Does Professional Anethesia Services Have Online Payment Link
Healthc (Amst). Author manuscript; available in PMC 2017 Sep ane.
Published in final edited form as:
PMCID: PMC5027066
NIHMSID: NIHMS721143
Value Based Care and Arranged Payments: Anesthesia Care Costs for Outpatient Oncology Surgery Using Time-Driven Activity-Based Costing
Katy E. French
The University of Texas M. D. Anderson Cancer Center
Alexis B. Guzman
The University of Texas M. D. Anderson Cancer Heart
Augustin C. Rubio
Segmentation of Anesthesiology & Critical Care, The University of Texas M. D. Anderson Cancer Eye
John C. Frenzel
The University of Texas M. D. Anderson Cancer Middle
Thomas W Feeley
The University of Texas M. D. Anderson Cancer Center; Senior Young man, Harvard Business organisation Schoolhouse
Abstruse
Background
With the movement towards bundled payments, stakeholders should know the true price of the care they deliver. Time-driven activeness-based costing (TDABC) tin can exist used to judge costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of eleven common oncologic outpatient surgical procedures.
Methods
Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures. Using the anesthesia tape, drugs, supplies and equipment costs were identified and calculated. The current staffing model was used to determine baseline personnel costs for each procedure. Using the costs identified through TDABC analysis, the effect of dissimilar staffing ratios on anesthesia costs could be predicted.
Results
Costs for each of the procedures were adamant. Procedure time and costs are linearly related. Personnel represented 79% of overall cost while drugs, supplies and equipment represented the remaining 21%. Changing staffing ratios shows potential savings betwixt xiii-28% across the 11 procedures.
Conclusions
TDABC tin exist used to estimate the costs of anesthesia intendance. This costing information is disquisitional to assessing the anesthesiology component in a bundled payment. It tin can likewise be used to identify areas of cost savings and model costs of anesthesia care. CRNA to anesthesiologist staffing ratios profoundly influence the cost of care. This methodology could be practical to other medical specialties to help determine costs in the setting of bundled payments.
Introduction
Equally our nation moves to redesign healthcare commitment and reimbursement the concept of value is gaining e'er increasing attention. Michael Porter defines value in healthcare as the remainder between outcomes that matter to patients and the cost to achieve those outcomesi Alternative payment models include bundled-payment arrangements where health care providers are accountable for the outcomes and cost of the care they evangelize to patients2. As nosotros transition away from our electric current model of reimbursement health care organizations need to have a better understanding of their outcomes and their costs of care.
Well-nigh healthcare costing systems are based upon charges yet cost shifting has made most charge-based systems unreliable when used to measure costs3. In 2004, Kaplan and Anderson introduced a new arroyo to activity based costing called fourth dimension-driven activity based costing (TDABC) which uses estimates of resources consumption during business activities to measure costs of servicesfour. Recently, TDABC has been applied to healthcare to develop more accurate estimates of healthcare costsfive,half dozen.
Anesthesia is one of the most plush aspects of healthcare delivery. In a 2011 report, the Healthcare Cost Institute establish that anesthesia intendance had the highest average price per service for a professional procedure7. Previously, anesthesia cost assessments take been tied to coding systems for reimbursement, such as the American Society of Anesthesiologists (ASA) classification or American Social club of Anesthesiologists' Relative Value Scale organisation 8. Anesthesia cost assessments focused on differences in anesthesia technique, personnel costs, staffing models, and budgets related to physician salaries, equipment, drugs and service contracts 9,10. Other studies accept described anesthesia cost drivers and proposed culling costing methodologies to assess hospitals' costs of anesthesia care9,xi. A study from Serbia reported the apply of activity-based costing to quantify anesthesia costs. It found 40% of direct costs related to personnel salaries, 32% to drugs and supplies, and 28% on other costs such as analyses and equipment 12.
The current method for billing anesthesia services includes a time component; nevertheless, this is combined with 2 other process and patient related factors that may or may not correlate to the bodily price of anesthesia. Anesthesia professional person billing is unique because information technology is the only professional service that uses time as a component of its billing methodology. All other professional services (e.g. surgery) bill for visits and procedures.
