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CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2018; 10(01): e55-e60
DOI: 10.1055/s-0038-1647249
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

TDABC Cost Analysis of Ocular Disorders in an Ophthalmology Emergency Department versus Urgent Care: Clinical Experience at Massachusetts Eye and Ear

Jonathan Chou
1   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
,
Mahek Shah
2   Harvard Business School, Soldiers Field, Boston, Massachusetts
,
Amy Watts
1   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
,
Matthew Gardiner
1   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
,
Robert Kaplan
2   Harvard Business School, Soldiers Field, Boston, Massachusetts
,
Joan Miller
1   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
,
John I. Loewenstein
1   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding None.
Further Information

Publication History

14 January 2018

27 March 2018

Publication Date:
07 May 2018 (online)

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Abstract

Purpose To perform a cost analysis comparison for managing common ocular disorders in an eye emergency department (ED) versus an urgent care setting using a time-driven activity-based cost model (TDABC) to assist physicians and staff in appropriate allocation of resources at their own institution.

Design Retrospective analysis.

Setting Massachusetts Eye and Ear (MEE) ED and Same-Day Services (SDS), which runs as an urgent care clinic.

Population Patients diagnosed with corneal abrasions, dry eyes, conjunctivitis, and styes were identified between April 2014 and August 2015 (n = 2,408 [ED], 26 [SDS]). We determined resources used in delivery of care, which included personnel, consumables, space capacity, and equipment. Costs were identified based on time the patient spent with each resource.

Main Outcome Average visit length and associated personal, space, equipment, and consumable costs.

Results Average visit length was 196 and 53 minutes, respectively, primarily due to longer wait times in the ED. Personnel and space costs were higher in the ED compared with SDS ($68.92 vs. $51.37 and $24.44 vs. $12.86, respectively). This led to an overall higher total resource cost for patients seen in the ED compared with SDS ($108.41 vs. $81.53, respectively).

Conclusion For common ocular disorders, total SDS costs were 25% less than ED costs at MEE primarily due to personnel and space utilization. Treating patients with nonemergent ocular problems outside the ED can lead to shorter visit times for patients as well as lower overall costs.

Keywords

cost analysis - time-driven activity-based cost model - emergency room - urgent care clinic
 

  • References

  • 1 National Health Expenditure Data. Centers for Medicare & Medicaid Services. 2016 . Available at: CMS.gov
    PubMedGoogle Scholar
  • 2 Andersen R. Medicine's dilemmas: infinite needs versus finite resources. JAMA 1994; 272 (23) 1870-1871
    PubMedGoogle Scholar
  • 3 Porter ME, Lee TH. The strategy that will fix health care. Harv Bus Rev 2013; 91 (10) 50-70
    PubMedGoogle Scholar
  • 4 Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of eye-related emergency department visits. JAMA Ophthalmol 2016; 134 (03) 312-319
    CrossrefPubMedGoogle Scholar
  • 5 Kaplan RS, Anderson SR. Time-driven activity-based costing. Harv Bus Rev 2004; 82 (11) 131-138 , 150
    PubMedGoogle Scholar
  • 6 Porter ME, Kaplan RS. How to pay for health care. Harv Bus Rev 2016; 94 (7-8): 88-98 , 100, 134
    PubMedGoogle Scholar
  • 7 Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev 2011; 89 (09) 46-52 , 54, 56–61
    PubMedGoogle Scholar
  • 8 Yun BJ, Prabhakar AM, Warsh J. , et al. Time-driven activity-based costing in emergency medicine. Ann Emerg Med 2016; 67 (06) 765-772
    CrossrefPubMedGoogle Scholar
  • 9 McLaughlin N, Burke MA, Setlur NP. , et al. Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives. Neurosurg Focus 2014; 37 (05) E3
    CrossrefPubMedGoogle Scholar
  • 10 DiGioia III AM, Greenhouse PK, Giarrusso ML, Kress JM. Determining the true cost to deliver total hip and knee arthroplasty over the full cycle of care: preparing for bundling and reference-based pricing. J Arthroplasty 2016; 31 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 11 Mandigo M, O'Neill K, Mistry B. , et al. A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti. Lancet 2015; 385 (Suppl. 02) S22
    PubMedGoogle Scholar
  • 12 Najjar PA, Strickland M, Kaplan RS. Time-driven activity-based costing for surgical episodes. JAMA Surg 2017; 152 (01) 96-97
    CrossrefPubMedGoogle Scholar
  • 13 French KE, Guzman AB, Rubio AC, Frenzel JC, Feeley TW. Value based care and bundled payments: anesthesia care costs for outpatient oncology surgery using time-driven activity-based costing. Healthc (Amst) 2016; 4 (03) 173-180
    PubMedGoogle Scholar
  • 14 Oklu R, Haas D, Kaplan RS. , et al. Time-driven activity-based costing in IR. J Vasc Interv Radiol 2015; 26 (12) 1827-1831
    CrossrefPubMedGoogle Scholar
  • 15 Porter ME. What is value in health care?. N Engl J Med 2010; 363 (26) 2477-2481
    CrossrefPubMedGoogle Scholar
  • 16 Geiger NF. On tying Medicare reimbursement to patient satisfaction surveys. Am J Nurs 2012; 112 (07) 11
    CrossrefPubMedGoogle Scholar
  • 17 Bleustein C, Rothschild DB, Valen A, Valatis E, Schweitzer L, Jones R. Wait times, patient satisfaction scores, and the perception of care. Am J Manag Care 2014; 20 (05) 393-400
    PubMedGoogle Scholar
  • 18 Kaplan RS, Haas DA, Warsh J. Adding value by talking more. N Engl J Med 2016; 375 (20) 1918-1920
    CrossrefPubMedGoogle Scholar