School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
Curr Eye Res. 2021 May;46(5):694-703. doi: 10.1080/02713683.2020.1825747. Epub 2020 Oct 15.
PURPOSE/AIM OF THE STUDY: To quantify the cost of performing an intravitreal injection (IVI) utilizing activity-based costing (ABC), which allocates a cost to each resource involved in a manufacturing process.
A prospective, observational cohort study was performed at an urban, multi-specialty ophthalmology practice affiliated with an academic institution. Fourteen patients scheduled for an IVI-only visit with a retina ophthalmologist were observed from clinic entry to exit to create a process map of time and resource utilization. Indirect costs were allocated with ABC and direct costs were estimated based on process map observations, internal accounting records, employee interviews, and nationally-reported metrics. The primary outcome measure was the cost of an IVI procedure in United States dollars. Secondary outcomes included operating income (cost subtracted from revenue) of an IVI and patient-centric time utilization for an IVI.
The total cost of performing an IVI was $128.28; average direct material, direct labor, and overhead costs were $2.14, $97.88, and $28.26, respectively. Compared to the $104.40 reimbursement set by the Centers for Medicare and Medicaid Services for Current Procedural Terminology code 67028, this results in a negative operating income of -$23.88 (-22.87%). The median clinic resource-utilizing time to complete an IVI was 32:58 minutes (range [19:24-1:28:37]); the greatest bottleneck was physician-driven electronic health record documentation.
Our study provides an objective and accurate cost estimate of the IVI procedure and illustrates how ABC may be applied in a clinical context. Our findings suggest that IVIs may currently be undervalued by payors.
目的/研究目的：利用作业成本法（ABC）量化玻璃体腔内注射（IVI）的成本，该方法将成本分配给制造过程中涉及的每个资源。
这是一项在城市多专业眼科实践机构进行的前瞻性观察队列研究。对 14 名仅接受视网膜眼科医生 IVI 就诊的患者进行观察，从进入诊所到离开诊所，创建一个时间和资源利用过程图。间接成本通过 ABC 分配，直接成本根据过程图观察、内部会计记录、员工访谈和全国报告的指标进行估计。主要观察指标是美元计价的 IVI 手术成本。次要结果包括 IVI 的运营收入（成本减去收入）和 IVI 的以患者为中心的时间利用率。
进行 IVI 的总费用为 128.28 美元；平均直接材料、直接劳动和间接费用分别为 2.14 美元、97.88 美元和 28.26 美元。与医疗保险和医疗补助服务中心为 Current Procedural Terminology 代码 67028 设定的 104.40 美元报销相比，这导致运营亏损为-23.88 美元（-22.87%）。完成 IVI 的平均诊所资源利用时间为 32:58 分钟（范围[19:24-1:28:37]）；最大的瓶颈是医生驱动的电子病历记录。
我们的研究提供了 IVI 手术的客观准确成本估计，并说明了 ABC 如何在临床环境中应用。我们的发现表明，支付者可能目前低估了 IVI 的价值。
