Abstract
Purpose :
Healthcare spending in the US is steadily increasing, and healthcare systems must consider approaches to delivering high-quality care at lower cost. Using oral instead of IV sedation for cataract surgery has been safely demonstrated in large retrospective studies, allowing some healthcare systems to transition cataract surgery into a procedure room (PR) without the support of an Anesthesiologist in the room. This article presents a cost analysis of adopting oral sedation as standard practice for cataract surgery at Boston Medical Center, an urban-based, tertiary care academic center, and provides a method for estimating cost savings.
Methods :
Cost reduction was estimated by comparing the actual cost of cataract surgery in the operating room (OR) to the projected cost of cataract surgery in the PR. Costs were evaluated using EPSi software, allocated using a Cost to Charge ratio, and broken down by salary and drug. Analysis of itemized costs revealed the difference is attributable to three items: 1) IV vs oral drug, 2) anesthesia support, and 3) OR vs PR use. All remaining costs are required for surgery in both the OR and PR, and do not impact the cost reduction. Cost reduction can be modeled as follows: Cost delta = [Midazolam – Triazolam] + [((OR cost – PR cost)/min)*minutes per case] + [((Anesthesia cost)/min)*minutes per case].
Results :
The total cost of performing one cataract surgery in the OR is $1,801.92 for an average case of 45 minutes. The same procedure performed in a PR using oral sedation without anesthesia support is an estimated $1,374.87, a cost reduction of $427.05 per 45-min case. Based on a total of 1,463 cataract procedures performed at BMC in fiscal year 2017, the estimated annual savings of moving cataract surgeries to PRs is $624,774.15. Applying the cost delta model to other ocular procedures, the estimated annual savings is $203,796.03 for retina procedures, $106,375.22 for cornea procedures, $100,699.26 for glaucoma procedures, totaling a yearly reduction of $1,035,644.66 for all ocular procedures at BMC.
Conclusions :
Performing ocular procedures under oral sedation in a PR vs an OR has the potential to substantially reduce healthcare costs. These variables are not specific to cataract surgery, and the model can be extrapolated to estimate the cost reduction for all procedures that can be moved into a PR.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.