The impact of longer-than-average anesthesia times on the billing of academic anesthesiology departments

Academic anesthesiology departments provide clinical services for surgical procedures that have longer-than-average surgical times and correspondingly increased anesthesia times. We examined the financial impact of these long er times in three ways: 1) the estimated loss in revenue if billing were do ne on a flat-fee system by using industry-averaged anesthesia times; 2) the estimation of incremental operating room (OR) sites necessitated by longer anesthesia times; and 3) the estimated potential gain in billed units if t he hours of productivity of current anesthesia time were applied to surgica l cases of average duration. Health Care Financing Administration average t imes per anesthesia procedure code were used as industry averages. Billing data were collected from four academic anesthesiology departments for 1 yr. Each claim billed with ASA units was included except for obstetric anesthe sia care. All clinical sites that do not bill with ASA units were excluded. Base units were determined for each anesthesia procedure code. The mean co mmercial conversion factor (US$45 per ASA unit) for reimbursement was used to estimate the impact in dollar amounts. In all four groups, anesthesia ti mes exceeded the Health Care Financing Administration average. The loss per group in billed ASA units if a flat-fee billing system were used ranged fr om 18,194 to 31,079 units per group, representing a 5% to 15%. decrease (es timated billing decrease of US$818,719 to US$1,398,536 per group). The numb er of excess OR sites necessitated by longer surgical and anesthesia times ranged from 1.95 to 4.57 OR sites per group. The potential gain in billed u nits if the hours of productivity of current anesthesia time were applied t o surgical cases of average duration was estimated to be from 13,273 to 21, 368 ASA units. Longer-than-average anesthesia and surgical times result in extra hours or additional OR sites to be staffed and loss of potential reim bursement for the four academic anesthesiology departments. A flat-fee syst em would adversely affect academic anesthesiology departments.