USAP allegedly paid a competitor $9 million to stay out of the Dallas market. A Texas teachers' pension system says it's paying twice the going rate for anesthesia because of it. Joe Rodriguez (Chief Growth Officer, Guide Anesthesia) is joined by Tracy Young (COO, Essential Anesthesia) and Gary Keeling (VP, Anesthesia Services at Coronis Health) to unpack the USAP consolidation fallout, why anesthesia pay works the way it does, and the debt mechanics behind CHG Healthcare's acquisition of Krewe Anesthesia.

First: Representative Tom Oliverson's Houston Chronicle testimony and the Texas Teacher Retirement System's claim that USAP charges double the going rate, including the allegation that USAP paid Envision $9 million to stay out of the Dallas market entirely. Tracy makes the business case for what USAP did before making the ethics case against how they did it.

Second: why anesthesiologists and CRNAs actually get paid what they get paid, and why "fair" isn't a market principle derived from your length of training. It's derived from what two parties subjectively determine.

Third: CHG Healthcare's acquisition of Krewe Anesthesia, traced back through Leonard Green Partners and the collapse of Crozer Health. Tracy breaks down how debt-funded acquisitions work and why the model only survives as long as interest rates stay low.

Plus: Joe's three-part fix for what's actually driving healthcare costs, and a listener question on practicing anesthesia in New York.

Takeaways:

Want more Dr. Joe Rodriguez?

Tik Tok: @jrodcrna21

Instagram: @jrod.crna & @abouttherestpod

YouTube: @AboutTheRest

Thanks for my co-hosts:

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

Gary Keeling (VP of Anesthesia Services, Coronis RCM)

To Learn More about Human Content Visit: ⁠⁠⁠http://www.human-content.com⁠⁠⁠

To Learn More about About The Rest Visit: www.abouttherest.com

Got a Question? [email protected]

Part of the Human Content Podcast Network

Learn more about your ad choices. Visit megaphone.fm/adchoices

UnitedHealthcare posted $5.5 billion in profit this quarter. Another state just opted out of physician supervision requirements. And CMS quietly gutted what's left of anesthesia's quality reporting program.

Joseph A. Rodriguez, Co-Founder and Chief Growth Officer at Guide Anesthesia, is joined by Randy Moore, Chief Anesthetist Officer and Executive Vice President for Strategy, and Gary Keeling, VP Business Development at Coronis Revenue Cycle Management, for a wide-ranging read on where anesthesia economics are actually headed. They don't agree on how much of this changes practice on the ground. That's the point.

Ohio becomes the 27th opt-out state, and the three break down why the practical impact rarely matches the headline. CMS's 2027 proposed rule drops the conversion factor again and dismantles MIPS reporting, Gary explains why almost nobody hits the threshold anymore. UnitedHealthcare's quarterly numbers spark a sharper conversation about what a 7% margin on $112 billion in revenue actually signals about the system underneath it, and about the difference between a flawed idea and a poorly executed one. A new rural healthcare bill promising higher CRNA and anesthesiologist reimbursement gets a clear-eyed "it won't work" from all three.

Plus: the pre-op smoking conversation nobody has ever actually had, and why "productivity, not cost" might be the real headline healthcare keeps missing.

TAKEAWAYS

Want more Dr. Joe Rodriguez?

Gary Keeling (VP of Anesthesia Services, Coronis RCM)

Learn more about your ad choices. Visit megaphone.fm/adchoices

Anesthesia coverage is now the single most cited financial headache for surgery center leaders in the country, and MD-only care is disappearing fast: QZ billing is up 15%, team-based coverage is up 30%, and CRNA-involved cases have nearly doubled in Florida over 14 years. Joe Rodriguez sits down with Randy Moore, Chief CRNA and Chief Strategy Officer at North Star Anesthesia, and first-time guest Andrew Woodmancey, founder and managing partner of Anesthesia Operations Consultants, a mid-sized consulting firm based in Florida, to break down what's actually driving these numbers.
 
They don't agree on all of it.
 
The conversation opens with a new VMG Health survey on where anesthesia subsidies are headed in 2026, then moves into the billing data behind the shift away from MD-only care. Andrew, brought on as the non-clinical voice in the room, argues the real economic problem is reimbursement and industry infighting, not scope-of-practice fights.
 
Joe pushes further, arguing that credentials alone don't guarantee value: the market only pays for solving someone else's problem, and if surgeons can eventually do it without anesthesia providers, they will. Randy and Joe also spar over how much weight to give data versus identity in shaping the industry's direction. Also in this one: what change management actually looks like for an anesthesiologist moving from a one-to-three model to zone coverage, and why the math behind CRNA-only staffing might be quietly reversing in some markets.
 
