Hultman Charles Scott, Edkins Renee E, Cairns Bruce A, Meyer Anthony A
Division of Plastic Surgery, University of North Carolina Health Care System, Chapel Hill, NC 27516-7195, USA.
Ann Plast Surg. 2013 May;70(5):581-6. doi: 10.1097/SAP.0b013e31827eac0c.
Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars.
We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light. Cases were performed in an operating room, with anesthesia, after preauthorization. We examined professional charges and collections, case time, variable and indirect expenses, and breakeven volumes.
Our practice grew as follows: 2008, 1 case; 2009, 44 cases; 2010, 169 cases; and 2011, 415 cases. Overall collection rate was 32.1%. Expenses incurred by the provider, per 8-hour session, included laser rental/lease ($2375), personnel salaries ($1900), and physician overhead ($808), for a total cost of $5083. Mean charge was $1642 per case; mean collection was $527 per case. Median case time (procedure plus turnover) was 40 minutes. In this model, breakeven volume is 9.7 cases per day; breakeven time is 49.7 minutes. Provider profit margin for 10 cases per day, or 83% capacity utilization, is $187 per day (income - expenses = $5270 - $5083).
Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.
尽管激光可改善烧伤瘢痕，但由于开展此项业务存在操作挑战以及认为该项目在经济上不可行，这种治疗方法尚未得到广泛应用。我们报告了建立用于治疗增生性烧伤瘢痕的激光业务的相关事宜。
我们分析了激光业务的临床、操作和财务组成部分，重点关注使用脉冲染料激光、剥脱性二氧化碳激光和强脉冲光治疗增生性烧伤瘢痕。病例在手术室进行，经预先批准后实施麻醉。我们研究了专业收费与收款、病例时间、可变费用和间接费用以及盈亏平衡量。
我们的业务发展情况如下：2008年，1例；2009年，44例；2010年，169例；2011年，415例。总体收款率为32.1%。每8小时的业务，提供者产生的费用包括激光租赁（2375美元）、人员工资（1900美元）和医生间接费用（808美元），总成本为5083美元。平均收费为每例1642美元；平均收款为每例527美元。病例平均时间（手术加周转）为40分钟。在此模型中，盈亏平衡量为每天9.7例；盈亏平衡时间为49.7分钟。每天10例（即产能利用率83%）时提供者的利润率为每天187美元（收入 - 费用 = 5270 - 5083）。
尽管开展和运营用于治疗增生性烧伤瘢痕的激光业务成本高昂，但当提供者积累了足够数量的病例以便在一整天内批量处理时，仍可实现可持续发展。实现盈亏平衡的关键在于预先批准、控制间接费用和高效的工作流程。
