Franklin Dexter

Whether in a private practice anesthesia group, academic institution, hospital organization, or some hybrid of these, understanding how regional anesthesia (RA) affects your budget and costs, as well as the perceptions and outcomes of patients, is important for planning and conducting economic discussions with health care administrators and surgeons. This chapter reviews the costs and economics of RA and describes the concepts that apply to anesthesia providers and groups across the globe. Billing is not included as each country chooses how it bills and is paid for RA procedures. Moreover, we focus on outpatient anesthesia, for which cost savings can be better defined. While facilities may benefit financially from RA applied in inpatient settings, such billing and cost issues are local. The economics of heterogeneity in bringing down costs for measured reductions in length of stay (LOS) were reviewed recently. In brief, although RA can reduce patient LOS, Taheri et al demonstrated that for patients with an average LOS of 4 days or more, the majority of costs occur in the initial days of the hospital stay, and only 3% of costs are incurred in the concluding hospital days.

This chapter focuses on the determinants of anesthesia labor productivity and costs in operating rooms. It is intended to help physicians apply evidence-based management as they plan staffing for their facilities (hospitals, day surgery centers, etc). Both productivity and the cost of providing operating room (OR) anesthesia care are inextricably linked to the choices of how many ORs to open at the start of the day and how to schedule cases into those locations.

The decisions of this chapter are of considerable importance to hospitals because anesthesia group productivity is linked to the difference between the gross revenue (reimbursement) received by the hospital for surgery and the associated variable costs (eg, supplies, implants). Net revenue is used to pay for the substantial fixed costs such as the electronic medical record systems and operating and maintenance expenses of the physical plant. At hospitals where anesthesia providers are salaried employees, low productivity results in the need to hire more providers than otherwise necessary, resulting in greater costs. At hospitals where anesthesia providers receive direct compensation from insurers for their professional fees, low productivity often results in the need for the hospital to provide institutional support to the anesthesia group.

Chapter 96-
This chapter focuses on the determinants of anesthesia labor productivity and costs in operating rooms. It is intended to help physicians apply evidence-based management as they plan staffing for their facilities (ie, hospitals, day surgery centers, etc). Although the concepts are the same worldwide, the specific examples and their relevance to daily practice focus on US nonfederal facilities. Both productivity and the cost of providing operating room (OR) anesthesia care are inextricably linked to the choices of how many ORs to open at the start of the day and how to schedule cases into those locations. That is, evaluation of anesthesia care (productivity, costs, efficiency) within an OR is a surrogate for evaluation of OR management (productivity, costs, efficiency) and vice versa. The principles and processes for the evaluation discussed can be used equivalently for anesthesia OR care and OR management.