“Utilization and Associated Spending for Anesthesiologist Administered Services in Minor Hand Surgery”

Background: Evidence is lacking to support the use of specialized anesthesia providers in minor surgical operations for patients without medical necessity. We sought to estimate the extent of potentially discretionary service use (anesthesiologist-administered anesthesia services among low-risk patients). Methods: We performed a retrospective claims analysis using the Truven Marketscan Database to estimate the prevalence and cost of anesthesiologist-administered anesthesia services provided to patients undergoing minor hand surgery (carpal tunnel release, trigger finger release, or de Quervain release) from 2010-2015. A predictive probability model was created to estimate patient risk-status. We examined the relationship between patient risk-status and anesthesia use using multivariable regression models. Results: Of 441,579 eligible procedures, 352,779 (80%) involved anesthesiologist-administered anesthesia services. The total proportion of estimated anesthesiologist-administered anesthesia use in low-risk patients who do not need anesthesiologist support declined over the study period (69.7% in 2010 to 65.8% in 2015). Although total payments for anesthesiologist-administered anesthesia services remained steady between 2010 and 2014, the average payment per procedure increased regardless of procedure type (from $376.8 in 2010 to $427.9 in 2015 for a carpal tunnel release operation). Approximately 83.7% ($133 million) of payments to anesthesia providers is credited to services in low-risk patients. Conclusions: Anesthesiologist-administered anesthesia services are commonly rendered to low-risk surgical patients. Existing health reform efforts do not adequately address discretionary services that can be a targeted area for cost saving. It is important to consider the implications of potentially discretionary use of specialized anesthesia providers particularly with the advancement of bundled payment models. Financial Disclosure Statement: This work was supported by a Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) (to Dr. Kevin C. Chung). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Acknowledgement: The authors thank Yiwen Lu, MS, and Lin Zhong, MPH, MD, for their assistance in data analysis and technical support. Presented at: American Society for Surgery of the Hand (ASSH) Annual Meeting, San Francisco, CA, September 2017 Corresponding Author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5340, kecchung@umich.edu, Phone 734-936-5885 ©2017American Society of Plastic Surgeons