Currently, the anesthesia accuse results from the creation of two separate charges – professional charge and facility charge. Anesthesia charge covers pre-operative anesthesia assessment, commitment of anesthesia and firsthand postoperative intendance. Professional charges comprise three units: Base Unit of measurement, Time Unit, and Special Units. Assigned by the ASA, Base Unit relates to surgery procedure type and difficulty level to deliver anesthesia. The Time Unit of measurement is the fourth dimension anesthesia care starts to the stop of the surgical case. Most insurance carriers and Centers for Medicare & Medicaid Services (CMS) assign 15 minutes to each Time Unit. Special Units may be added for several complicating weather condition. Examples include patients of extreme age (e.g. less than one year former) or anesthesia complicated by patient acuity (e.g. ASA status). The terminal professional charge is determined by adding Base of operations, Fourth dimension, and Special Units together. Professional person practices determine the charge per unit. The total professional charge is the Total Units multiplied by per unit charge.
The facility charge for anesthesia services is related to supplies, equipment, time of technical personnel used to back up the service and overhead. Its adding methodology is less proscriptive than the professional person charge. At this institution, the facility charge is determined by two factors: location of anesthesia service and anesthesia time associated with the instance. All related, immune expenses are bundled into this charge.
For a bundled payment, costs of anesthesia care will be built into the reimbursement for a specific surgical procedure or a longer episode of care and paid in the form of a lump sum to the healthcare provider and/or provider organization. Most anesthesiologists and anesthesia provider organizations have independent billing relationships with insurance companies and CMS. In a bundled payment model, the internal allotment of the unmarried payment will almost probable reflect the proportional costs of the care delivered past all services. Therefore, anesthesiologists and all stakeholders demand costing systems that accurately define costs of the intendance every bit internal negotiations for their portion of the bundled payment begin.
Our institution has used a form of activity-based costing known as time-driven activity-based costing (TDABC)four to appraise the costs of patient intendance cycles within the caput and neck center and preoperative assessment eye5,6. In this study, TDABC estimates the cost of the entire episode of anesthesia care for 11most unremarkably performed outpatient oncologic surgical procedures. The objective was to quantify the anesthesia costs for each outpatient oncologic surgical procedure, define the distribution of those costs and identify cost drivers. Once the predominant price driver was defined, dissimilar staffing ratios were modeled to better understand how these scenarios afflicted anesthesia costs. The overall goal was to judge the costs of anesthesia care using the TDABC methodology for a proposed bundled payment arrangement.
Methods
Process maps of anesthesia care for xi most usually performed outpatient oncologic surgical procedures were created every bit seen in Effigy A. Process times were either estimated or measured directly. Anesthesia providers and staff estimated clinical procedure time directly associated with the patient for the commencement of the three phases shown in the process map - the Pre-Procedure Phase. The other two phases, Operating Room and Mail service-Anesthesia Care Unit, times were derived from the anesthesia record.
Process Map for Outpatient Oncologic Surgical Procedures- Overview
Fourth dimension-driven activity based costing process maps of anesthesia patient care were created for each of the 11 most commonly performed outpatient oncologic surgical procedures.
Preliminary information was extracted from the institution's perioperative electronic wellness tape one , billing database 2 , financial database 3 , and the pharmacy database iv . Nosotros evaluated 5,357 outpatient anesthesia cases across 261 procedure codes. At the discretion of anesthesia providers, procedures were grouped by common procedure terminology codes (Appendix 1). The resulting 11 process groups were generated: thyroid surgery (n=221), mastectomy (north=1242), breast reconstruction (northward=567), lymphadenectomy axillary (n=100), excision wide local (n=443), parathyroid surgery (n=93), brachytherapy seeds (n=88), biopsy cervix cone (n=172), cystoscopy (n=953), port-a-cath (n=1348) and exam nether anesthesia (EUA) dilatation and curettage with hysteroscopy (n=130) (Table ane). Anesthesia providers and administrators defined the following cost drivers for assay: anesthesia personnel, drug, supplies and equipment depreciation. Indirect costs were excluded.
