I have a bit of time this evening to provide an update. I’m less involved in the day-to-day now than I was five years ago, so some of the details below are based on second-hand reports from colleagues. A few items labeled as “rumored” I’ve seen directly, while some first-hand accounts come from discussions with others in the field.
Envision
Envision appears to have exited Orange County, and possibly Southern California entirely. UCI acquired Tenet’s four struggling hospitals and awarded the anesthesia contract to NAPA. Colleagues who have joined NAPA report that payments remain reliable, though one (in a small sample) noted that billing discrepancies consistently favor the corporation and are rarely corrected. The unit value began at $37 (including blocks) and may have increased slightly since. Any call stipends from NAPA are unclear at this time.
This is not meant to suggest NAPA is an improvement over Envision. In fact, NAPA’s decision to appoint Doctors Wyn.som T0m and Mi.nh B.ui. as co-chiefs at those sites — given their well-known reputations individually and together — suggests conditions there will likely remain challenging for the foreseeable future.
NAPA
NAPA was recently removed from Orange Global, which must sting.
They have struggled to recruit for the new UCI hospitals, leading UCI to close at least two adjacent surgical centers: one on the Fountain Valley campus and one on the Los Alamitos campus.
Anesthesiologists working at two of the four UCI hospitals believe NAPA will be replaced within the next three months.
Somnia
Somnia secured the contract at Orange Global. They also appear to be retaining the contract at St. Mary’s in Long Beach, though leadership turnover there continues — they seem to average more than one new chief per year. Both facilities operate as Level II trauma centers using the care team model, a fact which speaks for itself.
Daydream
Daydream is a smaller group covering plastic surgery offices around Newport/Fashion Island. The owner previously worked with Allied before starting his own practice. He requires billing to route through him and then through Allied, with Allied taking a substantial cut followed by an additional 5% for the owner.
The anesthesiologists I know there are generally above average. Several have noted that the most appealing long-term aspect of the arrangement is the likelihood that the owner will eventually alienate the surgeons, prompting them to bypass Daydream and contract directly with the anesthesiologists.
Crystal
Crystal was a short-lived group (lasting roughly 2–3 years) that covered three or four SCA facilities. It was assembled by a former Allied executive as a last-ditch effort to prevent NAPA from taking over those sites. In late 2025, the founder handed the operation over to Allied. Initial reports suggested retirement, but it now appears he simply grew tired of dealing with SCA and Optum.
CAAMG
CAAMG lost its contracts at Orange Coast and Laguna Woods to Vituity (formerly CEP, and at one point operating as MedAmerica). It’s worth noting that repeated name changes like this often signal an attempt to distance from a poor reputation.
Talbert Anesthesia Group
This is another smaller, independent group. Their contracts appear less lucrative than Daydream’s, offering roughly mid-$30s per blended unit after Daydream’s layered cuts. On the positive side, they recently walked away from a difficult Optum facility in Huntington Beach and declined an ASC opportunity in Laguna Woods (after Vituity failed to retain all former CAAMG physicians). This shows a willingness to avoid desperate contracts.
Allied
Allied continues to pursue aggressive growth, primarily by accepting Optum facilities that most physicians with basic financial sense decline. In the past four months alone, they have taken on four new Optum contracts that appear burdensome.
Optum agrees to lose less money on CalOptima/Medicaid cases in surgical centers than they would in hospitals and, as a minority partner with SCA, may internally offset losses. Surgeons who sold equity to SCA/Optum now use these facilities for complex or low-reimbursement cases while directing higher-value work elsewhere. This leaves Allied staffing rooms with physician anesthesiologists for as little as 90 minutes of operating time per day (often not even consecutive).
One of these four new facilities recently experienced a GI death and an ENT near-miss within the past four weeks. It is also losing staff at a rate of roughly one nurse or scrub tech per week.
Allied remains physician-only on paper, which is theoretically preferable. However, when the majority of volume consists of Medicare cataracts, Medicare colonoscopies, and Cal-Optima carpal tunnels in a high cost-of-living area, maintaining competitive physician compensation becomes difficult. More flexible practices use CRNAs, creating a counter-intuitive dynamic: cost-conscious facilities often retain physician owners who prioritize margins over provider type. Many of these centers bill anesthesia charges directly while paying CRNAs a salary, directing the best-paying cases to the lowest-cost providers (CRNAs) while Allied absorbs the lowest-reimbursing work.
This structure helps explain Allied’s ongoing recruitment challenges.
