![]() Different statistics (also known as productivity measurements) are used to determine who is the better hitter, better pitcher, or better fielder. For example, in baseball, how one measures productivity of individual players is very dependent on the player position. To illustrate this concept that group and individual productivity measurements are not necessarily the same, one just needs to look at any team sport. Because the group has to provide care in multiple settings and functions, individual measurements will need to be tailored to each of these areas. 7–13 In contrast, group measurements should be focused on how well the team of individuals are functioning and producing. From a management perspective, individual measurements are used often as part of incentive systems or behavior modification systems. Individual measurements should reflect activities under the individual’s discretion and control. Last, group leaders need to be cognitive that measuring group productivity is different than measuring individual productivity. Similarly, if the anesthesiologists at a facility are organized in distinct specialty teams providing care in distinct OR sites and/or with specific surgical services, group leaders might choose to compare productivity by specialty teams. On the other hand, if the group uses economies of scale for administrative activities for multiple facilities but do not move staff during the day, then it would be better to understand clinical activity by keeping the facilities separate. On the flip side, if a group covers two facilities but actually shares staff on a daily basis-that is, anesthesiology leaders may distribute mid-level providers and anesthesiologists between facilities based on actual demand by day or move providers between facilities during the day as demands are needed, then one could consider the two facilities as one facility because they combine resources. Anesthesiology leaders might find this separation to be helpful in comparing productivity and may use it to show how non-OR productivity and OR productivity are very different and one might actually think of creating two virtual facilities in one building. For example, non–operating room anesthesia care may be separated from operating room (OR) anesthesia care. ![]() In addition, the methodology described in this review can also be applied to areas in one facility if these areas represent unique and distinct clinical areas. Because the term group measurements is still commonly used, we also use this term however, one should note that measurements for a “group” really mean measurements at the “facility” level. In other words, viewing “group” productivity at each facility is essential for anesthesiology leaders to make informed decisions. Because the type of facility is a major variable for productivity measurements, 4 it is not possible to make meaningful comparisons and conclusions when measurements at the group level encompass multiple and varied facilities. Academic departments now provide care in more than in a single large academic medical center. Even local groups typically provide care in more than one facility. Today, there are national groups or companies that provide care in multiple facilities. That is, the anesthesiology group provided care in one facility, and sometimes in a smaller second facility. Over the past 20 yr and accelerating more recently, the acquisition and merger of anesthesiology groups have changed the definition of “anesthesiology group.” Previously, an anesthesiology group was synonymous with the anesthesiology department in one facility. Types of activities include, but are not limited to, wRVU procedures done with surgical anesthesia ( e.g., placement of arterial or central vein catheters, transesophageal echocardiography), acute postoperative pain blocks and inpatient hospital visits (consultations and follow-up visits), chronic pain medicine evaluation and management (E&M) services and procedures, and critical care E&M services and procedures. Clinical work billed using wRVUs is excluded when comparing surgical anesthesia work. In addition, because ASA units include both base units and time units, ASA units allow for differentiation of work performed more than a more general measurement such as “cases.” But because all other clinical care is billed with a different kind of unit (relative value units, whose one component represents work ), comparison of wRVUs and ASA units is not readily possible. Therefore, for anesthesiology groups, ASA units billed are relatively easy data to find. As will be seen in this review, surgical anesthesia care in the United States is billed using ASA units.
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