Table ane
Distribution of Defined Cost Drivers by Outpatient Oncologic Surgical Procedure Groups
The distribution of costs by defined price drivers are shown beneath for each outpatient oncologic surgical procedure grouping.
| Outpatient Oncologic Surgical Procedures | Northward | % Personnel | % Drugs | %Supplies | %Equipment |
|---|---|---|---|---|---|
| Thyroid Surgery | 221 | 79% | 16% | three% | 1% |
| Mastectomy | 124 2 | 83% | 13% | 3% | 1% |
| Chest Reconstruction | 567 | 80% | 15% | 4% | i% |
| Lymphadenectomy Axillary | 100 | 83% | 12% | 4% | one% |
| Excision Wide Local | 443 | 83% | 11% | 4% | 2% |
| Parathyroid Surgery | 93 | 81% | 13% | five% | 2% |
| Brachytherapy seeds | 88 | 81% | 12% | 5% | 2% |
| Biopsy Cervix Cone | 172 | 77% | 15% | 6% | two% |
| Cystoscopy | 953 | 71% | 21% | 6% | 2% |
| Port A Cath | 134 8 | 78% | 14% | 6% | 2% |
| EUA Dilatation & Curettage w/ Hysteroscopy | 130 | 75% | 16% | 6% | two% |
| 5357 | 79% | 15% | 4% | 2% |
Personnel Costs
To determine the per-minute cost for each anesthesia team member, a model of the current staffing ratio was created that identified the total full-time evaluates (FTE) required to staff the outpatient operating room (OR). For analysis, the average length of a workday in the OR was defined as the time between scheduled get-go and boilerplate maximum anesthesia end time plus and additional to account for patient and discharge. This was determined to be x hours and 44 minutes. The staffing model was based on an anesthesia-staffing ratio of i anesthesiologist providing medical management to two CRNA'due south. The total FTE'southward needed to staff the OR too included not-productive time (e.k. Sick Get out). Not-productive time was derived from the average of the group over the menses of a year. Using boilerplate length of day Non-productive time and staffing ratios the full number of FTE's required for anesthesia services is determined. From the general ledger, full annual personnel costs were divided past total FTE's to calculate the cost/FTE/twelvemonth. To calculate toll per infinitesimal for each resource the toll/FTE/year was divided by the product of average total minutes for a length of day (644 minutes) and the number of workdays (250 days). The result was the cost rate/minute/FTE. Cost rates were derived for all anesthesia providers involved in direct patient intendance: anesthesiologist, CRNA's, anesthesia and supply technicians. Using a process map (Figure A), personnel costs were derived for each outpatient oncologic surgical procedure. The total anesthesia procedure time included three phases: Phase 1: Pre-Process, boilerplate elapsing of 23 minutes; Phase 2, Operating Room, average durations 62-172 minutes; and Phase 3, Post-Anesthesia Intendance Unit of measurement, average duration of 38 minutes.
Drug Toll
Patient pharmacy data was matched with institutional drug conquering costs to determine the per-case cost of all drugs, fluids and inhalation agents delivered. These costs varied past case type and provider.
Supply & Equipment Depreciation Costs
Boilerplate annual supply cost per example rate was derived from the general ledger so practical to each procedure. Total anesthesia equipment depreciation for the written report period was identified from the general ledger and allocated equally to each case.
Average Estimated Total Anesthesia Patient Care Costs
The estimated total costs for each of the 11 surgical procedure groups were calculated by calculation the weighted averages of each case within each procedure group. Costs include personnel, drug, supply and equipment. Average total cost for each of the common oncologic surgical procedures is depicted with standard deviations in Figure B. All costs are reported as normalized ratios to the lowest total TDABC in all three proposed staffing models to permit for relative cost comparisons (Tabular array 2).
Cost of Anesthesia Patient Intendance for Outpatient Oncologic Surgical Procedures
The graph displays the boilerplate total cost for the 11 common outpatient oncologic surgical procedures; total costs include personnel, drug, and supply and equipment costs. The boilerplate cost for each of the common oncologic surgical procedures is depicted with standard deviations. Costs are reported as normalized ratios.
