Publications
Publications
- February 2025
- NEJM Catalyst Innovations in Care Delivery
Innovations in Evaluating Ambulatory Costs of Cystic Fibrosis Care: A Comparative Study Across Multidisciplinary Care Centers in Ireland and the United States
By: Emma Brady, Ryan C. Perkins, Kate Cullen, Gregory S. Sawicki, Robert S. Kaplan and Gerardine Doyle
Abstract
Lead clinicians at two large pediatric cystic fibrosis (CF) centers in the United States and Ireland measured and compared their ambulatory care costs. The clinicians selected three strata of patients (0–11 months, 1–5 years, and 6–17 years of age). Process maps were developed for each of the age cohorts at each site, and the costs of ambulatory care—with emphasis on routine CF clinic visits—were measured utilizing time-driven activity-based costing (TDABC). Variance analysis was applied to identify the components of cost variation between the two sites. The quantity variance showed that clinicians in Ireland spent 108% more time with patients than at the U.S. site; the skill mix variance showed the U.S. site with a 49% higher personnel cost mix, and the price (rate) variance showed that U.S. personnel had a 31% higher compensation level. The costing and variance analysis provided organizationally relevant insights into the distinctive features of each site’s CF care delivery processes and how costs could be reduced without adverse impact on patient outcomes.
Keywords
Citation
Brady, Emma, Ryan C. Perkins, Kate Cullen, Gregory S. Sawicki, Robert S. Kaplan, and Gerardine Doyle. "Innovations in Evaluating Ambulatory Costs of Cystic Fibrosis Care: A Comparative Study Across Multidisciplinary Care Centers in Ireland and the United States." NEJM Catalyst Innovations in Care Delivery 6, no. 2 (February 2025).