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Understanding Provider Cost of MRI for Appendicitis in Children: A Time-Driven Activity-Based Costing Analysis
Pradipta Debnath1, Shireen Hayatghaibi2, Andrew T Trout3
1Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: https://twitter.com/pro_debnath.
Objective:
To use time driven activity-based costing to characterize the provider cost of rapid MRI for appendicitis compared to other MRI examinations billed with the same Current Procedural Terminology codes commonly used for MRI appendicitis examinations.
Methods:
Rapid MRI appendicitis examination was compared with MRI pelvis without intravenous contrast, MRI abdomen/pelvis without intravenous contrast, and MRI abdomen/pelvis with intravenous contrast. Process maps for each examination were created through direct shadowing of patient procedures (n = 20) and feedback from relevant health care professionals. Additional data were collected from the electronic medical record for 327 MRI examinations. Practical capacity cost rates were calculated for personnel, equipment, and facilities. The cost of each step was calculated by multiplying the capacity cost rate with the mean duration of each step. Stepwise costs were summed to generate a total cost for each MRI examination.
Results:
The mean duration and costs for MRI examination type were as follows: MRI appendicitis: 11 (range: 6-25) min, $20.03 (7.80-44.24); MRI pelvis without intravenous contrast: 55 (29-205) min, $105.99 (64.18-285.13); MRI abdomen/pelvis without intravenous contrast: 65 (26-173) min, $144.83 (61.16-196.50); MRI abdomen/pelvis with intravenous contrast: 128 (39-303) min, $236.99 (102.62-556.54).
Conclusion:
The estimated cost of providing a rapid appendicitis MRI examination is significantly less than other MRI examinations billed using Current Procedural Terminology codes typically used for appendicitis MRI. Mechanisms to appropriately bill rapid MRI examinations with limited sequences are needed to improve cost efficiency for the patient and to enable wider use of limited MRI examinations in the pediatric population.
Insights
Rapid MRI for appendicitis is significantly more cost-effective than other MRI examinations. Developing appropriate billing for these rapid MRI exams is crucial for patient cost efficiency and wider pediatric use.
Area of Science:
- Radiology
- Health Economics
- Cost Analysis
Background:
- Magnetic Resonance Imaging (MRI) is a key diagnostic tool.
- Appendicitis diagnosis often involves imaging, with MRI offering a radiation-free option.
- Current billing practices may not accurately reflect the cost of rapid MRI protocols.
Purpose of the Study:
- To determine the provider cost of rapid MRI for appendicitis.
- To compare this cost with other MRI examinations using similar billing codes.
- To inform cost-efficiency and billing strategies for limited MRI sequences.
Main Methods:
- Time-driven activity-based costing was employed.
- Process maps were created via direct observation and professional feedback.
- Costs were calculated based on personnel, equipment, facility rates, and procedure duration.
Main Results:
- Rapid MRI appendicitis examinations averaged 11 minutes and cost $20.03.
- Compared to longer, more complex MRI scans, rapid appendicitis MRI was substantially less expensive.
- MRI pelvis without contrast: 55 min, $105.99; MRI abdomen/pelvis without contrast: 65 min, $144.83; MRI abdomen/pelvis with contrast: 128 min, $236.99.
Conclusions:
- Rapid MRI for appendicitis is significantly less costly to provide than other MRI examinations.
- Current billing codes may not align with the actual cost of rapid MRI.
- Improved billing mechanisms are needed to enhance cost efficiency and promote wider use of rapid MRI, especially in pediatrics.
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