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Uncovering the Hidden Costs of Anesthesia Care

Nathan, Naveen MD

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doi: 10.1213/ANE.0000000000005931

Conventional reimbursement models for clinical anesthesia services often do not reflect the full scope of services provided in large, tertiary level hospitals. As an example, anesthesia care team members may be deployed to assist with acute emergencies in hospital wards. Often this coincides with the more familiar role of providing care to patients undergoing surgical procedures and as such, strains resources. In many cases, the anesthesia care team may not generate a traditional, “billable” intervention, such as an acute patient status evaluation that does not result in intubation. Even when such events are documented, they may easily evade capture and ultimately fail to reflect the true supply/demand characteristics of the essential services anesthesia departments provide. In this issue, Stone et al uniquely used a time-driven activity-based costing model to uncover the specific impact of anesthesia airway response team on reimbursement. They determined that providing this service incurs a cost that is significantly under-compensated using current reimbursement models. Although the staffing costs for airway response teams approximated the amount billed for, it did not reflect the ancillary equipment costs. Nor did the revenue collected reflect non-billable activity as described in the example above. Less than one third of all the airway response team activations resulted in reimbursement. This illuminates the hidden demand of anesthesia services in just one aspect of the specialty. Exploring and affirming the true demand of clinical anesthesia expectations is imperative as it can be leveraged to negotiate hospital subsidies. This defines the true economy of our specialty.


    1. Stone AB, et al. Understanding the economic impact of an essential service: applying time-driven activity-based costing to the hospital airway response team. Anesth Analg. 2022;134:445–453.
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