Whether in a private practice anesthesia group, academic institution, hospital organization, or some hybrid of these, understanding how regional anesthesia (RA) affects your budget and costs, as well as the perceptions and outcomes of patients, is important for planning and conducting economic discussions with health care administrators and surgeons. This chapter reviews the costs and economics of RA and describes the concepts that apply to anesthesia providers and groups across the globe. Billing is not included as each country chooses how it bills and is paid for RA procedures. Moreover, we focus on outpatient anesthesia, for which cost savings can be better defined. While facilities may benefit financially from RA applied in inpatient settings, such billing and cost issues are local. The economics of heterogeneity in bringing down costs for measured reductions in length of stay (LOS) were reviewed recently.1,2,3,4 In brief, although RA can reduce patient LOS, Taheri et al demonstrated that for patients with an average LOS of 4 days or more, the majority of costs occur in the initial days of the hospital stay, and only 3% of costs are incurred in the concluding hospital days.1
Understanding how RA and analgesia affects budget and costs, as well as the perceptions and outcomes of patients, is important for planning and conducting economic discussions with health care administrators and surgeons.
OPERATING ROOM EFFICIENCY
Perhaps the most basic and important management decision is to increase the efficiency of use of operating room (OR) time. Maximizing OR efficiency is a major cost reduction strategy that is implemented by reducing the hours of over- and underutilized OR time. Allocated OR times are assigned by the institution to its surgical services. On days of the week that a service has allocated time, their cases are scheduled within the specified start and stop times of the service.5,6,7
Overutilized time is the positive difference between the total duration of cases (including all turnover times) and the allocated OR time interval, when the allocated time has been calculated as that which maximizes the efficiency of use of OR time. For example, cases and turnover times have a total duration of 10 hours, yet 8 hours of time are allocated—this yields 2 hours of overutilized time. Importantly, referring to time as overutilized implicitly assumes that the time allocated has been calculated to maximize the efficiency of use of OR time (ie, minimizing the weighted combination of overutilized and underutilized time).
Underutilized time is the positive difference between total case duration, including turnover time, and the time allocated for that day. An example would be having 8 hours allocated and cases completed in 6 hours, including all turnover time, resulting in 2 hours of underutilized time. If a surgical services committee sets the policy that all ORs ...