 
TAKEAWAYS
 
1. MD-only anesthesia care is significantly decreasing, not because of politics or scope-of-practice wins, but because the economics stopped supporting it. QZ billing is up 15%, team-based coverage up 30%.

2. In Florida, roughly 90% of anesthesia cases now involve a CRNA, up from about 70%.

3. Credentials alone don't create economic value. Value in this market is transactional to some degree, tied to solving someone else's problem, not to years of training.

4. QZ utilization is increasing across states, though unevenly, some markets seeing modest growth, others far more dramatic shifts. MD-only care is significantly decreasing nationally, and medical direction/team models are increasing at varying rates by state.

Want more Dr. Joe Rodriguez?

Gary Keeling (VP of Anesthesia Services, Coronis RCM)

Learn more about your ad choices. Visit megaphone.fm/adchoices

Six days before a federal rule was set to take effect, the courts stepped in. The Department of Education tried to redefine who counts as a professional, a move that would have capped student loans for nurse anesthetists and the advanced-practice clinicians training behind them. The courts said the challenge is likely to succeed and hit pause.

This week I sat down with Tracy Young, twenty-six years in the field, and Randy Moore, who runs anesthesia at enterprise scale, to work through what the ruling actually means and what it does not. It is a win in a battle, not the war.

We get into the argument a federal regulator made that landed harder than we wanted to admit, why a rule written to require supervision is now being used against us, and where the line sits between what government should decide and what the people doing the work should. Plus the student-loan fight both parties get half-right, and why credentials stopped predicting who can lead.

Good information first. Then the honest conversation about where anesthesia goes next.

TAKEAWAYS

The court blocked the rule on a preliminary injunction, not the merits. It buys time. It does not end the fight.

The professional designation fight has real money behind it. Redefining the term caps federal loans for CRNAs, PAs, and nurse practitioners.

The strongest argument against us was ours to fix. A federal statute still references supervision, and that language is being used to question our standing.

Both sides of the student-loan debate are right. Treat the subsidy as a return question, and CRNAs are a good bet. We pass boards 95 percent of the time.

Regulators are the wrong body to design clinical practice. The people closest to the work adapt faster than any rule can.

Want more Dr. Joe Rodriguez?

Tracy Young: Incoming President of the American Association of Nurse Anesthesiology

Learn more about your ad choices. Visit megaphone.fm/adchoices

Joe Rodriguez (co-founder, Guide Anesthesia) sits down with Randy Moore (EVP and National Chief CRNA, NorthStar Anesthesia) and Gary Keeling (VP of Anesthesia Services, Coronis RCM). Three seats, three vantage points on the same business. Let the spicy takes flow.

First docket: the Arizona reimbursement fight. Gary calls the QZ cut a pure money grab. Randy steelmans the insurer's lobbyist before dismantling him, and explains why the hospitals least prepared to absorb the hit will be the ones paying it. Joe walks through why reimbursement parity doesn't raise costs when subsidies fill the gap, and tells the story of the insurer that paid patients directly for eight years.

Second docket: the Texas non-compete case. Gary argues exits should hurt but not kill. Randy says hospitals deserve the right to fire bad vendors, but a $30 million buyout is anti-competitive. Joe draws the line between covenants that trap clinicians and the non-solicit rule that just says don't be shady.

Plus: why the resume from Hawaii is a red flag, and what the law of inertia does to anesthesia groups that confuse stability with health.

Reimbursement parity does not raise costs in anesthesia. Compensation sits above reimbursement and subsidies fill the gap, so cutting one payer's rate changes who pays, not how much is paid.

The facilities that use QZ most are the ones least able to absorb the cut. Rural and underserved programs run closest to the margin, which makes this bad policy independent of the scope debate.

CRNAs can lose non-compete fights. In the Texas case, the new employer contractually agreed to cover legal costs and damages, and the court sided with the original group anyway. A buyout promise is not a shield. The covenant you signed is enforceable as written, and "I read online it's unenforceable" is not a legal strategy.

The line is solicitation, not competition. A non-solicit protects the group that gave you access to its surgeons and referrals without trapping you in place. Competing down the street is fair game. Taking the business with you is shady.

Switching costs are a strategy. A $30 million buyout stops being protection and becomes a hostage situation. Hospitals should be able to fire bad vendors at a price that hurts but doesn't kill.

Sign contracts like you plan airways. Have a plan A, B, and C for your exit before the honeymoon period ends, because the group that looks great at signing may not look great in year three.

