Increasing the value of time reduces the lost economic opportunity of caring for surgeries of longer-than-average times.

MD‡*Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas; †Department ofAnesthesiology and Pain Management, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas;and ‡Department of Anesthesiology, Baylor College of Medicine, Houston, TexasAnesthesiologygroupsthatprovidecareforsurgicalpro-cedures of longer-than-average duration are economi-cally disadvantaged by both increased staffing costs andreduced revenue. Under the current billing system, anes-thesia time is valued the same regardless of the total caseduration. In this study, we evaluated the effect on fouracademic anesthesiology departments of two hypotheti-cal scenarios by changing the anesthesia care billing sys-temtomakemorevaluableeither1)alltimeunitsor2)justsecond-hour and subsequent time units. From the fourdepartments, case-specific data (anesthesia Current Pro-cedural Terminology code and minutes of care) were col-lected for all anesthesia cases billed for 1 yr. Basic unitswere determined from the American Society of Anesthe-siologists(ASA)relativevalueguide.Theaveragetimeforeach case was defined as the average anesthesia time forthat specific Current Procedural Terminology code, aspublished by the Center for Medicare and Medicaid Ser-vices (CMS). The actual total ASA units per hour(tASA/h) was determined by adding all the basic unitsand time units and dividing by hours of anesthesia care(minutesofanesthesiacaredividedby60).Wethencalcu-lated a hypothetical CMS tASA/h for each group by sub-stitutingtheCMSaveragetimeforeachanesthesiaproce-dure time for the actual time reported by each group andusing 15-min time units. For each group, the Actual (Act)tASA/h and CMS tASA/h were calculated for both op-tions—changing the interval for all time units or only forsecond and subsequent hours. Intervals were 15, 12, 10, 7,6,or5min.Whenchangingalltimeunits,ActtASA/handCMS tASA/h were never equal for all groups. The twoproductivity measures became approximately equal ifonly time units after the first hour were changed to 6- to7-min intervals. When changes were applied only to theAct tASA/h (with CMS tASA/h remaining at 15-min in-tervals), at the 12-min interval either option resulted in asimilar or higher Act tASA/h than CMS tASA/h. Bothoptions increase the value of time and help compensatefor the lost economic opportunity of longer-than-averagesurgical durations.(Anesth Analg 2004;98:1737–42)