A Time-Driven Activity-Based Costing Analysis of New Uveitis Patient Visits

Purpose: To use time-driven activity-based costing to calculate the complete cost profile of new uveitis patient visits. Methods: A multicenter cohort of consecutive patients referred for new uveitis evaluation, including all anatomic locations of uveitis, was included for economic analysis. Process flow mapping, electronic health record time logs, and manual validation were used for time-driven activity-based costing analysis. Imaging time and resources, which are billed separately, were excluded. Results: Time-driven activity-based costing analysis of new uveitis patient visits resulted in an average total cost of $550.50 per visit, including $56.78 of overhead (95% CI, $493.74 to $607.27). On average, patient visits required 36.6 minutes of physician time pre-visit, 30.1 minutes during the visit, and 31.7 minutes post-visit. Relative to Medicare reimbursement, the average cost resulted in losses of $325.78 for Current Procedural Terminology (CPT) code 99205 and $380.16 for CPT code 99204. The G2211 add-on CPT code compensated for 3.23 minutes of in-visit physician time. Conclusions: The cost of new uveitis patient visits exceeds maximum Medicare reimbursement in both academic and private practice settings. These findings may inform policy discussions on reimbursement to better reflect the time and expertise required for complex uveitis patient evaluation and management.