Abstract
Purpose :
To use electronic health record (EHR) time logs and Time-Driven Activity Based Costing (TDABC) to calculate the complete cost profile of office-based fluorescein angiography (FA)
Methods :
Process flow mapping for routine FA was used to define the care episode. De-identified time logs were sourced from the EHR and manually validated to calculate durations for each stage. The cost of materials was calculated from internal financial figures. Cost per minute for space, equipment, and personnel were based on internal figures. Published fluorescein costs were used for base case analysis with scenario analysis based on a range of internal figures from pharmacy quotes. These inputs were used for a Time-Driven Activity Based Costing (TDABC) analysis.
Results :
Cost analysis of office-based fluorescein angiography resulted in an average total cost of $116.35 (nominal) per interpreted image per patient, which was close to breakeven - $0.08 more than the maximum Medicare reimbursement for CPT 92235 in Mac Locality for Tennessee 10312 for FY 2022, $116.43 ($76.11 technical component and $40.33 physician component). The low contribution margin is driven primarily by the increased cost of fluorescein which comprises 42.2% of the episode.
Conclusions :
The current analysis here shows that the recently increased cost of fluorescein has driven up the cost of office-based fluorescein angiography relative to the current maximum allowable Medicare reimbursement leading to minimal contribution margin. Given conservative cost estimates here, it is unlikely for profitability to be achieved without changes in the cost of fluorescein or increased reimbursement. These results may be informative for policy discussion regarding appropriate reimbursement for codes using injectable fluorescein.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.