About the Rest

Joe Rodriguez
  • 4.7 (388)
  • Medicine
  • Semimonthly

I'm Joe Rodriguez, CRNA. After co-hosting the podcast Anesthesia Deconstructed for years, I kept running into the same problem. I was told that if I stayed clinically excellent and kept my head down, the rest would take care of itself. If you're reading this, you know all too well… IT DOES NOT. Unfortunately, time and time again, I discovered that the most impactful tools to leverage throughout my career in anesthesia (e.g. money, influence, deal negotiations, power) are never taught to us in school or in practice. I had to pick it all up at dinners, off the record, wherever the valuable conversations take place but go unheard. Honestly, my issue with every other podcast in our field is that clinical teaching and polite leadership talk are…are a little boring. I figure if it bores me, it bores you. So then, where can we learn how groups do or don't make money? How do hospital deals get structured? Why do subsidies keep climbing? What separates a holding company from private equity? What does it take to build leadership that holds up under pressure? The list goes on. Which brings us here. I present to you the show I've been wanting to see and got tired waiting around for. About the Rest is a twice-monthly inside baseball podcast for the people who run things. Join me as I sit down with fellow anesthesia business leaders Randy Moore and other key voices from the field to take real positions and hash out the big questions, warts and all. If it's in the public record, it's on the table: announcements, policy changes, lawsuits, the big RFP nobody will explain, the conference moment everyone clocked. If you want to learn how to get into the OR, this isn't it. About the Rest is about, well, the rest! Learn More: www.abouttherest.com About the Rest is a Human Content Production

  1. 3d ago

    Anesthesia Business in 2026: AI and Group vs. Payer Trench Warfare

    Anesthesia groups and payers have always fought over reimbursement. AI just changed the weapons. Joe Rodriguez sits down with Randy Moore of NorthStar Anesthesia and Gary Keeling of Coronis Health to break down the AI billing arms race, what a new BCBS study revealing $942 million in AI-driven billing means for premiums, and why insurers may not actually want perfect billing. They also cover the latest CRNA opt-out news, the state of independent dispute resolution (IDR) under the No Surprises Act, and the factor that quietly decides which anesthesia groups thrive: leadership and culture. Takeaways: AI is escalating the oldest fight in healthcare. Providers use AI to capture more revenue; payers are building AI to deny more claims. BCBS alone points to $942 million in AI-driven billing. Insurers may not want perfect billing. Errors create room for denials. Expect humans in the loop for a long time. Patients pay for the arms race. Higher billing costs to payers move into premiums. AI makes knowledge cheap. The premium shifts to people who frame the right questions and execute. IDR works, but it isn't free money. Fees, months of float, contract exposure, and payer pushback make execution the difference. Leadership decides which contracts survive. Site-level clinical leadership and culture matter more than most groups treat them. _____________ 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

  2. Oct 13

    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. Insourcing anesthesia stalled because success requires focus. A hospital running anesthesia is managing a business it doesn't specialize in, and the 20 to 30% cost gap shows it. Every anesthesia contract runs on a 3 to 5 year cycle. Groups lose contracts by getting comfortable, not by getting outbid. When a referring physician owns the anesthesia billing company, that's self-dealing. Legal sign-off doesn't protect you. Only a judge's ruling does. AI will split anesthesiologists and CRNAs into two groups. The few with judgment and accountability will pull further ahead, and the rest will fall behind. _____________ 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

  3. Sep 29

    Office Hours: Peak CRNA Locums? Is MD Supervision a Convenience? 1099 vs W2, Hospital Execs Who Shrug

