Evaluation of economic efficiencies in clinical retina practice: activity-based cost analysis and modeling to determine impacts of changes in patient management

Figures & data

Table 1 Relative value unit distributions by retinal physician subgroup

	Nonlaser surgery	Laser surgery	Office visits	OCT	Non-OCT diagnostics	Injections
Surgical	48%	22%	10%	3%	14%	3%
Mixed	34%	27%	19%	4%	3%	13%
Medical	0%	3%	25%	12%	2%	59%

Abbreviation: OCT, optical coherence tomography.

Table 2 Expense allocation schemes for direct cost departments

Hospital department	Retinal-related cost allocation scheme1	Service line cost allocation scheme2
Surgery	Number of retinal surgery cases to total number of hospital surgery cases	Distribution of hospital (CPT/HCPCS) units billed across nonlaser and laser surgery service lines
Ambulatory surgery	Hospital staff estimate	None – 100% of retinal-related costs attributable to nonlaser surgery
Anesthesiology	Number of retinal surgery cases to total number of hospital surgery cases	Distribution of hospital (CPT/HCPCS) units billed between nonlaser and laser surgery
Recovery room	Number of retinal surgery cases to total number of hospital surgery cases	Distribution of hospital (CPT/HCPCS) units billed between nonlaser and laser surgery
Outpatient nursing	“Unit cost” allocation	“Unit cost” allocation
Retina clinic	None – 100% of department expenses attributable to retinal practice	None – 100% of retinal-related costs attributable to E&M
Photography	Hospital staff estimate	“Unit cost” allocation
Echography	Hospital staff estimate	“Unit cost” allocation
Pharmacy	“Unit cost” allocation	“Unit cost” allocation
Physician logistics	Hospital staff estimate	Distribution of hospital (CPT/HCPCS) units billed across all service lines

1 Notes: Identifies the allocation scheme used to carve out retinal-related cost from total departmental expenses;

2 Identifies the allocation scheme used to distribute retinal-related cost across relevant service lines.

Abbreviations: E&M, evaluation and management; CPT, Current Procedural Terminology; HCPCS, Healthcare Common Procedure Coding System.

Figure 1 Small single-specialty group practice: percent change in procedure volume.

Abbreviation: OCT, optical coherence tomography.

Figure 2 Small single-specialty group practice: percent change in revenue.

Abbreviation: OCT, optical coherence tomography.

Figure 3A Small single-specialty group practice: distribution of costs by service line.

Abbreviation: OCT, optical coherence tomography.

Figure 3B Small single-specialty group practice: distribution of costs by cost center.

Figure 4 Small single-specialty group practice: profit margin across service lines.

Abbreviation: OCT, optical coherence tomography.

Figure 5 Academic hospital-based practice: percent change in procedure volume.

Abbreviation: OCT, optical coherence tomography.

Figure 6A Academic hospital-based practice: percent change in revenue.

Abbreviation: OCT, optical coherence tomography.

Figure 6B Academic hospital-based practice: percent change in revenue by retinal physician subgroup.

Figure 7A Academic hospital-based practice: distribution of costs by service line.

Abbreviation: OCT, optical coherence tomography.

Figure 7B Academic hospital-based practice: distribution of costs by retinal physician subgroup.

Abbreviation: OCT, optical coherence tomography.

Figure 8 Academic hospital-based practice: overall profit margin across service lines.

Abbreviation: OCT, optical coherence tomography.

Figure 9 Medicare national physician payment for bilateral OCT and intravitreal injections between 2010 and 2011.

Abbreviation: OCT, optical coherence tomography.

Figure 10 Average change in Medicare reimbursement between 2008 and 2011 across service lines.

Abbreviation: OCT, optical coherence tomography.

Figure 11A Mixed practice: 2008 distribution of revenue by service line.

Abbreviation: OCT, optical coherence tomography.

Figure 11B Mixed practice: 2011 distribution of revenue by service line (assuming OCT procedures are performed bilaterally).

Abbreviation: OCT, optical coherence tomography.

Figure 11C Mixed practice: change in total revenue between 2008 and 2011.

Figure 12A Surgical practice: 2008 distribution of revenue by service line.

Abbreviation: OCT, optical coherence tomography.

Figure 12B Surgical practice: 2011 Distribution of revenue by service line (Assuming OCT procedures are performed bilaterally).

Abbreviation: OCT, optical coherence tomography.

Figure 12C Surgical practice: change in total revenue between 2008 and 2011.

Abbreviation: OCT, optical coherence tomography.

Figure 13A Medical practice: 2008 distribution of revenue by service line.

Abbreviation: OCT, optical coherence tomography.

Figure 13B Medical practice: 2011 distribution of revenue by service line (assuming OCT procedures are performed bilaterally).

Abbreviation: OCT, optical coherence tomography.

Figure 13C Medical practice: change in total revenue between 2008 and 2011.