title: A matrix model for valuing anesthesia service with the resource-based relative value system.
abstract: BACKGROUND
  The purpose of this study was to propose a new crosswalk using the resource-based relative value system (RBRVS) that preserves the time unit component of the anesthesia service and disaggregates anesthesia billing into component parts (preoperative evaluation, intraoperative management, and postoperative evaluation). The study was designed as an observational chart and billing data review of current and proposed payments, in the setting of a preoperative holing area, intraoperative suite, and post anesthesia care unit. In total, 1,195 charts of American Society of Anesthesiology (ASA) physical status 1 through 5 patients were reviewed. No direct patient interventions were undertaken.
  
  
  RESULTS
  Spearman correlations between the proposed RBRVS billing matrix payments and the current ASA relative value guide methodology payments were strong (r=0.94-0.96, P<0.001 for training, test, and overall). The proposed RBRVS-based billing matrix yielded payments that were 3.0%±1.34% less than would have been expected from commercial insurers, using standard rates for commercial ASA relative value units and RBRVS relative value units. Compared with current Medicare reimbursement under the ASA relative value guide, reimbursement would almost double when converting to an RBRVS billing model. The greatest increases in Medicare reimbursement between the current system and proposed billing model occurred as anesthetic management complexity increased.
  
  
  CONCLUSIONS
  The new crosswalk correlates with existing evaluation and management and intensive care medicine codes in an essentially revenue neutral manner when applied to the market-based rates of commercial insurers. The new system more highly values delivery of care to more complex patients undergoing more complex surgery and better represents the true value of anesthetic case management.
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Sinclair
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Lubarsky
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Vigoda
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Harris
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Vicente
authors.initials: V
authors.lastname: Behrens
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Bazan
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Williams
authors.affiliation: Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Arheart
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
keywords: billing; crosswalk; payment reform