Anesthesia IDR Is a Knife Fight. Who Walks Away?

Anesthesia IDR is a knife fight, and in 2026 both sides finally have a knife. Providers are winning most No Surprises Act disputes. Payers are answering with canceled contracts and warnings to hospitals. Who walks away?

Host Joseph Rodriguez (Co-Founder and Chief Growth Officer, Guide Anesthesia) is joined by Randy Moore (Chief Anesthetist Officer, NorthStar Anesthesia) and Brian Schmutzler, MD, PhD (Executive Vice President of Medical Affairs, CCI Anesthesia). They don't agree on all of it. That's the point.

Anesthesia reimbursement. Randy explains why the math stopped working. Labor costs keep climbing while reimbursement falls, and a divided specialty looks like easy pickings to payers. Brian says the cuts don't reduce the cost of care, they shift it to hospitals and ASCs, and rural hospitals can't absorb it. He also shares a surprise: Elevance raised its Indiana anesthesia rates about 26% this year.

The IDR knife fight. Brian walks through how independent dispute resolution works and why mediators side with anesthesia providers most of the time. Joe counters with the fine print: nine to twelve months to get paid, the fees, and some groups whose win rates are losing them money. Randy predicts that companies winning contracts on 100% IDR assumptions will be in trouble within 18 to 24 months.

ASC anesthesia stipends. From Tenet's USPI to Ascension's AmSurg deal to the Surgery Partners sale, surgical volume keeps moving to ASCs, and stipends follow it. Brian explains how one center cut a $20K-a-month subsidy to nearly zero by billing surgeon-owners for unused block time. Randy breaks down why ASC contracts turn over faster than hospital contracts.

CRNA and anesthesiologist workforce. Randy sees early stabilization in metro markets, while rural sites still depend on locums. Brian warns that wages won't come down and that an anesthesiologist cliff is coming. Joe argues the real competition is between organizations that get the most out of both professions.

Plus: how each leader responded internally to the Nashville spinal medication tragedy, and the hardest professional lesson each of them learned in 2026.

Takeaways

1. IDR is leverage, not free money. Payment takes nine to twelve months, the fees come first, and a weak win rate turns the whole process into a loss.
2. Payment cuts don't lower the cost of anesthesia. They shift it to hospitals and ASCs. In rural markets, a few hundred thousand dollars of shifted cost can close a hospital.
3. Many ASC subsidies are an efficiency problem with a price tag. When surgeon-owners pay for their unused block time, the subsidy can drop to zero.
4. The CRNA shortage is no longer uniform. Metro markets with training programs are stabilizing, while rural and exurban sites still run on locums. The anesthesiologist pipeline is the bigger long-term risk.
5. The competition that matters isn't CRNA versus anesthesiologist. It's which organizations get the most value out of both.

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Thanks for my co-hosts:

Randy Moore (EVP & National Chief CRNA, NorthStar Anesthesia)

Gary Keeling (VP of Anesthesia Services, Coronis RCM)

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