Table 2
Current and Projected Anesthesia Patient Intendance Costs
The current and projected relative cost per procedure for each staffing model are shown with projected change in cost.
| Outpatient Oncologic Surgical Procedure | 2 CRNA : 1MD | 3 CRNA : 1MD | 6 CRNA : 1MD | ||
|---|---|---|---|---|---|
| Relative Cost per Procedure (baseline) | Relative Cost per Process | % Change (from baseline) | Relative Cost per Procedure | % Alter (from baseline) | |
| Thyroid Surgery | 5.xix | iv.46 | -fourteen.0% | three.74 | -28.0% |
| Mastectomy | 4.83 | 4.12 | -14.6% | iii.42 | -29.2% |
| Breast Reconstruction | 4.73 | 4.06 | -fourteen.2% | 3.39 | -28.3% |
| Lymphadenectomy Axillary | four.52 | 3.86 | -fourteen.7% | 3.20 | -29.3% |
| Excision Wide Local | 3.68 | 3.14 | -14.half-dozen% | 2.60 | -29.2% |
| Parathyroid Surgery | 3.35 | 2.87 | -fourteen.2% | 2.40 | -28.four% |
| Brachytherapy seeds | 3.34 | 2.86 | -14.4% | two.38 | -28.7% |
| Biopsy Cervix Cone | 2.97 | two.56 | -xiii.vii% | 2.16 | -27.3% |
| Cystoscopy | 2.95 | 2.58 | -12.half dozen% | 2.21 | -25.1% |
| Port A Cath | 2.87 | two.47 | -thirteen.8% | 2.08 | -27.5% |
| EUA Dilatation & Curettage w/ Hysteroscopy | two.73 | 2.36 | -thirteen.3% | 2.00 | -26.half dozen% |
Projected Anesthesia Patient Care Costs
Projected costs were calculated by changing the ratio of CRNA-to-anesthesiologist, from the current model of 2:1 to models of both three:1 and 6:1. Each of these models alter the per-minute price of the personnel variable in the full cost of anesthesia patient care. The two resulting personnel cost per infinitesimal values were and so inserted into the existing TDABC based process map to determine and quantify the change in costs.
Statistical Analysis
Eleven of the nigh common outpatient oncological process categories were adult with multiple procedure codes within each group (Appendix 1). Descriptive and quantitative statistical analyses were used to draw the nature of cost information and illustrate the quantitative measure of correlation betwixt time and costs. Mean of relative TDABC cost was calculated for each process category for comparison. Standard difference was calculated for each process category to evaluate variability of costs due to instance difference inside i category. Correlation coefficient was tested to evaluate potential relationships betwixt relative costs and full process time for all cases in the 11 most common outpatient oncologic procedures categories 5 . This analysis help to illustrate the portion distribution of costs across four predominant cost drivers.
Results
Relative TDABC mean and standard deviation were compared for eleven common outpatient oncologic surgical procedure categories in Figure B. Estimated cost for thyroid surgery procedures topped the list with a relative cost mean of 5.nineteen. EUA sDilation/Curettage/Hysteroscopy was estimated least costly with a relative cost mean of 2.73. The standard deviation showed variation of costs within each procedure group was relatively small, largest value of i.54 for mastectomy procedures. The case frequency distribution was unbalanced among the 11procedure groups with a maximum 1348 Port-A-Cath procedures and minimum 88 cases of brachytherapy seeds.
The correlation coefficient was computed between the cost mean and process fourth dimension mean among eleven procedure groups in Effigy C. A strong correlation is seen between the total relative price and total process time for each procedure with an R2 value of 0.9461 and p-value of less than 0.05.
Relationship between Anesthesia Patient Care Cost and Process Time
There is a positive correlation betwixt the relative cost and total process time for all cases in the eleven common outpatient oncologic surgical process groups. Costs are reported every bit normalized ratios.
