Economic Impact, Cost, and Reimbursement Issues
Healthcare delivery costs in the perioperative setting have increased due to varying factors. Regional anesthesia (RA) minimizes costs and would lead to cost benefits on evaluation. RA allows for airway avoidance and minimizes/eliminates general anesthesia requirements for perioperative patient care. Additionally, patients receiving RA have fewer effects from perioperative anesthetic agents than their general anesthesia cohorts.
Bypassing Phase I recovery leads to tangible savings that medical center leadership may tangibly notice. Older patients and those with comorbidities are able to have surgery on an outpatient basis, largely on the strengths of RA, leading to a fiscally viable healthcare delivery.
With the implementation of programs to enhance care and recovery via protocol-driven algorithms (ERAS and ERPs), RA plays a vital role in virtually all surgical encounters, enabling cost beneficial and safe patient care.
The anesthesiologists of today and tomorrow will play a vital role in the perioperative home and in executing the ERAS programs via a RA service. Fiscal responsibility is reflected by perioperative physician’s technical choices in care delivery. This cost-saving approach also allows for new avenues and revenue for the anesthesia service team. Key considerations are required in the implementation of a RA service and in the documentation of procedures performed for economic viability.
Armed with an analysis of evaluating the plethora of techniques and agents to provide safe and cost-effective care, the anesthesiologist with regional expertise and insight into the economics of healthcare will be poised to lead the operating room of tomorrow.
KeywordsRegional anesthesia Anesthesia-controlled times (ACT) Economics Peripheral nerve block Billing Ultrasound guidance Operating room management Fixed and variable costs Performance standards Perioperative efficiency
- 1.Center for Medicaid and Medicare Services. NHE fact sheet [Internet]. Baltimore: Center for Medicaid and Medicare Services; 2016 [cited 2016 Jan 30]. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html.
- 5.Alzahrani T, Eldawlatly A. The enigma of regional anesthesia in enhanced recovery after anesthesia protocols. Basic Res J Med Clin Sci. 2016;5(7):127–33.Google Scholar
- 9.Institute for Healthcare Improvement. IHI triple aim initiative [Internet]. Cambridge, MA; 2010 [cited 2016 Jan 31]. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/Materials.aspx.
- 10.Healthcare Cost Institute. Health care cost and utilization report: 2011. Washington, DC: Health Care Cost Institute; 2012 [cited 2016 Feb 1]. http://www.healthcostinstitute.org/report/2012-health-care-cost-utilization-report/.
- 19.Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.CrossRefPubMedGoogle Scholar
- 22.Foster BD, Terrell R, Montgomery SC, Wang JC, Petrigliano FA, McAllister DR. Hospital charges and practice patterns for general and regional anesthesia in arthroscopic anterior cruciate ligament repair. Orthop J Sports Med. 2013;1(5):1–5.Google Scholar
- 27.Williams BA, DeRiso BM, Figallo CM, Anders JW, Engel LB, Sproul KA. Benchmarking the perioperative process: III. Effects of regional anesthesia clinical pathway techniques on process efficiency and recovery profiles in ambulatory orthopedic surgery. J Clin Anesth. 1998;10:570–8.CrossRefPubMedGoogle Scholar
- 35.Williams BA, Kentor ML, Vogt MT, Vogt WB, Coley KC, Williams JP, et al. The economics of nerve block pain management after anterior cruciate ligament reconstruction: significant hospital cost savings via associated PACU bypass and same-day discharge. Anesthesiology. 2004;100:697–706.CrossRefPubMedGoogle Scholar
- 40.Ilfeld BM, Mariano ER, Williams BA, Woodward JN, Macario A. Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case control, cost-minimization analysis. Reg Anesth Pain Med. 2007;32:46–54.PubMedPubMedCentralGoogle Scholar
- 51.American Medical Association. CPT 2017 Professional Edition. American Medical Association; 2017.Google Scholar