Acute trauma with multiple injuries.

Trauma with multiple injuries is a leading cause of death. It presents a diversity of challenges and requires many healthcare workers to care for its victims. Advances continue in the organization of pre-hospital care, the techniques of trauma surgery and critical care, and understanding the pathophysiology of traumatic injuries.

Financial impact if payers use medicare rates: anesthesiology versus other specialties.

BACKGROUND: In 1992, Medicare changed its method for calculating physician payments. The resulting fee schedules have contained low payments for anesthesiologists. Now, other third-party (insurance) payers are using these schedules. The financial impact on anesthesiologists if all payers pay Medicare rates is unknown. METHODS: Payments from Medicare were compared with payments from other third parties in each clinical procedural terminology (CPT) grouping used by the West Virginia University Department of Anesthesiology during 1998. Changes in total Department of Anesthesiology receipts were determined if non-Medicare third-party payers paid Medicare rates. Then, the effect of adding payments at Medicare rates from patients without insurance was determined. Finally, potential changes in receipts of the Departments of Anesthesiology, Radiology, Surgery, and Medicine were compared by considering only patients with insurance and recalculating total payments to the departments using Medicare rates. RESULTS: Medicare paid less than other third-party payers in every clinical procedural terminology group. Total Department of Anesthesiology payments would decrease by 31% if all non-Medicare third-parties paid Medicare rates. Adding payments at Medicare rates from patients without insurance still leads to a 21% decrease in total Department of Anesthesiology receipts. Considering only patients with third-party coverage, Medicare-rate payments would decrease total Department of Anesthesiology payments by 37%, whereas radiology, surgery, and medicine payments would decrease by 26, 22, and 13% respectively. CONCLUSIONS: Universal payments at Medicare rates would substantially reduce revenue to anesthesiologists, proportionally more than to radiologists, surgeons, or internists.

Evaluation of an anesthesiology department newsletter.

The West Virginia University Department of Anesthesiology has distributed a weekly newsletter to department members for several years. A recent survey and discussion among members found the newsletter to be useful and important in shaping the culture of the department and marketing it. A weekly format of three to five pages was judged best. News about anesthesiology, department policies, and practice management information were most valued.

Cost containment in anesthesiology: a survey of department activities.

STUDY OBJECTIVE: To survey cost containment activities in anesthesiology and to determine to what extent departments use cost policies and guidelines. DESIGN: Mail survey. SETTING: Academic and large nonacademic anesthesiology departments. MEASUREMENTS AND MAIN RESULTS: 147 responding departments answered 20 questions. 38% of surveys were returned. 90 responders identified themselves as academic departments and 57 responders as nonacademic. 73% of departments reported pressure from hospital administrators to reduce anesthesia costs. The most common cost-saving activity, used by 90% of departments, is improving operating room (OR) utilization. 53% of all departments have policies or guidelines to contain drug costs, while 48% of departments have these to contain other product costs. Departments reporting themselves as academic generally reported greater use of cost policies. CONCLUSIONS: Anesthesiology departments are experiencing pressure to reduce costs and the majority have cost policies and guidelines concerning utilization of ORs and anesthetic drugs. Academic anesthesiology departments may be experiencing more cost-containment pressure than nonacademic departments.

Managing pharmaceutical sales activities in an academic anesthesiology department.

To contain costs, departments of anesthesiology must control the use of new, expensive drugs. Conflicts with pharmaceutical companies can arise when they promote drug sales. Pharmaceutical company sales represent anesthesiology department expenses. Anesthesiologists hold diverse opinions on this clash of interests, on the proper roles of pharmaceutical sales representatives in anesthesiology departments, and on the ethics of accepting industry gifts. Our department has managed pharmaceutical sales activities by encouraging discussion of the ethics and legal limits of industry gifts, by banning sales representatives from bringing food into the department, and by adopting The American Medical Association Guidelines on Gifts.

Knowledge of medical charges.

Ignorance of medical charges by decision-makers could handicap cost control programs. By written survey, we determined the ability and confidence of 267 adults, including 85 health care workers, to estimate four medical charges: epidural anesthesia for childbirth, outpatient hernia surgery, dipyridamole-thallium heart stress test, and a one month supply of nicotine drug patches. Only 36% of the estimated charges fell within 50% of the actual charges for the four medical services. Accuracy did not differ among physicians, non-physician health care workers and consumers; estimates varied greatly with many being extremely low or high. Respondents rated medical charges significantly more difficult to estimate than non-medical. Seventy percent of respondents felt that most physicians do not know enough about medical charges to give good advice and 92% felt that they did not know enough about medical charges to make satisfactory choices.

Market costs of short-term physician and nurse anesthesia services.

STUDY OBJECTIVE: To estimate the market costs of short-term physician and certified registered nurse-anesthesia (CRNA) services. DESIGN: Survey of large locum tenens agencies. SETTING: University hospital. MEASUREMENTS AND MAIN RESULTS: Negotiations were carried out with agencies for best prices for four weeks of routine anesthesia work. The average cost for an anesthesiologist was $133 per hour and a CRNA, $86 per hour. The agencies received approximately 18% of these costs. CONCLUSIONS: Despite competitive pressures, the locum tenens market charges 55% more for physician than CRNA services. The implications for the different charges are discussed.