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  • NEJM Catalyst Innovations in Care Delivery

Costs Without Value When Treating Pediatric Behavioral Patients in the ED

By: Marcella Jewell, Syed S. Shehab, Robert S. Kaplan, Jack Fanton and Joeli Hettler
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Abstract

Pediatric Emergency Department (ED) visits have greatly increased in recent years. An academic pediatric ED that annually treats about 1,000 behavioral health patients conducted a study to assess the true cost of caring for nonacute behavioral health patients. It learned that the hospital’s traditional costing system failed to recognize the cost of many unreimbursed or undocumented care activities. The study applied time-driven activity-based costing to capture these hidden costs as well as the actual costs of reimbursed services. It documented a cost of $219 per hour to care for a behavioral health patient in the pediatric ED, with little to no value for the patient during most of the time spent in the ED. This article describes the underlying reasons for such low-value care and potential solutions to overcome the regulatory burdens and bottlenecks that cause expensive and sub-optimal care in a pediatric ED setting.

Keywords

Costs; Value; Healthcare; Health Care and Treatment; Cost Management

Citation

Jewell, Marcella, Syed S. Shehab, Robert S. Kaplan, Jack Fanton, and Joeli Hettler. "Costs Without Value When Treating Pediatric Behavioral Patients in the ED." NEJM Catalyst Innovations in Care Delivery 3, no. 2 (February 2022).
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About The Author

Robert S. Kaplan

Accounting and Management
→More Publications

More from the Authors

    • October 2023
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    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
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    • Journal of Breast Imaging

    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
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
  • Update on E-liability Accounting By: Robert Kaplan, Karthik Ramanna and Piyush Jha
  • 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
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