Tabular array 1 showed cost distribution of iv predominant toll drivers for each of the eleven outpatient oncologic surgical procedure categories. The dominant cost driver was personnel, which deemed for 79% of the full costs, followed by drugs (15%), supplies (4%) and equipment (2%).
Modeling changes to personnel, by substituting dissimilar CRNA to anesthesiologist staffing ratios; Table 2, shows current and projected anesthesia patient care relative costs. These changes show projected cost decreases between xiii-28%.
Give-and-take
While there is generalized supposition that personnel is the most costly area of anesthesia care, this study provides new insight into the cost breakup past quantifying the very big component of personnel costs(79%)compared to the small contribution of all other anesthesia related costs (21%). It provides a costing framework that can be applied to other specialties that supervise midlevel providers, such as advanced practice nurses, physician's assistants, and residents in training. A basic concept of care redesign is that each provider work to the highest level of their degree and training. Applying TDABC to other clinical care settings could help to design care that is less costly. Mapping clinical processes across specialties could highlight other areas for cost savings across an institution or multi-specialty practice in addition to the optimization of staffing ratios of all Medico to MLP'south illustrated by the anesthesia instance in this study. TDABC is a tool to assistance predict cost savings prior to implementing change. However, in all intendance redesign the outcomes of that care must exist evaluated to exist sure that less costly care does not diminish the quality of the care provided. Further investigations need to be adult to study how diverse staffing ratios within anesthesia and other healthcare specialties affect outcomes.
TDABC identifies areas of potential cost savings
Personnel was identified as the primary commuter of cost and quantified the relationship between personnel cost and total surgical process process time. Opportunity to potentially decrease costs exists via 2 pathways, decrease overall process time or increment productivity of the personnel. This study assessed augmenting personnel productivity by increasing the number of CRNA's each anesthesiologist would supervise, or staffing ratios. Using TDABC, proposed changes to the current 2:1 staffing ratio were applied to assess the total costs for each procedure using 3:1 and 6:1 staffing ratios. These proposed changes modeled potential price savings between xiii-28%, depending on the specific surgical procedure.
Although various CRNA staffing models take not been constitute to exist associated with increased risks to patients13, our study acknowledges that serious thought must continue to go into determining the anesthesia staffing that is appropriate given the complication of patient comorbidities and instance acuity. This study does not assume to suggest there is ane all-time staffing model, or that the most toll saving ratio should exist applied in all scenarios. Proper matching of patients and cases with anesthesiologists and CRNA's is essential. In add-on to modeling dissimilar staffing ratios for CRNA's, this grade of assay can be used to evaluate the costs of care provided past other doctor extenders in the operating room such as anesthesia assistants and anesthesia residents. In all situations where intendance delivery is modified based on price, it is essential to monitor the outcome of care to be sure that cost reduction does not diminish the quality of care provided.
Secondary toll drivers were identified equally drug, supplies and equipment costs. While the contributions of secondary drivers in total comprise just 21% of the overall toll, standardizing and decreasing variability could as well lead to decreased costs.
TDABC identifies relationship between anesthesia costs and procedure duration
TDABC illustrates an important connection, the relationship betwixt surgical duration and cost of anesthesia. Phase 2 of the procedure map (Figure A) contributes the largest amount of time to the total procedure fourth dimension, approximately 64%. Phase 2 is almost entirely comprised of the surgical duration, the length of which anesthesia providers accept petty, if any, control over. Current billing of anesthesia services is based on units of fourth dimension, thus it is imperative to empathize this relationship as reimbursement moves towards bundled payments. How volition the anesthesia providers and other healthcare providers negotiate their portion of the payment? How is the payment separate if surgical times for the aforementioned process vary profoundly due to surgeon and patient variability? This variation can exist seen in this written report in the course of the standard difference shown in Figure B. The standard deviation represents the departure in costs based on different surgeons performing the aforementioned procedures. Given this correlation, information technology would behoove all stakeholders to piece of work towards reducing the variability betwixt surgical times. It remains hard to determine how this standardization should take place, just equally payment reform continues to develop, this relationship needs to be best-selling and addressed.
