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

ABSTRACT

Purpose/Aim of the study

To quantify the cost of performing an intravitreal injection (IVI) utilizing activity-based costing (ABC), which allocates a cost to each resource involved in a manufacturing process.

Materials and Methods

A prospective, observational cohort study was performed at an urban, multi-specialty ophthalmology practice affiliated with an academic institution. Fourteen patients scheduled for an IVI-only visit with a retina ophthalmologist were observed from clinic entry to exit to create a process map of time and resource utilization. Indirect costs were allocated with ABC and direct costs were estimated based on process map observations, internal accounting records, employee interviews, and nationally-reported metrics. The primary outcome measure was the cost of an IVI procedure in United States dollars. Secondary outcomes included operating income (cost subtracted from revenue) of an IVI and patient-centric time utilization for an IVI.

Results

The total cost of performing an IVI was $128.28; average direct material, direct labor, and overhead costs were $2.14, $97.88, and $28.26, respectively. Compared to the $104.40 reimbursement set by the Centers for Medicare and Medicaid Services for Current Procedural Terminology code 67028, this results in a negative operating income of -$23.88 (−22.87%). The median clinic resource-utilizing time to complete an IVI was 32:58 minutes (range [19:24–1:28:37]); the greatest bottleneck was physician-driven electronic health record documentation.

Conclusions

Our study provides an objective and accurate cost estimate of the IVI procedure and illustrates how ABC may be applied in a clinical context. Our findings suggest that IVIs may currently be undervalued by payors.

KEYWORDS:

• Intravitreal injection
• activity-based costing
• process map

Financial disclosures

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflicting relationship exists for any author; CYW is a consultant for Allergan/AbbVie, Inc.; Alimera Sciences, Inc.; Alcon, Inc.; Regeneron, Inc.; REGENXBIO; Novartis; Dutch Ophthalmic Research Center.

Other disclosures

This manuscript has not been published elsewhere and that it has not been submitted simultaneously for publication elsewhere.