Nisenbaum H L, Birnbaum B A, Myers M M, Grossman R I, Gefter W B, Langlotz C P
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
J Comput Assist Tomogr. 2000 Sep-Oct;24(5):813-23. doi: 10.1097/00004728-200009000-00026.
The purpose of this work was to determine the costs of computed tomography (CT) procedures in a large academic radiology department, including both professional (PC) and technical (TC) components, by analyzing actual resource consumption using an activity-based costing (ABC) method and comparing them with Medicare payments.
Over a 12 month period from July 1, 1996, to June 30, 1997, 1,011 CT procedures, representing 16 Physicians' Current Procedural Terminology (CPT) codes and 98.3% of CT studies performed, were carefully observed by a research assistant trained in ABC methodology. Information collected during these time and motion studies included personnel/machine time and direct materials used. Actual resource units used during the different activities in each CT procedure were valued using appropriate cost drivers. Unit values for both direct and overhead costs were calculated: the cost of an individual procedure equaled the sum of component costs. Costs were compared with PC and TC payments according to the 1997 Medicare Fee Schedule.
Total costs of CPT codes 70450 (CT Head unenhanced), 71260 (CT Chest enhanced), and 74160 (CT Abdomen enhanced), which represented 71.2% of CT studies performed, were $189.19, $273.53, and $343.20, respectively. For all 16 nonmodified CPT codes analyzed, Medicare's professional reimbursement was less than the professional cost, whereas its technical reimbursement exceeded respective cost in 14 of the 16 codes.
In the setting and time period studied, Medicare underreimbursed professional costs while overreimbursing technical costs.
本研究旨在通过运用基于活动的成本核算（ABC）方法分析实际资源消耗情况，并将其与医疗保险支付费用进行比较，从而确定一家大型学术放射科中计算机断层扫描（CT）检查的成本，包括专业成本（PC）和技术成本（TC）。
在1996年7月1日至1997年6月30日的12个月期间，一名接受过ABC方法培训的研究助理仔细观察了1011例CT检查，这些检查涵盖了16个医师现行操作术语（CPT）编码，占所进行CT研究的98.3%。在这些时间与动作研究中收集的信息包括人员/机器时间以及所使用的直接材料。每个CT检查中不同活动所使用的实际资源单位通过适当的成本动因进行估值。计算了直接成本和间接成本的单位价值：单个检查的成本等于各组成部分成本之和。根据1997年医疗保险费用表，将成本与专业成本和技术成本支付进行了比较。
CPT编码70450（未增强头部CT）、71260（增强胸部CT）和74160（增强腹部CT）的总成本分别为189.19美元、273.53美元和343.20美元，这些编码的检查占所进行CT研究的71.2%。对于所分析的所有16个未修改的CPT编码，医疗保险的专业报销低于专业成本，而其技术报销在16个编码中的14个超过了相应成本。
在所研究的环境和时间段内，医疗保险对专业成本报销不足，而对技术成本报销过度。
