Anesthesia practitioners with a tendency to report times rounded to 5 minutes are more likely to submit billing times that correspond to higher payments for anesthesia services, according to research results published in JAMA Network Open.

To better understand the extent that physicians may inappropriately choose billing details that affect payment for their services, researchers in this cross-sectional study utilized data from an anesthesia registry of 6,261,955 procedures performed by 4221 separate anesthesia practitioners — including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants — between January 2010 and March 2015.

Of these practitioners, 453 worked primarily in university hospitals, 3047 primarily in community hospitals, and 721 in other settings, such as specialty hospitals. Each practitioner performed 300 or more anesthetic procedures. Researchers identified all practitioners with anomalous reporting patterns, such as an unusually high number of times that end in a multiple of 5, to determine the incidence of such patterns and the consequent increase in anesthesia billing times after adjusting for factors indicating particularly complex medical cases.

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Of these 4221 anesthesia practitioners, those in the top fifth percentile reported times in a multiple of 5 a mean of 53.7% of the time (range, 36.8%-96.1%), while practitioners in the sixth through tenth percentiles did so a mean of 31.8% of the time (range, 29.2%-36.7%). After adjusting for surgery type, the site where the procedure occurred, age, sex, and patient comorbidities, the top fifth percentile of practitioners submitted anesthesia billing times that exceeded expectations by a mean 21.5 minutes (141 minutes [95% CI, 132-151] vs 120 minutes [95% CI, 112-128]; 95% CI, 15.8-27.1 minutes)

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Study investigators concluded that anesthesia practitioners are unlikely to be unique in these types of behaviors, and given these findings, suggest that “future studies should examine the degree to which physicians and other health care practitioners inappropriately use their discretion in determining reimbursement, as well as the potential effect of alternative payment policies.”


Sun EC, Dutton RP, Jena AB. Comparison of anesthesia times and billing patterns by anesthesia practitioners [published online November 9, 2018]. JAMA Netw Open. 2018; 1(7):e184288. doi: 10.1001/jamanetworkopen.2018.4288