Many Variables Affect Pain Management Hours Per Case Benchmark

Q: We are a single-specialty ASC doing pain management procedures only. Can you tell me a benchmark for pain management staff hours per case and a formula for calculating it?

Amy Mowles, president and CEO of Mowles Medical Practice Management: Unfortunately there is no single benchmark or formula for calculating staff hours per case because there are so many variables in pain cases that can affect this figure.

For example, what type of sedation are your ASC and pain doctors credentialed to use? There are pain doctors that use a separate anesthesia provider; there are pain doctors that provide their own moderate sedation themselves or direct an RN or nurse practitioner to do that; and then there are other pain doctors that use only local, topical or a PO RX (a written prescription for a mild anti-anxiety — usually one Valium — to be taken pre-procedure). When moderate sedation is given by the same physician performing the procedure that the sedation supports, it affects the staffing as this requires the presence of an independently trained observer to assist in the monitoring of the patient. This is typically an RN. Depending on the procedure, we often see a medical assistant or surgical technician in the procedure room as well.

You must also take into consideration the type of patients receiving treatment — their acuity — which certainly will affect the staffing. Some pain doctors treat only healthier patients — ASA class I or II — whereas others are setup for and treat class III. For higher acuity patients, you may need or want an additional licensed person in the procedure room (other then the one monitoring the sedation)

Radiology is state specific. State laws dictate and differ when it comes to who is and who is not allowed to use the C-arm, so that may add an additional staff member to the procedure. Most states allow pain management physicians to use the C-arm as long as they are either trained or registered. Many physicians feel that a registered radiology technician adds to the efficiency of the case and certainly the room turnover time.

These are only some of the intraprocedure variables that affect hours per case; there are certainly pre- and post-procedure variables. Time and duties for pre-op staff is typically 10 minutes; intra-procedure for the vast majority of pain management procedures is 15 minutes; and time and duties in the PACU, based on type of sedation and patient response, could be up to 20 minutes.

So for pain centers, hours per case is a difficult figure to determine and benchmark. The most typical seen is a procedure room turnover to allow for four patients per hour. It is the variables above that will affect the actuality. The emphasis should always be on instituting best practices to run an efficient practice.

Ms. Mowles (amy@mowles.com) is president and CEO of Mowles Medical Practice Management, which is dedicated to assisting pain management and other specialists develop efficient, productive and profitable ASCs and practices. Learn more at www.mowles.com.