    CRNA locums pay has been on a steep curve, and curves correct. The internet says 1099 vs W2 CRNA conversion is 50%. Real conversions land at 20 to 25%. And some CRNAs are supervised all week, then trusted to run solo every weekend. Host Joe Rodriguez, CRNA and anesthesia group co-founder, answers your questions in the first About the Rest Office Hours. Locums and new grads. Joe breaks down the three curves that set locum rates (education, locums, and anesthesia group economics) and explains why falling rates don't mean fatter margins for groups. He also makes the case that new grads going straight into locums are entering the most dangerous years of their careers alone. 1099 vs W2 CRNA. The real conversion range, the tax factor everyone misses, and why most CRNAs who go 1099 never go back. Supervision when convenient. A listener asks why the care team model flips from ACT to independent on nights and weekends. Joe explains the two bets behind it. Hospital contracts. Joe covers what happens when contract volume comes in 20% short and the hospital shrugs, and who should control anesthesia contracts. He also walks through how anesthesia RFPs are actually won: on the denominator, by small margins. Plus: the $40K-per-CRNA misclassification trap, and why Joe's own group nearly failed in 2021. Takeaways: Locum rates move on a curve, and curves correct. When the correction comes, anesthesia groups don't keep the difference: revenue guarantees cap their margin, and a competitor underbids at renewal. New grads need two to three years of mentorship, and locum work doesn't provide it. A locum assignment is built to fill a gap on the schedule, not to develop the clinician filling it. 1099 vs W2 CRNA comes down to conversion, tax savings, and risk. Conversion ranges from 16 to 35%. The bigger advantage is tax treatment, conservatively about 10% more of every dollar kept. The risk is misclassification, which has cost groups about $40K per CRNA. Supervision that disappears on nights and weekends reflects convenience, not acuity. The model bets that no one will check and no one will put the contract at risk. Anesthesia RFPs are won on the denominator. Everyone models payer mix and volume; the winner understands service requirements and labor cost, and the margin between winning and losing is small. Every group needs a mission beyond money and an operating margin to protect it. A mission without margin nearly failed in 2021. Change is how the mission survives. _____________ 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

  4. Sep 15

    The CAA Certification Debacle, the Locums Bubble, and Why Anesthesia Groups Keep Losing Contracts. They Shouldn't.

    20 exam windows invalidated. Roughly 150 graduates who thought they had a job in September now retaking a national certification exam. And a workforce gap between CRNAs and anesthesiologists that's up to 11,000 and accelerating. Joe Rodriguez sits down with Randy Moore and Tracy Young, three days into Tracy's term as president of his professional association. They don't agree on all of it. That's the point. The docket opens with the CAA certification crisis: what NCCAA found, why Tracy says the CRNA community shouldn't take a victory lap, and what it means for hospitals already stretched thin. From there, Randy walks through the supply and demand curves reshaping the locums market, Tracy lays out the data on the widening CRNA-anesthesiologist gap, and both agree a locums company bubble is forming, even if they disagree on the timeline. The sharpest moment of the episode: Randy makes the case that anesthesia groups have spent years selling themselves as a cost to minimize instead of an investment that drives OR volume, and argues that's the real reason contracts get lost. Plus: a difficult conversation about a real-world medication error making national headlines, handled from a systems and second-victim lens rather than a blame lens, and Joe closes with a personal reflection on what changes when you stop trying to win every argument. Takeaways: Test-bank leaks don't just fail an exam. They retroactively threaten seven years of certifications. Confidentiality isn't a control, it's a hope. Anesthesia supply is exploding on a delayed timeline. Cohort increases decided during COVID take three-plus years to hit the market. 2025's record graduate numbers are the first wave, not the peak. Pricing anesthesia is not a simple supply and demand exercise. Margins are sticky. Recruiting gets easier before rates ever move, and the real correction only lands when a hospital's actual costs force the renegotiation. Anesthesia groups lose contracts for one reason about 70% of the time: they can't cover the points of service. Cost is rarely the actual failure point, even though it's the stated one. Framing anesthesia as a cost to minimize instead of an investment that unlocks OR volume is the biggest strategic error facility partners make, and anesthesia groups reinforce it every time they lead with price. Power without discipline just wins arguments. Power used well finds the best answer and lets the argument go. _____________ 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

  5. Sep 1

    USAP Paid Envision $9 Million to Stay Out of Dallas per FTC; Union Updates, Krewe Acquired