Limitations of TDABC to estimate costs and unanticipated consequences of arranged payments
There are limits to the accuracy of TDABC methods. TDABC calculates merely direct patient contact time. When reviewing the process map, documented times practise non include time salaried anesthesia providers are working merely non conducting direct patient intendance. Assigning costs to a process of care based solely on time spent providing direct patient care could pb to underestimation of provider work load, decreasing reimbursement and bounty. This could atomic number 82 to provider dissatisfaction and inaccuracy of documentation past providers when not in the presence of patients. Conversely too much focus could exist placed on documenting, causing distraction while in the presence of patients in society to add more time to this procedure step.
Basing models for change and cost saving on models that substitute physicians with mid-level providers could lead to patient dissatisfaction, compromise patient safety, and provider burnout every bit clinicians are asked to exercise more in less fourth dimension. How changing staffing models across all specialties of medicine potentially upshot patient safe is an surface area which needs further report with outcomes data. The correct residue of costs while preserving quality of patient care also warrants further investigation.
The implementation of a bundled payment arrangement requires significant startup costs and effort and must be understood before developing and implementing a package. The current billing organization does not easily support a bundled payment system and would require, at to the lowest degree in the near term, a second organisation of accounting and billing. This could create additional expense for the administration of this program. An anesthesia package that is developed independently from surgery or postoperative care could besides be negatively impacted past surgeons and nursing if they practice not share the same incentives.
As well absent-minded from the anesthesia care costs in this study are the basic overhead costs of running the outpatient surgical center. This is a limitation in using this model since these costs are not insignificant. Nonetheless, TDABC identifies baseline costs, toll drivers and how those contribute to overall patient care costs. TDABC and process mapping will be a useful tool in allocating payments to services in a bundled payment structure. It allows for changes to be modeled and costs visualized prior to implementation, such that the highest level of patient care may be maintained, while continuously assessing ways to amend value.
Acknowledgments
My-Hanh Five. Phan, Inquiry Developer, The Academy of Texas Chiliad. D. Anderson Cancer Center
Gilbert Castro, Application Analyst, The University of Texas M. D. Anderson Cancer Center
Financial Support: This research is supported in part by the National Institutes of Health through 1000. D. Anderson'southward Cancer Centre Back up Grant CA 016672 and the Helen Shafer Fly Endowment fund.
Appendix 1
| Outpatient Oncologic Surgical Procedures | CPT Code | Code Description |
|---|---|---|
| Lymphadenectomy Axillary | 00400 | Biopsy Breast due west/ Needle Loc |
| Excision Lesion/ Nodule Breast | ||
| 00912 | Lymphadenectomy Axillary | |
| 01610 | Biopsy Lymph Node Axillary | |
| Lymphadenectomy (Other) | ||
| Mastectomy | 00400 | Biopsy Excisional Breast |
| Mastectomy Prophylactic | ||
| Mastectomy Segmental | ||
| 00402 | Excision Boosted Margin Breast | |
| Mastectomy w/ Plastic Recon | ||
| 00404 | Mapping & Biopsy Picket Lymph Node (IOLM& SNB) | |
| Mastectomy | ||
