Ten years ago, the stipend conversation was about coverage. Today it is about proof. When an anesthesia group asks a hospital or surgery center for support, the first thing the facility asks for is not a staffing plan. It is a stack of revenue cycle reports.
That shift changes who wins the negotiation. Groups that walk in with clean, current, facility-level billing data get taken seriously. Groups that cannot show where their collections stand often end up accepting less support than they need, or defending numbers they did not prepare.
This guide explains why stipends have become so common, what facilities look at, and how to build a stipend case on your own data before anyone else builds it for you.
Why Anesthesia Stipends Are Now the Norm
Stipends used to be the exception. Now they are close to the default. Becker's ASC reports that the share of surgery centers expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, and roughly 80% of hospitals already offer some form of anesthesia support.
The reasons are structural, not temporary:
Medicare anesthesia payment per unit has fallen about 5.5% since 2019, while CRNA salaries have risen about 59% over a similar period, according to data cited by Becker's ASC.
Commercial payers are trimming anesthesia payments through policies such as reduced rates for non-medically directed CRNA services and the removal of physical status units.
The anesthesia workforce is tight, so the cost of covering every anesthetizing location keeps rising.
Many facilities have payer mixes, schedules, or low-volume rooms that professional fees alone cannot support.
In other words, the gap between what it costs to staff a facility and what professional billing can collect is real. The stipend exists to close that gap. The negotiation is about how big the gap actually is.
What a Facility Will Ask to See
Facilities are increasingly sophisticated about stipend requests. Industry guidance from Coronis Health notes that facilities typically request revenue cycle reports and review metrics such as net collection rate, days in A/R, aged A/R, and bad debt. Each one tells the facility something different about your group.
| Metric | What it tells the facility | What weakens your case |
|---|---|---|
| Net collection rate | How much of what you are owed you actually collect | A low rate suggests the gap is a billing problem, not a funding problem |
| Days in A/R | How fast cases turn into cash | Slow cash flow looks like inefficiency the facility should not subsidize |
| A/R over 90 or 120 days | How much revenue is stuck or at risk | A large aged balance invites the question "why not collect this first?" |
| Payer mix by facility | How much of the volume is Medicare, Medicaid, or uninsured | Group-wide averages hide the facility-specific reality |
| Collections per anesthetizing location per day | What each room actually earns | Without it, idle or low-volume rooms are invisible |
| Bad debt | How much patient responsibility goes uncollected | High bad debt can be read as weak patient collections |
Notice the pattern. Every metric that reflects a weak revenue cycle becomes an argument against your stipend. The facility's reasoning is simple: before we pay to close the gap, prove the gap is not caused by billing.
Fix the Leaks Before You Ask
The most credible stipend request comes from a group that has already captured everything it is owed. That means looking hard at the leaks that quietly shrink collections:
Cases that were performed but never billed, such as add-on cases, OB epidurals, or cases in off-site locations.
Missing or inconsistent care team modifiers that reduce payment on medically directed cases.
Anesthesia time that is documented inconsistently across providers.
Denials that were never appealed and simply expired.
Commercial payers paying below contract without anyone noticing.
Closing these gaps does two things. It raises collections on its own, and it removes the facility's strongest counterargument. A group that can say "our net collection rate is high and our A/R is current, and we still cannot cover these rooms" is in a much stronger position than one that cannot.
How to Build a Stipend Model on Your Own Data
Industry advisors recommend that groups prepare their own subsidy assessment so the negotiation starts from a number the group can defend. A practical model looks like this:
Separate collections by facility. Group-wide numbers blur the picture. Build a profit and loss view for each site.
Show payer mix by facility. Medicare, Medicaid, and self-pay volume drive most of the funding gap.
Calculate collections per anesthetizing location per day. This shows which rooms pay for themselves and which do not.
Calculate the true cost of coverage. Include anesthesiologists, CRNAs, call, benefits, malpractice, and administrative overhead.
Quantify idle time. Late starts, long turnovers, and cancelled cases cost money even when no one bills for them.
Define the gap. Cost of coverage minus realistic collections, after leaks are fixed, is the support you need.
Project forward. Include known changes such as the proposed 2027 Medicare anesthesia conversion factor reduction and any commercial policy changes.
The output is not just a number. It is a story the facility can follow from data it trusts.
Performance-Based Stipends Are Coming
Facilities increasingly want to tie support to performance. Common benchmarks include first-case on-time starts, turnover times, block utilization, and patient satisfaction. Some surgery centers are experimenting with "cascading" stipends that shrink as case volume rises above an agreed baseline.
This can work in your favor, but only if you can measure the same things the facility measures. Groups with reliable operational and billing data can negotiate fair targets. Groups without it end up accepting targets they cannot verify.
Where Accreda Fits
Accreda, the anesthesia revenue cycle division of Cosentus, builds facility-level reporting into every engagement. Every case on the schedule is reconciled against what was billed, collections are tracked by site and payer, and A/R is worked continuously so aged balances do not become a negotiating liability. When it is time to talk stipends, your numbers are already clean, current, and defensible.
Accreda clients have increased collections by 10 to 30% on average. Average results are based on internal client reporting, and individual results vary.
FAQs
The Bottom Line
A stipend request is only as strong as the revenue cycle behind it. Capture every case, collect what you are owed, and report it by facility, and the conversation shifts from "why should we pay?" to "how do we keep this coverage?"
Schedule a no-cost anesthesia revenue analysis with Accreda and see your collections, A/R, and payer mix by facility before your next stipend conversation.