Operating Room Utilization Versus Anesthesia Provider Productivity

Summary

In an era of increasingly challenging negotiations between anesthesia practices and hospital administrators over subsidy requirements, it is becoming more difficult to justify additional financial support. Two issues that keep coming to the fore are operating room utilization and provider productivity. This study of shoulder cases puts these two critical factors in perspective and provides the anesthesia practice with some logical arguments as they push back on hospital requests for improved productivity.

No aspect of anesthesia practice management has become more important in the current environment than determining appropriate staffing. While hospital administrators strive to reduce anesthesia subsidies, department heads struggle to meet expectations. Department heads see themselves as captive to coverage requirements and administration expectations, as hospital administrators press for more leverage and efficiency. Ultimately, the question becomes how efficient and productive are the anesthesia providers? It is a tough question to answer objectively. There are so many variables that determine a provider's ability to generate billable units each day. The two key factors, operating room utilization and provider productivity, are inextricably linked with the result that anesthesia providers have very limited potential to impact their productivity. While this may be an obvious reality to any anesthesia provider, it is not always easy to convince administration. The following study is intended to provide some objective data and arguments to anesthesia practices in their struggle to educate administration.

Let us first clarify terms. Operating utilization involves the measurement of actual activity in an operating room, versus potential capacity. Anesthesia has some very useful tools for the determination of standard benchmarks. If a day typically involves 10 hours of coverage, 7 AM to 5 PM, then 7 hours of billable anesthesia time would be considered optimum, although rarely achieved consistently. This would equate to a target of 60 units per provider day. The average anesthesiologist does up to five cases a day, and the average case is worth 12 units, so a possible maximum of 60 units per day.

How often and how consistently are these ideal targets met? To some extent, the potential billable anesthesia time and units is a function of the venue. Ambulatory facilities typically generate less billable time and units than busy inpatient surgical suites. A fundamental challenge in most facilities is also the fact that these values have been declining over the past few years. This is the inevitable result of an increase in the number of anesthetizing locations that must be covered. Increasing the number of rooms may be a good way to attract more surgical cases, but it rarely leads to enhanced utilization.

Provider productivity cannot be measured on an absolute scale. It is a measure of how effectively providers manage the cases they are scheduled to administer. It involves factors such as timeliness of first case start, turnover times, speed of the surgeon, efficiency of anesthesia care and the ability to perform special anesthesia techniques, such as the use of invasive monitoring, nerve blocks and ultrasonic guidance.

Although the ultimate objective of both the provider and administrator is to optimize the profitability of each clinical day, it is important to note that the objectives of the provider are not always in alignment with those of the administration. Anesthesia providers prefer consistently busy days of work while hospital administrators may be more focused on providing availability to key surgeons. Surgeons tend to want their early starts so they can do their cases and get to their offices, which means O.R. utilization drops off dramatically in most facilities about 1pm. This is not good for the anesthesia providers who are then left idle.

While anesthesia providers often complain that they are captive to the schedule at their specific location, this is not always entirely true. The following analysis was designed to test this premise. The results are intriguing.

We identified five surgical procedures of the shoulder, all of which are typically performed with an interscalene block and ultrasonic guidance. The purpose of the study was to look at a small subset of common surgical procedures where anesthesiologists have some potential to impact revenue potential, through the use of nerve blocks for post-operative pain management. We then identified 10 practices, evenly dispersed across the country, and the top orthopedic surgeons at each. The goal was to see how much variability there was in average time and average billed units per case, by practice. We found there is considerable variability, even though every practice consistently took advantage of the use of interscalene blocks.

The table below lists the surgical procedures analyzed while the chart shows the average minutes and units per case for these procedures, as billed by 10 ABC client practices across the country. The standard deviation in average anesthesia times and units billed was significant. As one might expect, the smaller the practice, the higher the standard deviation.

Anesthesia times are determined by the speed of the surgeon. The table below compares the average times per CPT for the busiest nine surgeons in the study for one of the most common shoulder procedures: a rotator cuff repair, worth five units in the ASA Relative Value Guide. The variances in both average times and average units per case are dramatic and clearly beyond the control of the anesthesia provider. Ironically, anesthesia providers always prefer to work with fast surgeons, because short cases maximize the unit potential per hour. A five unit case that takes an hour generates nine units per hour, while a two-hour case only generates six and one-half units per hour. If the anesthesia provider had the potential to actually impact surgical case time, the room would be more productive. Unfortunately, this variable is beyond the anesthesia provider's control.

Our data clearly proves what anesthesia providers have always known when it comes to the efficiency of the surgeon, it is luck of the draw. This is why the anesthesia charge calculation was established as a formula. The base value determines the degree of difficulty of the case from an anesthesia perspective, while the time units captured reflect the reality of the relationship. Anesthesia is an invaluable service provided to the surgeon to ensure that the patient survives the trauma of surgery safely and comfortably.

Hospital administrators often suggest that the anesthesia provider can play a meaningful role in enhancing the efficiency and productivity of the operating room suite and this is probably true, but not in the way they might think. Anesthesia practices have more and better data about what actually happens in the operating room than any other source in the facility. The question is how do they use it to determine more effective operating room management strategies. The reality, though, is that this data probably has more value to help modify hospital and medical staff behavior than anesthesia staff behavior.

If you have questions about the appropriateness of your OR utilization, provider productivity or staffing, feel free to contact your account executive who will be happy to assess your specific practice metrics. ABC has a wealth of data for purposes of benchmarking your specific situation. Let us help you improve the efficiency and effectiveness of your practice.