    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: Comparing anesthesia rates to "the market average" is meaningless. Most rates are too compressed to cover the actual cost of staffing anesthesia care. Anesthesiologists and CRNAs get paid what they get paid for one reason: that's what the market is willing to pay. Supply and demand, not sympathy or spin. Fairness is not a market principle, per se. Compensation is only ever what a buyer is willing to pay and a provider is willing to accept. Locums companies are becoming management companies because hospitals want one vendor to own the whole staffing headache, not five vendors to coordinate. Solving healthcare costs at the system level takes three things: real investment in public health, broad coverage delivered privately, and better use of the professionals already in the system. 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

  6. Aug 18

    UnitedHealthcare $5.5B Profit, Another State Opts Out, and Why MIPS Is Dead

    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 Opt-out status changes almost nothing for practice models outside of all-CRNA sites already considering the switch. The headline outruns the operational impact by a wide margin. MIPS in anesthesia has become a check-the-box exercise with no measurable link to patient outcomes. Most providers no longer even hit the reporting threshold. Every CMS reimbursement cut gets absorbed the same way: pushed onto facility subsidies, which raises the cost of entry for new and smaller groups and accelerates consolidation. A rural anesthesia reimbursement bump sounds like an access fix but doesn't change the math for anesthesiologists or hospitals. Small percentages of small numbers stay small. Extreme profit sitting next to a broken system is not proof that free enterprise failed. It's proof that execution failed. Confusing the two is what pushes public opinion toward bad solutions. Healthcare's financial strain reads as a cost problem when it's actually a productivity problem. Fix throughput and OR utilization, and a large share of the "cost crisis" narrative disappears. 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

  7. Aug 4

    Does Your Schooling Actually Matter If You're Not Solving Problems for Surgeons and Patients?

    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? 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

  8. Jul 21

    Courts Hand CRNAs a Win

    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? Tik Tok: @jrodcrna21 Instagram: @jrod.crna & @abouttherestpod YouTube: @AboutTheRest Thanks for my co-hosts: Randy Moore (EVP & National Chief CRNA, NorthStar Anesthesia) Tracy Young: Incoming President of the American Association of Nurse Anesthesiology 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? hello@abouttherest.com Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

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About

I'm Joe Rodriguez, CRNA. After co-hosting the podcast Anesthesia Deconstructed for years, I kept running into the same problem. I was told that if I stayed clinically excellent and kept my head down, the rest would take care of itself. If you're reading this, you know all too well… IT DOES NOT. Unfortunately, time and time again, I discovered that the most impactful tools to leverage throughout my career in anesthesia (e.g. money, influence, deal negotiations, power) are never taught to us in school or in practice. I had to pick it all up at dinners, off the record, wherever the valuable conversations take place but go unheard. Honestly, my issue with every other podcast in our field is that clinical teaching and polite leadership talk are…are a little boring. I figure if it bores me, it bores you. So then, where can we learn how groups do or don't make money? How do hospital deals get structured? Why do subsidies keep climbing? What separates a holding company from private equity? What does it take to build leadership that holds up under pressure? The list goes on. Which brings us here. I present to you the show I've been wanting to see and got tired waiting around for. About the Rest is a twice-monthly inside baseball podcast for the people who run things. Join me as I sit down with fellow anesthesia business leaders Randy Moore and other key voices from the field to take real positions and hash out the big questions, warts and all. If it's in the public record, it's on the table: announcements, policy changes, lawsuits, the big RFP nobody will explain, the conference moment everyone clocked. If you want to learn how to get into the OR, this isn't it. About the Rest is about, well, the rest! Learn More: www.abouttherest.com About the Rest is a Human Content Production

Information

  • Creator
    Joe Rodriguez
  • Years Active
    2019 - 2026
  • Episodes
    72
  • Rating
    Explicit
  • Copyright
    © 2026 Rodriguez Anesthesia, LLC. All rights reserved.
  • Show Website
    About the Rest

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