Anesthesia Experts

Comparison of Anesthesia Times and Billing Patterns by Anesthesia Practitioners

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Authors: Eric C. Sun, MD, PhD et al
JAMA Netw Open. 2018;1(7):

Question  What is the incidence of anomalous billing among anesthesia practitioners in the United States?

Findings  In this cross-sectional study of 4221 anesthesia practitioners in the United States, 212 reported an unusually large number of cases with durations that were a perfect multiple of 5 minutes. These practitioners submitted billing for anesthesia times that exceeded the expected time by a mean of 21.5 minutes.

Meaning  Anesthesia practitioners with the highest tendency to report anesthesia times with a demonstrable anomaly (times rounded to 5 minutes) may be more likely to report longer-than-expected anesthesia times.

Importance  Most physicians must exercise discretion in choosing billing details that determine payment for their services. Understanding the degree to which physicians inappropriately use this discretion has important implications for payment policies. However, separating higher case complexity from inappropriate billing has made this a challenging issue to study. Anesthesia offers a useful test case because practitioners are partly compensated by self-reported length of time (anesthesia time) spent on a case.

Objective  To characterize the incidence and consequences of inappropriate billing practices among anesthesia practitioners.

Design, Setting, and Participants  In this cross-sectional study of data from a large anesthesia registry, 6 261 955 procedures performed by 4221 anesthesia practitioners (physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants) between January 1, 2010, and March 31, 2015, were studied. A total of 3047 practitioners practiced primarily in community hospitals, whereas 453 practiced primarily in university hospitals and 721 practiced in other settings (eg, specialty hospital).

Exposures  Practitioners with anomalous patterns were identified as those reporting an unusually high number of anesthesia times ending in a multiple of 5 minutes (eg, 65 minutes).

Main Outcomes and Measures  Incidence of anomalous patterns among anesthesia practitioners and the increase in anesthesia times associated with these patterns.

Results  This study included 4221 practitioners who each performed at least 300 anesthetic procedures. Practitioners in the top fifth percentile reported anesthesia times ending in a multiple of 5 minutes a mean (SD) of 53.7% (13.7%) of the time (range, 36.8%-96.1%), whereas practitioners in the 6th to 10th percentiles reported anesthesia times ending in a multiple of 5 minutes a mean (SD) of 31.8% (2.0%) of the time (range, 29.2%-36.7%). Practitioners in the top fifth percentile submitted billing for anesthesia times that exceeded the expected time by a mean of 21.5 minutes (95% CI, 15.8-27.1 minutes).

Conclusions and Relevance  In this study, findings suggest that anesthesia practitioners with the highest tendency to report anesthesia times ending in a multiple of 5 minutes did so with high frequency, which reflects anomalous billing. These practitioners also sought payment for longer-than-expected anesthesia times, which would correspond to higher payment for their services.

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