How does an anaesthetist construct their fee?
Anaesthetists usually charge a fee that is a multiple of the “anaesthesia basic unit”.
We structure our fees like this because the Medical Benefits Schedule (Medicare) and the private health insurance companies structure their subsidies based on this model.
Units are allocated for:
- The pre-anaesthetic consultation
- Initiating the anaesthetic for that particular operation
- For some other specialist anaesthetic procedures that may be necessary for optimal safety or that are considered best practice for this particular operation (such as arterial blood pressure monitoring for long surgery that may be associated with large blood loss, or spinal anaesthesia for its multiple advantages for hip or knee replacements)
- Patient factors that increase the risk or complexity of the operation (very young, very old, severe acute or chronic disease, emergency surgery.)
- The time it takes to perform the anaesthetic (usually a little bit longer than the time it takes to perform the surgery).
A rough guide to a typical number of anaesthesia basic units that some procedures occur are as follows:
- Knee arthroscopy: 8-10 units.
- Gallbladder removal: 15-20 units.
- Knee replacement: 22-28 units.
- Multiple level spinal fusion: 35-45 units.
To arrive at the final figure for the fee, the anaesthetist must decide what to charge for each anaesthesia basic unit. How the anaesthetist decides to price a unit is covered in next section here.
A complete list of anaesthesia “items” are available on the Medicare website Category 3 – Therapeutic Procedures pages 74-143, although I warn that it is somewhat complicated for me, let alone for the non-anaesthetist.