PD10-07 FASTER CARE FOR LESS? COST MODEL OF HEMATURIA CARE REDESIGN (2016)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2016PD10-07 FASTER CARE FOR LESS? COST MODEL OF HEMATURIA CARE REDESIGN Tony T. Chen, Wendy Webster, Mohammad Shahsahebi, Michael E. Lipkin, Glenn M. Preminger, Sharon K. Hull, and Charles D. Scales Tony T. ChenTony T. Chen More articles by this author , Wendy WebsterWendy Webster More articles by this author , Mohammad ShahsahebiMohammad Shahsahebi More articles by this author , Michael E. LipkinMichael E. Lipkin More articles by this author , Glenn M. PremingerGlenn M. Preminger More articles by this author , Sharon K. HullSharon K. Hull More articles by this author , and Charles D. ScalesCharles D. Scales More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2915AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Asymptomatic microhematuria (AMH) is a common incidental finding. Evaluation often involves two patient encounters (consultation and subsequent procedure), which increases time from referral to workup conclusion, is burdensome to patients and may increase costs of care. Using the health system perspective, we compared costs of our traditional two-visit evaluation process with those of a planned single-encounter process. METHODS We created a cost identification model to compare overall costs of the traditional and single-encounter pathways. First, a multidisciplinary team of primary care and urology providers and administrative leaders developed care process maps of the delivery value chain for microhematuria. Using the novel strategy of time-driven activity-based costing (TDABC), we then estimated indirect costs; direct costs were based on Medicare fees for the appropriate encounters. Using time-motion studies, we measured operational costs and process times to calculate personnel capacity costs. Finally, direct and indirect costs of each pathway were combined to calculate total cycle costs. RESULTS In the traditional evaluation cycle, the average total costs were $400; 75% were direct costs and 25% were indirect costs. By comparison, the single episode-based encounter reduced total costs by 15%. The majority of the savings accrued from lower indirect costs involved in the second visit of the traditional pathway. A number of modifiable personnel factors influence indirect costs. Assistance of resident physicians in the evaluation & management visit reduced indirect costs by 18%. Use of certified medical assistants in patient care reduced indirect costs incurred by registered nurses by 65%. From the patient perspective, projected time savings are substantial, including elimination of at least one office visit and the associated travel and opportunity costs. CONCLUSIONS Using the novel costing approach of TDABC, we estimate that the cost of hematuria evaluation may be reduced by 15% through an innovative care delivery pathway. The new pathway may also improve value by freeing up additional return appointment slots. Additionally, variation in personnel can drive indirect costs. As the new pathway is implemented, future studies will assess actual costs, referral to completion time, patient satisfaction and clinical outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e241 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Tony T. Chen More articles by this author Wendy Webster More articles by this author Mohammad Shahsahebi More articles by this author Michael E. Lipkin More articles by this author Glenn M. Preminger More articles by this author Sharon K. Hull More articles by this author Charles D. Scales More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...