Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records

Published in: Health Services Research, 2016

Posted on RAND.org on March 18, 2016

by Lane F. Burgette, Andrew W. Mulcahy, Ateev Mehrotra, Teague Ruder, Barbara O. Wynn, Ateev Mehrotra

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Research Questions

  1. How accurate are the estimates used by the Centers for Medicare and Medicaid Services (CMS) to set their fee schedules for surgical procedures?
  2. How can CMS use available data to make more accurate estimates?

OBJECTIVE: The median time required to perform a surgical procedure is important in determining payment under Medicare's physician fee schedule. Prior studies have demonstrated that the current methodology of using physician surveys to determine surgical times results in overstated times. To measure surgical times more accurately, we developed and validated a methodology using available data from anesthesia billing data and operating room (OR) records. DATA SOURCES: We estimated surgical times using Medicare 2011 anesthesia claims and New York Statewide Planning and Research Cooperative System 2011 OR times. Estimated times were validated using data from the National Surgical Quality Improvement Program. We compared our time estimates to those used by Medicare in the fee schedule. STUDY DESIGN: We estimate surgical times via piecewise linear median regression models. PRINCIPAL FINDINGS: Using 3.0 million observations of anesthesia and OR times, we estimated surgical time for 921 procedures. Correlation between these time estimates and directly measured surgical time from the validation database was 0.98. Our estimates of surgical time were shorter than the Medicare fee schedule estimates for 78 percent of procedures. CONCLUSIONS: Anesthesia and OR times can be used to measure surgical time and thereby improve the payment for surgical procedures in the Medicare fee schedule.

Key Findings

  • Current CMS estimates tend to overstate the time that is typically required to perform most services.
  • Anesthesia and operating room (OR) times can be used to measure surgical time and thereby improve the payment for surgical procedures in the Medicare fee schedule.

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