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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 Amr Abouleish, MD, MBA Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas aaboulei@utmb.edu
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)
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
Why is the analysis meaningless? The Report
Why is the analysis meaningless? Staffing Needs Workload The Report
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
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
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
Why is the analysis meaningless? Staffing Needs Workload The Report
Why is the analysis meaningless? Staffing Needs Workload Per FTE comparisons are inaccurate The Report
MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309
MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309
MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309
MD-only (Private) vs. Medical Direction (Academic) tASA = total ASA units Anesth Analg 2001; 93:309
Why is the analysis meaningless? Staffing Needs Workload Per FTE comparisons are inaccurate The Report
Why is the analysis meaningless? Staffing Needs Workload Per FTE comparisons are inaccurate The Report How do we compare clinical productivity of Anesthesiology groups?
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
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
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
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
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?
Are we producing as much as average group? tASA = total ASA units billed Concur= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108
Are we producing as much as average group? tASA = total ASA units billed Concur= Concurrency = OR site per anesthesiologist Anesthesiology 2001; 95:A1108
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
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
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
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
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
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
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
Comparing Departmental Productivity Subgroup Analyses • OR size • Number of Cases • Type of Practice (County, Closed Staff, Trauma) *p-value<0.05
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?
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
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