Comparison of Anesthesia Times and Billing Patterns by Anesthesia Practitioners
Comparison of Anesthesia Times and Billing Patterns by Anesthesia Practitioners
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DOI：
10.1001/jamanetworkopen.2018.4288
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发表时间：
2018-11-01
影响因子：
13.8
通讯作者：
Jena, Anupam B.
中科院分区：
文献类型：
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作者：
Sun, Eric C.;Dutton, Richard P.;Jena, Anupam B.
重要性大多数医生在选择决定其服务付款的账单细节时必须谨慎行事。了解医生在多大程度上不适当地使用这种自由裁量权，对支付政策具有重要意义。然而，将更高的案件复杂性与不适当的账单分开，使这一问题成为一个具有挑战性的研究问题。麻醉提供了一个有用的测试案例，因为从业者可以通过自己报告的在病例上花费的时间长度(麻醉时间)来部分补偿。目的为了表征麻醉从业者中不适当的计费做法的发生率和后果。设计、设置和参与这项来自大型麻醉登记数据的横断面研究，研究了2010年1月1日至2015年3月31日期间4221名麻醉从业者(内科麻醉师、护士麻醉师和麻醉师助理)进行的6 261 955例手术。共有3047名从业者主要在社区医院执业，453名从业者主要在大学医院执业，721名从业者在其他环境(如专科医院)执业。异常模式从业者被确定为那些报告麻醉时间超过5分钟倍数(例如65分钟)的人。主要结果和测量麻醉从业者中异常模式的发生率以及与这些模式相关的麻醉时间的增加。结果本研究包括4221名从业者，他们每人至少进行了300次麻醉程序。前5个百分位数的医生报告麻醉时间以5分钟的倍数结束(范围为36.8%-96.1%)，平均(SD)为53.7%(范围为36.8%-96.1%)，而第6至10个百分位数的从业者报告的麻醉时间以5分钟的倍数结束(SD为31.8%(2.0%))(范围为29.2%-36.7%)。排名前五分之一的医生提交的麻醉时间比预期时间平均超出21.5分钟(95%可信区间为15.8-27.1分钟)。结论和相关性在本研究中，研究结果表明，报告麻醉时间超过5分钟倍数的麻醉医生报告的频率很高，这反映了异常账单。这些从业者还要求为比预期更长的麻醉时间付费，这将对应于他们的服务更高的报酬。
IMPORTANCE Most physicians must exercise discretion in choosing billing details that determine payment for their services. Understanding the degree to which physicians inappropriately use this discretion has important implications for payment policies. However, separating higher case complexity from inappropriate billing has made this a challenging issue to study. Anesthesia offers a useful test case because practitioners are partly compensated by self-reported length of time (anesthesia time) spent on a case.OBJECTIVE To characterize the incidence and consequences of inappropriate billing practices among anesthesia practitioners.DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study of data from a large anesthesia registry, 6 261 955 procedures performed by 4221 anesthesia practitioners (physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants) between January 1, 2010, and March 31, 2015, were studied. A total of 3047 practitioners practiced primarily in community hospitals, whereas 453 practiced primarily in university hospitals and 721 practiced in other settings (eg, specialty hospital).EXPOSURES Practitioners with anomalous patterns were identified as those reporting an unusually high number of anesthesia times ending in a multiple of 5 minutes (eg, 65 minutes).MAIN OUTCOMES AND MEASURES Incidence of anomalous patterns among anesthesia practitioners and the increase in anesthesia times associated with these patterns.RESULTS This study included 4221 practitioners who each performed at least 300 anesthetic procedures. Practitioners in the top fifth percentile reported anesthesia times ending in a multiple of 5 minutes a mean (SD) of 53.7%(13.7%) of the time (range, 36.8%-96.1%), whereas practitioners in the 6th to 10th percentiles reported anesthesia times ending in a multiple of 5 minutes a mean (SD) of 31.8%(2.0%) of the time (range, 29.2%-36.7%). Practitioners in the top fifth percentile submitted billing for anesthesia times that exceeded the expected time by a mean of 21.5 minutes (95% CI, 15.8-27.1 minutes).CONCLUSIONS AND RELEVANCE In this study, findings suggest that anesthesia practitioners with the highest tendency to report anesthesia times ending in a multiple of 5 minutes did so with high frequency, which reflects anomalous billing. These practitioners also sought payment for longer-than-expected anesthesia times, which would correspond to higher payment for their services.