December 2, 2019

Traditionally, anesthesia staffing has involved the assignment of a provider—either a physician or a CRNA—to an anesthetizing location for a line-up of cases. The assumption is that a surgeon performs all his or her cases in one room. Increasingly, though, anesthesia practices are being confronted with the challenge of “flip rooms,” where a very productive surgeon will require two operating rooms (ORs) so as to allow the surgeon to quickly jump from one room to the other at the conclusion of each case. As a result, two separate anesthesia providers must be assigned to a single surgeon; and this, in turn, may lead to less than optimal outcomes, depending on how many cases are involved in the day’s line-up.

Standard Productivity Models

There are two ways to analyze anesthesia provider productivity. One method involves calculating normalized metrics such as ASA billed units, billed hours or net collections per anesthesia location day. This approach requires the identification of the OR for each case. As an alternative in practices or venues where providers may administer anesthesia in multiple locations in the course of a day, such as for NORA (non-OR anesthesia) cases, it may be more appropriate to perform the calculations per provider day. The use of the first method is ideally suited to care team practices, while tracking activity by medically directed CRNA in the second model may be slightly more challenging.

Conventional wisdom holds that in an eight-hour day a single anesthetizing location should yield six hours of billed anesthesia time or at least 42 billed ASA units. While these are reasonable targets, relatively few anesthesia practices consistently achieve them. Knowing these average values for weekday activity (Monday through Friday) provides a very useful benchmark by which to evaluate all coverage requirements. The question, then, is what is the impact of flip rooms on practice productivity?

Flipping the Models on Their Head

For purposes of analysis, flip rooms must be distinguished from medically directed rooms. For physician-only practices, flip rooms involve one surgeon per day and two or more anesthesiologists. A medically directing anesthesiologist may be directing multiple CRNAs. Only those scenarios where two CRNAs are working with the same surgeon constitute flip rooms. As a general rule, flip rooms are less impactful to medically directed practices.

We reviewed data for six ABC clients across the country based on cases performed in September and October 2019. As indicated below, the percentage of flip room days varied significantly from one practice to another. The average for this sample was 14 percent. The medically directed practices are highlighted in blue.

From a productivity perspective, there are two flip room scenarios: those that are productive and those that are not productive based on the benchmarks established above. Invariably, this is a function of the surgeon. One can say that some surgeons are so productive that they merit flip room coverage and others simply are not.

For purposes of the table above, we identified a typical line-up of cases for one of the busiest surgeons connected to each of the sample practices.  The examples given do not represent statistical averages. They are intended to represent typical scenarios. While the anesthesia department may not have much input with regard to which surgeons get flip room coverage and which do not, it is still relevant and useful to know how the coverage requirements of each surgeon may impact staffing considerations. While not all anesthesia practices are care team practices, the data does seem to indicate that they are better positioned to deal with the impact of flip rooms—especially when considering that the second room is invariably a less productive room.

We present this study here in an effort to help our clients identify those coverage requirements that may adversely impact the overall staffing plan for the practice. As is always the case, one cannot manage what one does not measure. Here we have one more aspect of anesthesia practice management that may merit closer scrutiny. If you would like to assess the impact of flip rooms on your practice, feel free to contact your ABC account executive.

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