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Comparing Clinical Productivity of Anesthesiology Departments: Focus on a Chair’s Perspective

Comparing Clinical Productivity of Anesthesiology Departments: Focus on a Chair’s Perspective. Amr Abouleish, MD, MBA Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas aaboulei@utmb.edu. The Dean and The Consultant.

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Comparing Clinical Productivity of Anesthesiology Departments: Focus on a Chair’s Perspective

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  1. Comparing Clinical Productivity of Anesthesiology Departments:Focus on a Chair’s Perspective Amr Abouleish, MD, MBA Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas aaboulei@utmb.edu

  2. The Dean and The Consultant • The Medical School is facing a Budget Deficit • Salaries are major costs • How to cut costs but not services? • The Dean has decided to measure clinical productivity and determine which departments are overstaffed (or underproducing)

  3. The Dean and The Consultant • Dean has hired a consultant • The consultant has made his report • The Dean has called you, the Chair of Anesthesiology, in to discuss what % you WILL cut from your faculty

  4. The Report

  5. The Report

  6. Why is the analysis meaningless? The Report

  7. Why is the analysis meaningless? Staffing Needs  Workload The Report

  8. For Anesthesiology GroupsStaffing Needs and Workload • For the next month, what determines how many anesthesiologists you need?1 1 ASA Newsletter August 2001;65:14

  9. For Anesthesiology GroupsStaffing Needs and Workload • For the next month, what determines how many anesthesiologists you need?1 • Number of clinical sites • Concurrency Ratio • 2nd Shift? – Hours of operations • Call and PostCall 1 ASA Newsletter August 2001;65:14

  10. For Anesthesiology GroupsStaffing Needs and Workload • For the next month, what determines how many anesthesiologists you need?1 • Number of clinical sites • Concurrency Ratio • 2nd Shift? – Hours of operations • Call and PostCall • What does not determine how many anesthesiologists you need? • Workload (e.g., number of cases in each room) • Productivity measurements 1 ASA Newsletter August 2001;65:14

  11. Why is the analysis meaningless? Staffing Needs  Workload The Report

  12. Why is the analysis meaningless? Staffing Needs  Workload Per FTE comparisons are inaccurate The Report

  13. MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309

  14. MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309

  15. MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309

  16. MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309

  17. Why is the analysis meaningless? Staffing Needs  Workload Per FTE comparisons are inaccurate The Report

  18. Why is the analysis meaningless? Staffing Needs  Workload Per FTE comparisons are inaccurate The Report How do we compare clinical productivity of Anesthesiology groups?

  19. Comparing Departmental ProductivityStudy of Multiple Groups • Although not a complete industry-wide study, the results are used to illustrate how to compare departments/groups • 14 groups • 9 Academic Departments • 5 Private-Practice Groups • 229,987 cases • 199 daily anesthesiologists • 274 daily OR sites (ORs) Anesthesiology 2001; 95:A1108

  20. Comparing Departmental Productivity Data Collected • Designed with industry-wide survey as goal • Limitations • available data that was not confidential • NOT too time consuming to complete • Total ASA units (tASA) • Time units • Total cases billed (case) • Ave daily OR sites staffed (OR site) • Ave Anesthesiologists to staff sites (Faculty Only) Anesth Analg 2001; 93:309 Anesthesiology 2001; 95:A1108

  21. Comparing Departmental Productivity Exclusions • Only OR Anesthesia care included • OB anesthesia care excluded • Any RVU-based services excluded • Line Placement • Pain management consult and procedures • Critical Care Services Anesth Analg 2001; 93:309 Anesthesiology 2001; 95:A1108

  22. Concurrency tASA/OR Site Hrs/OR/Day (Time units/OR Site) Hrs/case tASA/hr Comparing Departmental Productivity Productivity Measurements Designed to allow for meaningful comparisons … tASA = total ASA units Hr = 4 Time Units Anesth Analg 2001; 93:309 Anesthesiology 2001; 95:A1108

  23. Meaningful Comparisons allow these types of questions to be answered: • Are we producing as much as average group? • Are we working longer hours than others? Do we run our OR rooms longer hours than others? • How does speed of surgery affect my apparent productivity?

  24. Are we producing as much as average group? tASA = total ASA units billed Concur= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108

  25. Are we producing as much as average group? tASA = total ASA units billed Concur= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108

  26. Are we not working as long? If we increased hours, would this help? *TU/OR site TU = Time units billed tASA = total ASA units billed Concur= Concurrency = OR site per anesthesiologist

  27. Are we not working as long? If we increased hours, would this help? *TU/OR site Hrs = 4 time units tASA = total ASA units billed Concur= Concurrency = OR site per anesthesiologist

  28. tASA hr Total ASA Units Hour of Care Total Base + Total Time Units Total Time Units  4 = = tASA hr Total Base + 32 32  4 = Speed of Surgery and Productivity • If two groups work 8 billed hours, then for both groups: • Only difference is Total Base Units billed • What determines Total Base Units billed number of cases done in 8 hrs and base/case

  29. tASA hr Total ASA Units Hour of Care Total Base + Total Time Units Total Time Units  4 = = Speed of Surgery and Productivity tASA = total ASA units, Hr = 4 Time units Concur.= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108

  30. tASA hr Total ASA Units Hour of Care Total Base + Total Time Units Total Time Units  4 = = Speed of Surgery and Productivity tASA = total ASA units, Hr = 4 Time units Concur.= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108

  31. tASA hr Total ASA Units Hour of Care Total Base + Total Time Units Total Time Units  4 = = Speed of Surgery and Productivity tASA = total ASA units, Hr = 4 Time units Concur.= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108

  32. Speed of Surgery and Productivity • Multiple measures allow for better evaluation • Important if Academic group is being compared to Private Groups! tASA = total ASA units, Hr = 4 Time units Concur.= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108

  33. Comparing Departmental Productivity Subgroup Analyses

  34. Comparing Departmental Productivity Subgroup Analyses • OR size • Number of Cases • Type of Practice (County, Closed Staff, Trauma) *p-value<0.05

  35. Comparing Departmental ProductivityWhat next? Work to be done • OR Anesthesia Care Productivity: Industry-wide study to provide means to allow comparisons • How to measure clinical productivity for OB, ICU, or Pain Management?

  36. Comparing Departmental Productivity Take Home Messages • Staffing needs are not determined on productivity measurements or workload • “per FTE” measurements are inaccurate in comparing groups that have different concurrencies • Speed of Surgery influences the total ASA units billed by an Anesthesiology department • Multiple measurements should be used • “per OR site”, “per Case”, and “tASA/hr” allow for meaningful comparisons

  37. Comparing Clinical Productivity of Anesthesiology Departments:Focus on a Chair’s Perspective Amr Abouleish, MD, MBA Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas aaboulei@utmb.edu

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