Time-Driven Activity-Based Costing for Cataract Surgery in Canada: The Case of the Kensington Eye Institute

Sadri, Hamid; Sinigallia, Sara; Shah, Mona; Vanderheyden, Jason; Souche, Bernard

doi:10.12927/hcpol.2021.26496

Cited by 8 publications

(13 citation statements)

References 10 publications

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“…Prior to our study, limited literature focused on the cost of cataract surgery. 17,18 In our TDABC model, operating room costs accounted for 63% to 65% of total costs. A single-center study in Canada estimated cataract surgery costs using TDABC, attributing 57% of costs to the operating room, although this analysis did not compare different types of cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In our TDABC model, operating room costs accounted for 63% to 65% of total costs. A single-center study in Canada estimated cataract surgery costs using TDABC, attributing 57% of costs to the operating room, although this analysis did not compare different types of cataract surgery . Roberts et al compared femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery using a process similar to TDABC.…”

Section: Discussionmentioning

confidence: 99%

“…A singlecenter study in Canada estimated cataract surgery costs using TDABC, attributing 57% of costs to the operating room, although this analysis did not compare different types of cataract surgery. 18 Roberts et al 19 compared femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery using a process similar to TDABC. In their work, they found that the savings from reduced operating room time with FLACS were not sufficient to offset the increased costs directly associated with FLACS, particularly the laser consumables.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we found that complex cataract surgery was significantly more costly ($877.85) than simple cataract surgery. Prior to our study, limited literature focused on the cost of cataract surgery . In our TDABC model, operating room costs accounted for 63% to 65% of total costs.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven Activity-Based Costing

et al. 2023

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ImportanceCataract surgery is one of the most commonly performed surgeries across medicine and an integral part of ophthalmologic care. Complex cataract surgery requires more time and resources than simple cataract surgery, yet it remains unclear whether the incremental reimbursement for complex cataract surgery, compared with simple cataract surgery, offsets the increased costs.ObjectiveTo measure the difference in day-of-surgery costs and net earnings between simple and complex cataract surgery.Design, Setting, and ParticipantsThis study is an economic analysis at a single academic institution using time-driven activity-based costing methodology to determine the operative-day costs of simple and complex cataract surgery. Process flow mapping was used to define the operative episode limited to the day of surgery. Simple and complex cataract surgery cases (Current Procedural Terminology codes 66984 and 66982, respectively) at the University of Michigan Kellogg Eye Center from 2017 to 2021 were included in the analysis. Time estimates were obtained using an internal anesthesia record system. Financial estimates were obtained using a mix of internal sources and prior literature. Supply costs were obtained from the electronic health record.Main Outcomes and MeasuresDifference in day-of-surgery costs and net earnings.ResultsA total of 16 092 cataract surgeries were included, 13 904 simple and 2188 complex. Time-based day-of-surgery costs for simple and complex cataract surgery were $1486.24 and $2205.83, respectively, with a mean difference of $719.59 (95% CI, $684.09-$755.09; P &lt; .001). Complex cataract surgery required $158.26 more for costs of supplies and materials (95% CI, $117.00-$199.60; P &lt; .001). The total difference in day-of-surgery costs between complex and simple cataract surgery was $877.85. Incremental reimbursement for complex cataract surgery was $231.01; therefore, complex cataract surgery had a negative earnings difference of $646.84 compared with simple cataract surgery.Conclusions and RelevanceThis economic analysis suggests that the incremental reimbursement for complex cataract surgery undervalues the resource costs required for the procedure, failing to cover increased costs and accounting for less than 2 minutes of increased operating time. These findings may affect ophthalmologist practice patterns and access to care for certain patients, which may ultimately justify increasing cataract surgery reimbursement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven Activity-Based Costing

et al. 2023

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“…In the hospital setting, 46 US respondents completed the survey for cataract procedures and 41 provided information for retina procedures; technicians timed 140 cataract and 140 retina surgeries. Parameters adapted for Canada include percentage of procedures using comprehensive Custom-Pak, cost of taxes and benefits as a percentage of salaries, OR preparation time between cases, time to verify and pay invoices, and the number of people involved in certain tasks across departments; these inputs were based on historical data from the Independent Health Facility, Kensington Eye Institute (KEI, Toronto, Ontario) 17 ( Table 1 ). Historical data (D. Punch, personal communication, April 2021) reporting the cost per case from KEI was used to calculate the overhead cost per hour for the OR, which was then updated to reflect 2018 labor costs.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive Custom-Pak® in Cataract and Vitreoretinal Surgery in Canadian Hospitals: Time and Budget Impact Analysis

