How much labor is in a labor epidural? Manpower cost and reimbursement foran obstetric analgesia service in a teaching institution

Background Some anesthesiologists avoid provision of obstetric analgesia se rvices (OAS) because of low reimbursement rates for the work involved. This study defines the manpower costs of operating an OAS in a tertiary referra l center and examines reimbursement for this cost. Methods: The time spent providing OAS in a total of 55 parturients was stud ied prospectively using a modification of classic time and motion studies. Results: Mean duration of OAS in our population was 412 +/- 313 min. Mean b edside anesthesia staff time was 90 +/- 40 rain, and mean number of visits to each patient's bedside was 6.3 +/- 2.0 visits. Assuming staffing on dema nd for service (intermittent staffing), a minimum of 2.5 full-time equivale nt (FTE) attending anesthesiologists was required to meet demand. With inte rmittent staffing, labor cost was $325 per patient. Actual practice at Duke University Medical Center is around-the-clock (dedicated) staffing, which requires 4.4 FTEs at a cost of $728 per patient. Neither average indemnity reimbursement ($299) nor Medicaid reimbursement ($204) covered the cost per OAS patient. Breaking even is possible under indemnity reimbursement becau se operating room reimbursement subsidizes OAS costs. Breaking even cannot occur with Medicaid reimbursement under any circumstances. Conclusions: Obstetric analgesia services requires a minimum of 25 FTE atte nding anesthesiologists at Duke University Medical Center. With the current payer mix, positive-margin operating room activities associated with the o bstetric service are not sufficient to compensate for the losses incurred b y an GAS. Around-the-clock dedicated obstetric staffing (4.4 FTEs) cannot o perate profitably under any reasonable circumstances at our institution.