A budget is a quantitative financial plan for a defined period of time that serves to articulate financial and operational goals, objectives, and strategic plans. A budget allows you to quantify and prioritize these goals, objectives, and plans and provides you with a way to measure financial and operational performance. Approaches to budgets include the historical (uses historical data updated with new facts, trends, and assumptions), zero-based/bottom-up (assumes all costs must be justified), and flexible budgeting methodologies (updated throughout the budget period according to major cost drivers such as volume). Capital budgets focus on projects or tangible assets (eg, property, plant, or equipment items) that exceed a certain expense threshold. Important operating budget considerations include professional staff salaries and fringe benefits, payer reimbursement assumptions, malpractice costs, operational changes (such as additional anesthetizing locations), and investment income returns. Revenue budget assumptions should address volume growth of anesthetic procedures, contract rates for payment, payer mix, and collection rates, although expense budget assumptions should consider the impact of staffing needs (resignations and hiring), compensation and incentive plans, and inflationary costs. Operating room utilization and efficiency influence both staffing needs and revenue generation, and therefore they should be carefully reviewed as part of the budgetary process.