Once you have decided that you need to add a nurse anesthetist to your group, or that you may wish to allocate anesthesiologists differently, you will need to know how much a nurse anesthetist would cost and how much revenue he or she would generate. While adding up the direct costs may be relatively straightforward, calculating the indirect expenses involves assumptions, projections and allocation decisions. In particular, you will have to choose what portion of the practice's overhead should be attributed to the nurse anesthetist. This determination could be as simple as dividing the total overhead expenses by the total number of providers in the group, or it could involve a more sophisticated breakdown by type of provider, by compensation level, etc. Revenue Revenue depends on conversion factors as well as on payers' methods of handling reimbursement for nurse anesthetists.
Conversion factors vary significantly from one payer to another and from one region to another.
Payers also differ in how they allocate the fee between anesthesiologist and anesthetist. While many payers do not differentiate between staffing models and simply remit 100 percent of the fee to the practice without regard to the involvement of allied health personnel, Medicare and a growing number of commercial carriers divide the payment between the medically directing anesthesiologist and the nurse anesthetist. It is generally not feasible to staff operating rooms according to payer, so the analysis will be based on your own practice payer mix and on how your largest payers handle nurse anesthetist reimbursement. By tracking the time worked by each anesthetist at each facility and comparing it with the billable hours produced by those anesthetists at that facility, you can develop a daily productivity index. This could also be translated into an individual nurse anesthetist productivity index, but caution should be exercised in reading too much into the result.