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Updated: Jul 29, 2025
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Open Source High Content Analysis Utilizing Automated Fluorescence Lifetime Imaging Microscopy
Published on: January 18, 2017
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Time-driven Activity-based Costing Analysis of Fluorescein Angiography.
Sean T Berkowitz1, Shravika Lam1, Paul Sternberg1
1Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee.
Ophthalmology. Retina
|May 27, 2023
Summary
The cost of office-based fluorescein angiography (FA) now exceeds Medicare reimbursement due to increased fluorescein expenses, resulting in financial losses. Profitability for this diagnostic imaging procedure may require lower medication costs or higher reimbursement rates.
Area of Science:
- Ophthalmology
- Health Economics
- Medical Cost Analysis
Background:
- Office-based fluorescein angiography (FA) is a common diagnostic procedure in ophthalmology.
- Accurate cost profiling is essential for understanding the financial viability of medical services.
- Electronic health record (EHR) data and time-driven activity-based costing (TDABC) offer robust methods for cost analysis.
Purpose of the Study:
- To determine the complete cost profile of office-based fluorescein angiography (FA) using EHR time logs and TDABC.
- To compare the calculated costs with current Medicare reimbursement rates.
Main Methods:
- Utilized process flow mapping and manual observation to define the FA care episode.
- Extracted and validated deidentified time logs from EHR to calculate stage durations.
- Incorporated internal financial data for material, space, equipment, and personnel costs.
- Applied TDABC methodology for comprehensive cost calculation, including scenario analysis for medication costs.
Main Results:
- The average total cost per interpreted FA study was $152.95.
- This cost exceeded the maximum Medicare reimbursement for CPT 92235 by $36.52.
- The high cost of fluorescein (39.8% of episode costs) significantly impacted the negative contribution margin.
Conclusions:
- Increased fluorescein costs have made office-based FA financially unsustainable under current Medicare reimbursement.
- Achieving profitability likely necessitates reductions in fluorescein costs or increases in reimbursement.
- Findings can inform policy discussions on appropriate reimbursement for procedures involving injectable fluorescein.
