Reimbursement rates are dropping. As Medicare drops payment the insurance companies will follow. The problem is how anesthesia has worked in the past. Often anesthesia, (along with radiology and lab) would work on contract with a particular hospital. In return for the monopoly and guaranteed income, they had to provide care to ALL patients that come in, regardless of payment.
However, that is changing.
In a number of hospitals, two or more groups of anesthesia providers cover the hospital. They get selected for particular cases by the surgeon or even the patient. As a result, they can refuse non-emergent patients, just as any other type of medical service provider can. If a Medicare patient comes in and needs a hernia repair done, the anesthesia provider can refuse to provide care due to "lack of payment." If this happens enough, Medicare will have to raise the rates.
Or the anesthesia providers can just work in a surgery clinic. No payment up front, no surgery. The surgeons figured it out long ago and the anesthesia people are along for the ride.