Anesthesia Stipends Rising: Are Anesthesiologists and CRNAs the Cause? Insourcing, GI Self-Dealing

Anesthesia stipends are rising, and the contract structure may be part of the cause. When a facility guarantees revenue, the anesthesia group has less reason to chase collections or negotiate payer contracts. Facilities respond by insourcing, and the cycle starts again.

Joe Rodriguez answers listener questions in Part 2 of Office Hours.

Stipends. Every anesthesia stipend is either flat or dynamic. The real question in any dynamic deal is who absorbs the risk. Joe explains why subsidies are the norm for the foreseeable future, and how revenue guarantees can quietly reward groups for doing less.

Insourcing. In-house anesthesia was supposed to take over hospital systems. It mostly stalled. Joe breaks down the 20 to 30% cost gap between insourced and external anesthesia, and why every contract faces renewal risk on a 3 to 5 year cycle. His rule for groups: if you can't do it better than the hospital, there's no reason for you to exist.

The company model. The busy GI center had zero anesthesia revenue while the subsidy got pushed onto the ortho center. Then came the question: who owns the billing company? Joe covers self-referral, the $66M Tenet settlement, and why "our lawyers approved it" is not protection.

CRNA reimbursement. Why are commercial payers getting away with paying CRNAs 85%? There's no enforcement mechanism, the market has adjusted, and the fix likely requires a statutory change.

Clinical site barriers. Are anesthesiologists blocking student training because of guidelines, or because of power? Joe's take is that it's a power flex.

AI in anesthesia. AI won't replace anesthesiologists or CRNAs. It will split them. Judgment, execution, and accountability become the whole value proposition, and the 95% who coast fall behind the 5% who don't.

Plus: why the follow-the-surgeon model is fading in the West, and why credible, in-person conversations are making a comeback.

Takeaways:

Every anesthesia stipend is either flat or dynamic. In a dynamic deal, the only question that matters is who absorbs the risk.

Revenue guarantees can make anesthesia groups worse. When the facility fills every gap, collections and payer contracting stop mattering, and subsidies grow.