Gary Keeling (VP of Anesthesia Services, Coronis RCM)

Learn more about your ad choices. Visit megaphone.fm/adchoices

Joe Rodriguez sits down with Randy Moore and Tracy Young, to work through the week's hardest stories. Let the spicy takes flow!

Reimbursement: UnitedHealthcare stops paying for physical status. Oklahoma and Louisiana fight back with legislation. Tracy makes the case that anesthesia has been commoditized, and that hospital subsidies taught payers they never have to pay full price.

Private equity: California and Oregon pass laws to curb PE in medicine. Tracy argues we legislate against bad actors instead of punishing them. Randy defends consolidation, then explains why the Oregon deal was a playbook of what not to do. And the line nobody else will say: hospitals don't fire anesthesia groups that are doing a good job.

Workforce: AA bills fail in Iowa and Minnesota. Joe argues the entire AA strategy asks the wrong question. Tracy disagrees with both hosts and predicts a sorted market: CRNA-centric facilities on one side, MD and AA medical-direction models on the other, driven by math, not preference.

Plus: why anesthesia companies obsessed with growth keep losing contracts, and why CRNA residents work full-time hours unpaid while physician residents draw a salary.

Differentiation in anesthesia is no longer simply price. It is recruiting and retention, full stop. Culture is the product.

Hospitals don't replace groups that are performing. If a contract gets shopped, there was a problem, whatever the press release says.

Growth without product is a failure of leadership. The large groups losing contracts did it to themselves.

The workforce will sort itself in the next decade. The average anesthesiologist is 55. CRNA graduation just crossed 3,000 for the first time. 

Profit motive is not a disease. Imbalance is. Everyone you've ever hired has a profit motive, including you.

Learn more about your ad choices. Visit megaphone.fm/adchoices

The FTC just notched its second win against the biggest roll-up in anesthesia history. Welsh Carson settled first. Now USAP. So who actually won, and who pays next?

Learn more about your ad choices. Visit megaphone.fm/adchoices

Along life’s winding roads we’ve each worked tirelessly to hone our skills and ultimately become the excellent clinicians we are today. But what happens when being great in the OR isn't enough? Each week on About the Rest, Joe Rodriguez, DNAP, CRNA, gets into the weeds on the definitive podcast for fellow CRNAs and MDs who want to understand how our profession actually works behind the scenes… warts and all.

Learn more about your ad choices. Visit megaphone.fm/adchoices

Anesthesia Deconstructed is sunsetting, but the conversation is just getting started. Joe and Mike announce Joe’s new podcast, “About the Rest!” Get ready for the next chapter of critical career-driven discussions exploring the leadership, performance, and business of a career in anesthesia. Simply stay subscribed to this feed to automatically follow as Season One begins May 2026 (don’t worry, old eps of Anesthesia Deconstructed aren’t going anywhere). 

As we navigate the systems, incentives, and power shifts that happen around the OR we want to know what you think! Visit abouttherest.com to join the community and share what you want to hear next.

Get in Touch: [email protected]

A Human Content Production

Learn more about your ad choices. Visit megaphone.fm/adchoices

In this powerful and unfiltered episode, Dr. Joseph Rodriguez — CRNA, former state and national leader, faculty member, and host of Anesthesia Deconstructed — takes us inside the real lessons of anesthesia leadership.

From COVID-era disruption to contract losses, difficult boardroom conversations, and the relentless financial pressures of today’s anesthesia market, Joe shares stories that few leaders are willing to tell. Each story carries a hard-won lesson: why leadership is never just a title, how executive presence shapes outcomes, why data transparency can backfire, and how accountability transforms teams from fragile to high-performing.

We also dive into the frameworks that shaped his leadership journey — from Crucial Conversations to The Four Agreements and Five Dysfunctions of a Team — and how every leader can apply them to grow themselves, their organizations, and the people they serve.

This isn’t theory. It’s frontline leadership, with all the scars, pivots, and resilience required to survive in one of healthcare’s most disrupted specialties.

Whether you’re a CRNA, SRNA, or a healthcare leader navigating change, this conversation is a masterclass in turning setbacks into systems, failures into frameworks, and words into lasting impact.

Keywords:

Anesthesia, CRNA Leadership, Healthcare Business, Executive Presence, Leadership Lessons, Nurse Anesthesiology, Organizational Growth, Accountability, Professional Development, Anesthesia Contracts, No Surprises Act, Healthcare Strategy, Team Building, Crucial Conversations, Five Dysfunctions of a Team

Send us Fan Mail

Follow us at:

Instagram
Facebook
Twitter/X

Learn more about your ad choices. Visit megaphone.fm/adchoices