Providing anesthesia to patients continues to increase in non-OR anesthesia locations (NORA) such as radiology, cardiac catheterization suites, and other sites. With benchmarking from the individual faculty to the facility level becoming increasingly relevant, understanding how different locations perform is crucial. Previously, Abouleish et al. established productivity metrics at site and facility levels.1 More recently, Hudson et al. demonstrated that individual faculty productivity hinges on the percentage of NORA cases covered by the staff member.2 To understand NORA productivity metrics on a more granular scale, we define and apply a productive measure defined as ASA units produced by each service per day and an economic impact measure defined as net collections per ASA unit for each NORA and OR service.

1. A Methodology to Compare Disparities in Revenue Generation and Productivity
Between OR and NORA Locations
Brandon Peckham, MHA1; Mitchell H. Tsai, MD, MMM2; Christopher R. Giordano, MD1; Scott S. Sumner, MBA1; Christopher Mayhew, MD2; Timothy E. Morey, MD1
1Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL; 2Department of Anesthesiology, University of Vermont Larner College of Medicine
Background Results
ConclusionMethods
References
Figure 1
Providing anesthesia to patients continues to increase in non-OR
anesthesia locations (NORA) such as radiology, cardiac catheterization
suites, and other sites. With benchmarking from the individual faculty
to the facility level becoming increasingly relevant, understanding
how different locations perform is crucial. Previously, Abouleish et al.
established productivity metrics at site and facility levels.1 More
recently, Hudson et al. demonstrated that individual faculty
productivity hinges on the percentage of NORA cases covered by the
staff member.2 To understand NORA productivity metrics on a more
granular scale, we define and apply a productive measure defined as
ASA units produced by each service per day and an economic impact
measure defined as net collections per ASA unit for each NORA and
OR service.
1. Abouleish AE, Prough DS, Barker SJ, et al. Anesth Analg 2003;96(3):802–812.
2. Hudson ME, Lebovitz EE. Anesthesiol Clin XXXX;36(2):143–160.
3. Tsai MH, Huynh TT, Breidenstein MW, et al. A J Med Syst 2017;41(7):112.
At UF Health, a 1,232-bed quaternary care academic medical center,
we used professional billing and clinical encounter data from
1/1/2018 to 7/31/2018 to generate a productive measure defined as
ASA units produced by each service per day and an economic impact
measure defined as net collections per ASA unit for each service.
Additionally, each service was classified as a NORA or OR specialty.
Comparisons were conducted with two-tailed, unpaired t-tests with a
P value <0.05 denoting significance. The divisions of Critical Care
Medicine and Chronic Pain Medicine were excluded.
Data for all services with NORA and OR locations are shown in
orange and blue, respectively (Figure 1). When the analysis
includes GI, there was no significant difference in productivity (P =
0.097) or economic impact (P = 0.455). However, when GI data is
excluded, NORA locations generated significantly less productivity
(P = 0.0006) and the financial impact remained similar when
compared with traditional OR suites (P = 0.492; Figure 2). The
Table below shows the impact GI has on NORA locations.
For most anesthesia groups, NORA locations generate less
productivity than do traditional OR suites. The economic
impact, defined as net collections per ASA unit, remains
similar across OR and NORA locations. A GI endoscopy suite
may perform better than an OR suite. The opening of new
NORA locations requires a discussion about financial losses,
benchmarking of the individual NORA services, and an
alternative funds flow. 3 Furthermore, the disparity between
OR and NORA ASA Unit productivity has implications on the
productivity at the individual faculty level.
[CELLRANGE],
38.2, $33.90, $2,230,187
[CELLRANGE],
41.5, $34.24, $11,488,700
NORA (excl. GI)
25.4, $35.75, $991,763
$0.00
$10.00
$20.00
$30.00
$40.00
$50.00
$60.00
$70.00
0.0 10.0 20.0 30.0 40.0 50.0 60.0
EconomicImpact(NetCollections/ASAUnit)
Room Productivity (ASA Units/Room/Day)
$/ASA Unit & ASA Units/Room, Categorized into NORA & OR
Figure 2
[CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANG…
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRAN…
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
$70.0
0.0 10.0 20.0 30.0 40.0 50.0 60.0
EconomicImpact(NetCollections/ASAUnit)
Room Productivity (ASA Units/Room/Day)
$/ASA Unit & ASA Units/Room by Service
Metric OR
NORA
Incl GI
NORA
Excl GI
GI's Impact
on NORA
Distinct OR Days 212 198 180 10%
Sum of ASA Units 335,519 65,788 27,739 137%
Sum of Net Collections $11,488,700 $2,230,187 $991,763 125%
$/ASA $34.24 (9.96) $33.90 (8.36) $35.75 (8.73) -5%
ASA Units/Day 1,582 332 154 116%
Distinct Count of Provider Days 8,909 2,321 1,349 72%
ASA Units/Unique OR Day 41.5 (10.68) 38.2 (12.62) 25.4 (5.92) 50%
Figure 3
OR Services
NORA Services
Legend
*Size of bubble indicates Net Collections
*Numbers in parentheses denote standard deviation