The "OR Income Index" - Distribution of OR capacities based on revenue analysis

Background: In Germany the allocation of OR capacity is often a result of historical agreements rather than being based on practical financial considerations. The German DRG system might therefore result in conflicts between traditional hospital policy and politically motivated economic constraints. Currently there is no scientifically based agreement on how OR efficiency should be analysed, nor has an allocation system of OR capacity based on efficiency been introduced. Since no simple OR efficiency index for the German DRG system is available enabling the OR management to allocate OR capacity with a view to improving hospital revenue, we developed the OR capacity income index (ORII). This index is calculated by dividing the total amount of German-DRG cost-weights by the number of OR's allocated per year for each surgical department. The purpose of our investigation was to describe the possible effects of using this index alone, or in combination with other controlling data, as a management tool for efficiency-based OR allocation in our hospital. Methods: Using our own anaesthesia data base comprising an average of 12000 anaesthetic procedures a year together with additional data from our monthly controlling report, the following variables were calculated: degree of OR utilization (DORU), the allocated OR capacity for DRG-relevant operative procedures and the OR income index (ORII). The average duration of postoperative treatment (DOPT) in hospital was converted into a qualitative specification showing whether the average duration of postoperative treatment (DOPT) was below or above the projected duration of postoperative treatment (actual DOPT > or < objective DOPT). The effect of using the OR income index (ORII) alone or in combination with the degree of OR utilization (DORU) and the duration of postoperative treatment (DOPT) on the allocation of OR capacities were calculated afterwards. Results: The OR income index (ORII) is both simple to generate and easily to understand and thus enables OR management to allocate OR capacity in such a manner as to increase hospital revenue. Allocation of OR capacities based merely on OR income index on the other hand is not realistic. The OR income index (ORII) in combination with the degree of OR utilization (DORU) and the duration of postoperative treatment (DOPT) specification can be used for allocating block time to reduce OR costs while increasing OR revenue. Conclusions: Increasing overall hospital revenue can be achieved by using the OR income index (ORII) in combination with the degree of OR utilization (DORU) and the duration of postoperative treatment (DOPT) as an OR management tool.