Utilization and Associated Spending for Anesthesia Services During Ambulatory Hand Surgery

Abstract

There is no financial information to disclose. We aimed to (1) describe trends of anesthesiologist-administered anesthesia services (AAS) for three common, minor hand operations, (2) investigate demographic factors associated with AAS services in low-risk patients, and (3) estimate supplementary costs incurred for potentially discretionary anesthesia administration. We hypothesized that despite the threat of bundled payment, a substantial percentage of minor procedures still employed potentially discretionary anesthesiologist-administered anesthesia services (use of a specialized anesthesia provider in patients lacking medical necessity), marking increased healthcare costs and decreased take home income for surgeons and the practice. We performed a retrospective analysis using the Truven MarketScan database to estimate the prevalence and cost of AAS in patients who underwent carpal tunnel release, trigger finger release, or de Quervain release between January 1, 2010 and September 31, 2015. Medical necessity for anesthetic service was characterized according to the American Society of Anesthesiologists physical status classifications. Three unique predictive probability models were created to estimate an individual’s risk status for each procedure. We used the chi-squared test to determine significance between categorical variables (age, sex, region, and insurance type) and outcomes. We examined the relationship between patient risk-status and anesthesia use using multivariable regression models. Of 441,579 eligible procedures, 352,779 (80%) involved anesthesiologist-administered anesthesia services. The total proportion of estimated anesthesiologist-administered anesthesia use in low-risk patients who do not require anesthesiologist support declined over the study period (69.7% in 2010 to 65.8% in 2015; Fig. 30-1). Being female and a younger age (18-34) was significantly correlated with potentially discretionary anesthesiologist-administered anesthesia service utilization (P < 0.001). Although total payments for anesthesiologist-administered anesthesia services remained steady between 2010 and 2014, the average payment per procedure increased regardless of procedure type (from $376.8 in 2010 to $427.9 in 2015 for a carpal tunnel release operation). Approximately $133 million (83.7%) of the total payment to anesthesia providers is credited to services in low-risk patients (Table 30-1). •Although prevalence rates decreased over the study period, more than two-thirds of patients receiving AAS lacked medical necessity for a specialized anesthesia provider.•A substantial amount of healthcare expenditure in hand surgery is attributed to potentially discretionary anesthesia service use.•Given the persistence of anesthesia services that ignore the advancement of viable, cost-saving alternatives, health reforms efforts must consider the impact and value of every facet of care individually.Table 30-1Comparison of Payments for Anesthesiologist-administered Anesthesia Service Utilization during Minor Hand Surgery Procedures, 2010-2015*201020112012201320142015TotalCarpal Tunnel ReleaseTotal payment for AAS (in million dollars)20.421.725.219.418.79.0114.6Proportion of payment associated with potentially discretionary AAS, %85.7%84%83.4%84.5%81%82.4%83.6%Average payment for AAS per procedure (dollars)376.8368.9380.1387386.5427.9382.8Trigger Finger ReleaseTotal payment for AAS (in million dollars)5.76.27.46.25.93.034.2Proportion of payment associated with potentially discretionary AAS, %85.1%83.5%83.4%84.1%80.8%82.1%83.3%Average payment for AAS per procedure (dollars)287.9282.6290.9291.7289.7316.3290.8De Quervain ReleaseTotal payment for AAS (in million dollars)1.61.72.21.71.70.89.7Proportion of payment associated with potentially discretionary AAS, %87.7%86.2%86.9%85.3%85%84.3%86.1%Average payment for AAS per procedure (dollars)380.8375.3394.6401.5386.1430.9391.3*All prices adjusted to the 2015-dollar value using the consumer price index.Source: 2010-2015 Truven Health MarketScan Research DatabaseAAS, anesthesiologist-administered anesthesia services Open table in a new tab *All prices adjusted to the 2015-dollar value using the consumer price index. Source: 2010-2015 Truven Health MarketScan Research Database AAS, anesthesiologist-administered anesthesia services