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  • Journal of Academic Ophthalmology

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

By: Robert S. Kaplan, Jonathan Chou, Mahek Shah, Amy Watts, Matthew Gardiner, Joan Miller and John I. Lowenstein
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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

Time-driven Activity-based Cost Model; Emergency Room; Urgent Care Clinic; Cost; Analysis; Activity Based Costing and Management; Health Care and Treatment

Citation

Kaplan, Robert S., Jonathan Chou, Mahek Shah, Amy Watts, Matthew Gardiner, Joan Miller, and John I. Lowenstein. "TDABC Cost Analysis of Ocular Disorders in an Ophthalmology Emergency Department versus Urgent Care: Clinical Experience at Massachusetts Eye and Ear." Journal of Academic Ophthalmology 10 (2018).
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About The Author

Robert S. Kaplan

Accounting and Management
→More Publications

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More from the Authors
  • Health System Perspective on Cost for Delivering a Decision Aid for Prostate Cancer Using Time-Driven Activity-Based Costing By: David R. Ho, Robert S. Kaplan, Jonathan Bergman, David F. Penson, Benjamin Waterman, Kristin C. Williams, Jefersson Villatoro, Lorna Kwan and Christopher S. Saigal
  • Prospective Evaluation of the Cost of Performing Breast Imaging Examinations Using Time-Driven Activity-Based Costing Method: A Single Center Study By: Aamir Ali, Jordana Phillips, Damir Ljuboja, Syed S. Shehab, Etta D. Pisano, Robert S. Kaplan and Ammar Sarwar
  • Vanderbilt: Transforming an Academic Health Care Delivery System, 2020 By: Michael E. Porter, Robert S. Kaplan, Mary L. Witkowski and David N. Bernstein
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