Department of Radiology, Michigan Medicine, Ann Arbor, Michigan; Michigan Radiology Quality Collaborative, Ann Arbor, Michigan.
Department of Radiology, Michigan Medicine, Ann Arbor, Michigan; Michigan Radiology Quality Collaborative, Ann Arbor, Michigan; Department of Urology, Michigan Medicine, Ann Arbor, Michigan.
J Am Coll Radiol. 2018 Jan;15(1 Pt A):75-81. doi: 10.1016/j.jacr.2017.08.015. Epub 2017 Oct 20.
The aim of this study was to understand the financial ramifications of performing nonemergent inpatient and emergency department (ED) adult thyroid ultrasound studies at a US quaternary care center.
A HIPAA-compliant, institutional review board-exempt retrospective review of 10,334 thyroid ultrasound studies performed between February 2012 and December 2015 was conducted. Demographic, imaging, clinical, and financial data were reviewed. Labor cost analysis was calculated using national salary data and local scheduling practices. Professional and technical reimbursement and utilization trends were compared across 149 payers, multiple time spans, and visit settings (outpatient, ED, and inpatient).
Most thyroid ultrasound studies were performed on outpatients (97.4% [10,069 of 10,334]), with a minority performed on inpatients (2.1% [217 of 10,334]) or in the ED (0.5% [48 of 10,334]). Man-hour cost of performing thyroid ultrasound was higher in the inpatient and ED settings ($15.30) compared with the outpatient setting ($7.65). Professional reimbursement was highest in the outpatient setting (mean, $37.39) and varied by payer (proprietary data; SD, $21.36 per examination). Technical reimbursement loss due to diagnosis-related group billing for inpatients and admitted-via-ED patients was $44,376; this was partly compensated ($9,309) by technical reimbursement from discharged-from-ED patients (mean technical reimbursement loss, $746 per month). Utilization increased year by year and correlated with Medicare volumes. Inpatient utilization was highest in Medicare patients; outpatient and ED utilization was highest for patients with private payers.
Net revenue loss from and imaging volumes of inpatient and ED nonemergent adult thyroid ultrasound studies are low.
本研究旨在了解在美国一家四级保健中心进行非紧急住院和急诊部（ED）成人甲状腺超声检查的财务影响。
对 2012 年 2 月至 2015 年 12 月期间进行的 10334 例甲状腺超声检查进行了 HIPAA 合规性、机构审查委员会豁免的回顾性审查。审查了人口统计学、影像学、临床和财务数据。使用国家工资数据和当地调度实践计算了劳动力成本分析。比较了 149 个付款人、多个时间段和就诊设置（门诊、ED 和住院）的专业和技术报销和使用趋势。
大多数甲状腺超声检查是在门诊进行的（97.4%[10069/10334]），少数在住院患者中进行（2.1%[217/10334]）或在 ED 中进行（0.5%[48/10334]）。住院和 ED 环境中进行甲状腺超声检查的人工成本较高（15.30 美元），而门诊环境中较低（7.65 美元）。门诊环境中的专业报销最高（平均值，37.39 美元），并且因付款人而异（专有数据；SD，每次检查 21.36 美元）。由于按诊断相关组计费的住院和通过 ED 入院的患者的技术报销损失为 44376 美元；这部分通过从 ED 出院的患者的技术报销得到了补偿（平均每月技术报销损失为 746 美元）。利用量逐年增加，与医疗保险量相关。住院患者的住院利用率最高；私人支付患者的门诊和 ED 利用率最高。
从非紧急住院和 ED 成人甲状腺超声检查中获得的净收入损失和影像学量较低。
