Development of a Resource-Based Relative Value Scale and Fee of Advanced Nursing Practices by Nurse Anesthetists in South Korea

Abstract

Purpose: This study was aimed to develop fee and a resource-based relative value scale (RBRVS) advanced nursing practices done by nurse anesthetists under the national health insurance. Methods: The classification of practices in Nurse Anesthetists was performed by clinical panel and then the RBRVS of nurse anesthetists for 16 advanced nursing practices was calculated by magnitude estimation method, based on their workload and working time survey in the context of the national health insurance. A cost analysis including direct labor cost and indirect cost for advanced nursing practice was performed to estimate the conversion factor (unit price) for the RBRVS of nurse anesthetists. The share of nurse anesthetists’ contribution to the feefor-service was also analyzed. Results: Calculation of the RBRVS for the 16 advanced nursing practices showed a range of points from 100 to 305.2 with an average of 175.3 points. The relevant conversion factor for advanced nursing practices of nurse anesthetists was estimated at 14.9∼19.4 Korean won. The nursing fee for 16 advanced nursing practice was calculated by multiplying the RBRVS of the each practice and the conversion factor. The contribution rate for advanced nursing practices of nurse anesthetists using the relative value scale of the national health insurance was estimated at 9.3%∼100.0% (indirect cost 10%) with the rate varying widely. Conclusion: In order to address the shortage of anesthetic staffs, the employment of nurses specializing in anesthesia is thought to bring the national interests. In addition, we believe the Nurse Anesthetist system is an effective way to prevent a shortage of anesthetic care providers in South Korea.