RSNA 2016

Abstract Archives of the RSNA, 2016


SSQ20-08

Using Time-Driven Activity Based Costing (TDABC) to Characterize Cost Variability in Interventional Radiology Procedures

Thursday, Dec. 1 11:40AM - 11:50AM Room: N227B



William Hsu, PhD, Los Angeles, CA (Presenter) Nothing to Disclose
Cleo K. Maehara, MD, Brookline, MA (Abstract Co-Author) Nothing to Disclose
Lewellyn Andrada, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Katrina R. Beckett, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
Justin P. McWilliams, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
John M. Moriarty, MD, Los Angeles, CA (Abstract Co-Author) Speaker, AngioDynamics, Inc Consultant, AngioDynamics, Inc Speaker, Sequent Medical, Inc Consultant, Sequent Medical, Inc Speaker, Argon Medical Devices, Inc Consultant, Argon Medical Devices, Inc
Dieter R. Enzmann, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE

In a value-based healthcare environment, understanding the true cost of care delivery is necessary to improve efficiency and demonstrate cost savings, particularly in procedures that involve multiple providers and steps. Our department has adopted a data-driven TDABC approach that incorporates process modeling, time motion studies, and analysis of data from electronic hospital information systems to obtain per minute costs for labor, equipment, space, and supplies that can then be used to assess cost of each step.

METHOD AND MATERIALS

The initial process model (enumerating tasks and estimated timings) was developed in collaboration with an IR attending, nurse, and technologist. The model was further refined and validated through a time motion study of a hospital based IR port placement procedure. Following an IRB-approved protocol, timestamps from a total of 117 procedures (performed on 116 patients) were extracted from the electronic medical record. Departmental business systems were used to estimate current personnel, equipment, space, and supply cost rates.

RESULTS

Average times for tasks included: 50 min (patient prep), 38 min (IR suite prep), 80±33 min (procedure), 15 min (clean-up), and 120 min (patient recovery). Personnel capacity costs were: $6.00/min (IR attending), $1.50/min (nurse), $1.15/min (technologist), and $0.65/min (IR fellow). Equipment cost rate for fluoroscope and ultrasound are $0.94/min and $0.12/min, respectively. Inpatient procedures took significantly longer (112 min versus 72 min, p=0.004), resulting in a cost difference of $413 (equivalent to approximately 25% of the total cost). Among the seven IR attendings who performed at least one of the 117 port placement procedures, variation in average procedure times were insignificant (68 to 87 min), contributing a difference of $100 (less than 10% of the total cost).

CONCLUSION

TDABC is capable of elucidating differences in cost for a given procedure based on factors such as patient type, providers, equipment, and environment. We are conducting further analysis to compare cost with surgical port insertion and to better understand cost variability in different hospital settings.

CLINICAL RELEVANCE/APPLICATION

TDABC provides a more granular approach to investigating where further efficiencies can be achieved and ultimately, provide a basis for a more grounded cost-benefit analysis when comparing an exam to alternatives.