| 01610 | Mastectomy Total w/ IOLM SNB | |
| 64421 | Mastectomy Full westward/ IOLM SNB w/ Plastic Recon | |
| 99100 | Mastectomy Modified Radical | |
| Mastectomy Segmental IOLM SNB | ||
| Mastectomy Segmental Needle Loc IOLM SNB | ||
| Mastectomy Total | ||
| Excision Broad Local | 00300 | Excision Wide Local Facial Surface area |
| Excision Wide Local Head | ||
| Excision Wide Local IOLM SNB | ||
| Excision Wide Local Cervix | ||
| 00400 | Excision Broad Local IOLM SNB Lower Limb | |
| 01470 | Excision Wide Local Lower Limb | |
| 01610 | Excision Broad Local IOLM SNB Upper Limb | |
| 99100 | Excision Wide Local | |
| Excision Broad Local westward/ Light amplification by stimulated emission of radiation | ||
| Port A Cath | 00400 | Removal Port A Cath |
| 00532 | Placement Central Venous Catheter | |
| Placement Port A Cath | ||
| Biopsy Neck Cone | 00840 | Laparoscopic Ligation Fallopian Tube |
| Laparoscopic Salpingo Oophorectomy | ||
| 00940 | Ablation Laser Vagina/ Vulva | |
| Biopsy Neck | ||
| Biopsy Cervix Cone w/ Cold Pocketknife | ||
| Biopsy Cervix due west/ Laser | ||
| Biopsy Cervix due west/ LEEP | ||
| Biopsy Vulva Lesion | ||
| Colposcopy | ||
| Excision Lesion Wide Local Vagina | ||
| Excision Lesion Wide Local Vulva | ||
| Insertion Intrauterine Device | ||
| Repair Wound Vagina | ||
| Vaginectomy (Colpectomy) | ||
| 99100 | Biopsy Vaginal Lesion | |
| Colporrhaphy | ||
| Exam Nether Anesthesia Vaginal | ||
| EUA Dilatation & Curettage w/ Hysteroscopy | 00940 | EUA Dilatation & Curettage |
| 00952 | EUA Dilatation & Curettage w/ Hysteroscopy | |
| EUA Hysteroscopy | ||
| EUA Hysteroscopy w/ Thermal Ablation | ||
| Parathyroid Surgery | 00320 | Parathyroidectomy |
| 36620 | Parathyroidectomy w/ PTH Assay Studies | |
| Thyroid Surgery | 00100 | Parotidectomy |
| 00320 | Dissection Neck Paratracheal | |
| Dissection Neck Selective | ||
| Lobectomy Thyroid | ||
| Thyroidectomy | ||
| Thyroidectomy w/ Isthmusectomy | ||
| Thyroidectomy west/ Neck Dissection | ||
| 00404 | Dissection Neck | |
| 99100 | Exploration Neck | |
| Thyroidectomy Total | ||
| Chest Reconstruction | 00300 | Revision Flap |
| Transfer or Rearrangement Adjacent Tissue | ||
| 00320 | Reconstruction Acquired Defect | |
| 00400 | Autograft Fatty | |
| 00402 | Augmentation Mammoplasty | |
| Capsulectomy | ||
| Capsulotomy | ||
| Exchange Breast Implant | ||
| Substitution Tissue Expander (Other) | ||
| Commutation Tissue Expander to Chest Implant | ||
| Placement Tissue Expander Breast | ||
| Reconstruction Breast w/ Breast Implant | ||
| Reconstruction Nipple (Areola) | ||
| Reduction Mammoplasty | ||
| Release Scar | ||
| Removal Chest Implant Fill Port | ||
| Removal Implanted Breast | ||
| Removal Tissue Expander | ||
| Repositioning Breast Implant | ||
| Revision Breast Reconstruction | ||
| Revision Inframammary Fold | ||
| Revision Nipple Areolar Reconstruction | ||
| Revision Scar | ||
| Revision TRAM Flap | ||
| 99100 | Mastopexy | |
| Brachytherapy seeds | 00902 | Biopsy Prostate |
| 99100 | Implantation Brachytherapy Seed/south | |
| Cystoscopy | 00870 | Cystoscopy |
| Cystoscopy west/ Extraction Float Stone | ||
| Ureteroscopy | ||
| 00910 | Cystoscopy (Cystourethroscopy) due west/ Rectal EUA | |
| Cystoscopy Biopsy EUA | ||
| Cystoscopy Fulguration Float | ||
| Cystoscopy Ureteroscopy | ||
| Cystoscopy w/ Bladder Hydrodistention | ||
| Cystoscopy westward/ Insertion Ureteral Stent | ||
| Cystoscopy w/ Retrograde Pyelogram EUA | ||
| Exchange Ureteral Stent(s) | ||
| 00918 | Cystoscopy w/ Laser Lithotripsy | |
| 99100 | Cystoscopy Transurethral Resection Prostate EUA | |
| Cystoscopy TURBT EUA |
Footnotes
iPicis®, Optum, Inc. Wakefield, MA.
