Process Mapping and Activity-Based Costing of the Intravitreal Injection Procedure

Area of Science:

• Ophthalmology
• Health Economics
• Healthcare Management

Background:

• Intravitreal injections (IVIs) are a common treatment for various retinal diseases.
• Accurate cost assessment of medical procedures is crucial for financial sustainability and fair reimbursement.
• Activity-based costing (ABC) offers a detailed method for allocating costs in healthcare settings.

Purpose of the Study:

• To quantify the total cost of performing an intravitreal injection (IVI) using activity-based costing (ABC).
• To compare the procedure's cost against current reimbursement rates.
• To identify key resource utilization and bottlenecks in the IVI process.

Main Methods:

• A prospective, observational cohort study was conducted in an academic ophthalmology practice.
• Fourteen patients undergoing IVI-only visits were observed to map time and resource use.
• Direct and indirect costs were calculated using ABC, internal records, and national metrics.

Main Results:

• The total cost for an IVI was determined to be $128.28, exceeding the Medicare reimbursement of $104.40.
• This resulted in a negative operating income of -$23.88 per procedure.
• Physician-documented electronic health records were identified as the primary bottleneck, contributing to a median procedure time of 32:58 minutes.

Conclusions:

• The study provides an objective cost estimate for IVIs, demonstrating their potential undervaluation by payers.
• Activity-based costing (ABC) is a viable method for accurately assessing clinical procedure costs.
• Addressing documentation bottlenecks is essential for improving efficiency and financial viability of IVI procedures.