Punch¹,

Davis²,

Hahn³

et al. 2023

CEOR

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Purpose Surgical procedure packs are commonly used in ophthalmological surgeries, but quantitative evidence demonstrating the time efficiency and economic impact of their use is limited. Evaluating the time and cost of surgical pack use is particularly important for publicly funded healthcare systems with tight budgets and/or an emphasis on value-based care. This study sought to estimate the economic impact of comprehensive surgical pack use in cataract and vitreoretinal (retina) surgeries across operating room (OR), materials management, and accounting departments in Canada. Methods A budget impact model developed for the United States (US) from a self-reported cross-sectional study was adapted for Canada. The US study obtained data via an online survey and timing exercises of surgical procedures. The model was adapted using relevant Canadian-specific labor and cost inputs. Use of generic commodity packs (no proprietary equipment-specific supplies) was compared to full utilization of Custom-Pak ® , a comprehensive pack (disposables plus equipment-specific supplies) in cataract and retina surgeries at the facility and aggregate group (provincewide) levels. Results Switching from generic to comprehensive pack use in all 2500 cataract procedures at a community hospital saves 287 labor hours per year, primarily in the materials management department. Surgery preparation (OR) hours saved allow for an additional 196 potential procedures annually. Most of the Canadian Dollar (CAD) $39,815 annual cost savings are realized for the OR. Aggregating across 50,000 cataract surgeries at the provincial level yields savings of 5608 hours and 3916 additional procedures, translating to hidden cost reductions of CAD$790,632 annually. Implementing full Custom-Pak use at the facility level in 1000 retina cases saves $10,650 annually; provincewide, 127 potential additional procedures can be gained. Conclusion Comprehensive Custom-Pak use improves efficiency in cataract and retina surgeries saving substantial time and cost in Canadian hospitals, potentially allowing more patients to have these procedures, and reducing wait times.

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Systematic review and meta‐analysis of urinary incontinence prevalence and population estimates

Sadri,

Oliaei,

Sadri

et al. 2023

Neurourology and Urodynamics

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IntroductionIncontinence impacts the quality‐of‐life of people suffering from the disease. However, there is limited information on the prevalence of incontinence due to the stigma, lack of awareness, and underdiagnosis.ObjectiveThis study aims to conduct a systematic review and meta‐analysis of overactive bladder (OAB) and nonobstructive urinary retention (NOUR).MethodsThe authors conducted a systematic review following the PRISMA guidelines using Embase, MEDLINE, and PubMed databases to identify the relevant publications in the English language. Two reviewers independently assessed the articles and extracted the data. Review papers were assessed for content and references. A meta‐analysis of proportions was conducted using the RStudio software. To address the age heterogeneity, a subanalysis was conducted. Pooled data were overlayed on the Canadian population and a sample of 10 populous countries to estimate the number of people suffering from incontinence.ResultsTwenty‐eight and eight articles were selected for OAB and NOUR, respectively. The pooled prevalence of OAB in men and women was 12% (95% CI: 9%–16%) and 15% (95% CI: 12%–18%), respectively. The estimated prevalence of NOUR was 15.6%–26.1% of men over 60 and 9.3%–20% of women over 60. The subanalysis pooled prevalence of OAB in men and women was 11% (95% CI: 8%–15%) and 12% (95% CI: 9%–16%), respectively. We estimated that 1.4–2.5 million women and 1.3–2.2 million men suffer from OAB in Canada.ConclusionUrinary incontinence is an under‐reported and underdiagnosed prevalent condition that requires appropriate treatment to improve a patient's quality‐of‐life.

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Time-Driven Activity-Based Costing for Cataract Surgery in Canada: The Case of the Kensington Eye Institute

Cited by 8 publications

References 10 publications

Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven Activity-Based Costing

Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven Activity-Based Costing

Comprehensive Custom-Pak® in Cataract and Vitreoretinal Surgery in Canadian Hospitals: Time and Budget Impact Analysis

Systematic review and meta‐analysis of urinary incontinence prevalence and population estimates

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