2IDX Systems Corporation. South Burlington, VT.
3PeopleSoft®, Oracle, Inc. Redwood Shores, CA.
4Pyxis Technologies®, Care Fusion Corporation. San Diego, CA.
5StataCorp®, LP. College Station, TX.
Disharmonize of Interest Statement: The article "Bundled Payments: Measuring the Costs of Anesthesia Care in an Outpatient Oncology Surgery Middle Using Time-Driven Activity-Based Costing" is authored by Katy French, Alexis Guzman, Augustin Rubio, John Frenzel and Thomas Feeley and submitted to Healthcare equally an original commodity. Below all authors have disclosed relevant commercial associations that might pose a conflict of interest
Publisher'south Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. Every bit a service to our customers we are providing this early on version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof earlier information technology is published in its final citable class. Please notation that during the product process errors may exist discovered which could bear on the content, and all legal disclaimers that apply to the periodical pertain.
Contributor Information
Katy E. French, The University of Texas 1000. D. Anderson Cancer Middle.
Alexis B. Guzman, The Academy of Texas M. D. Anderson Cancer Centre.
Augustin C. Rubio, Division of Anesthesiology & Critical Care, The Academy of Texas One thousand. D. Anderson Cancer Center.
John C. Frenzel, The University of Texas M. D. Anderson Cancer Center.
Thomas Westward Feeley, The University of Texas M. D. Anderson Cancer Center; Senior Fellow, Harvard Business organization Schoolhouse.
References
i. Porter ME, Lee TH. The strategy that will fix wellness care. Harv Bus Rev. 2013;91:50–seventy. [Google Scholar]
2. Burwell SM. Setting Value-Based Payment Goals- HHS Efforts to Amend United states of america Health Intendance. Northward Engl J Med. 2015;372:897–9. [PubMed] [Google Scholar]
three. Kaplan RS, Porter ME. How to solve the price crisis in health care. Harv Bus Rev. 2011;89:46–52, 54. 56–61 passim. [PubMed] [Google Scholar]
4. Kaplan RS, Anderson SR. Time-driven activity-based costing. Harv Bus Rev. 2004;82:131–8. 150. [PubMed] [Google Scholar]
v. French KE, Albright HW, Frenzel JC, Incalcaterra JR, Rubio AC, Jones JF, Feeley TW. Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing. Healthcare. 2013;1:136–42. [PubMed] [Google Scholar]
six. Albright HW, Feeley TW. A cancer center puts the new approach to work. Harv Bus Rev. 2011;89:61–ii. [PubMed] [Google Scholar]
8. Dexter F, Lubarsky DA, Gilbert BC, Thompson C. A method to compare costs of drugs and supplies among anesthesia providers: a uncomplicated statistical method to reduce variations in toll due to variations in casemix. Anesthesiology. 1998;88:1350–6. [PubMed] [Google Scholar]
9. Schuster M, Standl T. Event of unlike cost drivers on price per anesthesia minute in different anesthesia subspecialties. Anesthesiology. 2004;101:1435–43. [PubMed] [Google Scholar]
10. Schuster M, Standl T. Price drivers in Anesthesia: Manpower, Technique and other Factors. Curr Opin Anaesthesiol. 2006;19:177–84. [PubMed] [Google Scholar]
11. Jones R, Plantes K. Toll containment in anesthesiology: a survey of the association of anesthesia clinical directors. J Clin Anesth. 1994;half dozen:409–10. [PubMed] [Google Scholar]
12. Majstorović BM, Kastratović DA, Vučović DS, Milaković BD, Miličić BR. Operating cost analysis of anaesthesia: activity based costing (ABC analysis) Srp Arh Celok Lek. 139:501–8. [PubMed] [Google Scholar]
13. Dulisse Brian, Cromwell J. No Harm Found When Nurse Anesthetists Piece of work Without Supervision By Physicians. Health Aff. 2010;29:1469–75. [PubMed] [Google Scholar]
Does Professional Anethesia Services Have Online Payment Link,
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027066/
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