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

Area of Science:

• Health Economics
• Medical Informatics
• Surgical Outcomes

Background:

• Accurate surgical procedure times are essential for Medicare physician fee schedule (PFS) reimbursement.
• Current methods for determining surgical times, relying on physician surveys, often lead to overestimations.
• A more accurate methodology is needed to reflect actual surgical times for fair payment determination.

Purpose of the Study:

• To develop and validate a novel methodology for measuring surgical procedure times.
• To utilize readily available anesthesia billing and operating room (OR) records for more accurate time estimation.
• To compare newly estimated surgical times with current Medicare PFS benchmarks.

Main Methods:

• Piecewise linear median regression models were employed to estimate surgical times.
• Medicare 2011 anesthesia claims and New York Statewide Planning and Research Cooperative System 2011 OR times were utilized.
• Validation was performed using data from the National Surgical Quality Improvement Program.

Main Results:

• Surgical times were estimated for 921 procedures using over 3 million data observations.
• A high correlation (0.98) was found between estimated and directly measured surgical times.
• The new estimates were shorter than Medicare PFS estimates for 78% of procedures.

Conclusions:

• Anesthesia and OR data offer a reliable method for measuring surgical procedure times.
• Implementing this methodology can lead to improved accuracy in Medicare PFS payments.
• This approach supports fairer reimbursement for surgical procedures based on actual time spent.