The direct costs of coronary CT angiography relative to contrast-enhanced thoracic CT: Time-driven activity-based costing

Michael E Zimmerman,Juan C Batlle,Cathleen Biga,Ron Blankstein,Brian B Ghoshhajra,Mark G Rabbat,George E Wesbey,Geoffrey D Rubin

doi:10.1016/j.jcct.2021.06.002

Abstract

BackgroundCoronary CT angiography (CCTA) and contrast-enhanced thoracic CT (CECT) are distinctly different diagnostic procedures that involve intravenous contrast-enhanced CT of the chest. The technical component of these procedures is reimbursed at the same rate by the Centers for Medicare and Medicaid Services (CMS). This study tests the hypothesis that the direct costs of performing these exams are significantly different. MethodsDirect costs for both procedures were measured using a time-driven activity-based costing (TDABC) model. The exams were segmented into four phases: preparation, scanning, post-scan monitoring, and image processing. Room occupancy and direct labor times were collected for scans of 54 patients (28 CCTA and 26 CECT studies), in seven medical facilities within the USA and used to impute labor and equipment cost. Contrast material costs were measured directly. Cost differences between the exams were analyzed for significance and variability. ResultsMean CCTA duration was 3.2 times longer than CECT (121 and 37 min, respectively. p < 0.01). Mean CCTA direct costs were 3.4 times those of CECT ($189.52 and $55.28, respectively, p < 0.01). Both labor and capital equipment costs for CCTA were significantly more expensive (6.5 and 1.8-fold greater, respectively, p < 0.001). Segmented by procedural phase, CCTA was both longer and more expensive for each (p < 0.01). Mean direct costs for CCTA exceeded the standard CMS technical reimbursement of $182.25 without accounting for indirect or overhead costs. ConclusionThe direct cost of performing CCTA is significantly higher than CECT, and thus reimbursement schedules that treat these procedures similarly undervalue the resources required to perform CCTA and possibly decrease access to the procedure.

Highlights

Coronary CT Angiography (CCTA) is gaining acceptance as a primary, and in some cases, preferred diagnostic test for assessing coronary artery disease.[1]
Recent meta-analyses and large prospective randomized clinical trials have demonstrated among other favorable qualities a decrease in subsequent myocardial infarctions and hospital visits compared with functional stress testing in evaluating chest pain in the setting of Abbreviations: ambulatory payment classification (APC), Ambulatory payment classification; cost-tocharge ratio (CCR), Cost-to-charge ratio; CCTA, Coronary CT angiography; contrast-enhanced thoracic CT (CECT), Contrast-enhanced chest CT; CPT, Current procedural terminology; Centers for Medicare and Medicaid Services (CMS), Centers for Medicare & Medicaid Services; outpatient prospective payment system (OPPS), Outpatient Prospective Payment System; relative value unit (RVU), Relative Value Unit; time-driven activity-based costing (TDABC), Time-driven activity-based costing
The aim of this study was to assess the direct cost of performing the technical components of CCTA and CECT in the outpatient setting, and to examine whether Medicare technical reimbursement as listed in CMS payment schedules aligns with the relative direct cost of performance

Summary

Introduction

Coronary CT Angiography (CCTA) is gaining acceptance as a primary, and in some cases, preferred diagnostic test for assessing coronary artery disease.[1]. The Centers for Medicare & Medicaid Services (CMS) national outpatient prospective payment system (OPPS) global facility price without modifiers for CECT (CPT 71260) is $246.13, while the global price for CCTA without modifiers (CPT 75574) is $303.15.5 Global payment without modifiers is inclusive of both the professional and technical components of performing a procedure. Because these tests both fall under the same ambulatory payment classification (APC), the technical components of these procedures start from the same national baseline of $182.25 under the OPPS schedule. Conclusion: The direct cost of performing CCTA is significantly higher than CECT, and reimbursement schedules that treat these procedures undervalue the resources required to perform CCTA and possibly decrease access to the procedure

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