Time and Cost Savings of Virtual Established Plastic Surgery Care Using Time-Driven Activity-Based Costing: Lessons from An Academic Clinic.

Abstract

Various surgical subspecialties, including plastic surgery, have begun to embrace virtual clinic visits, especially since the COVID-19 pandemic. However, the impact of video visits on time optimization and cost incurred in outpatient plastic surgery clinics has not been studied. Using the time-driven activity-based costing (TDABC) method, we examined the time and cost of in-person and virtual visits at an academic plastic surgery clinic. We formulated process maps for four visit types: physician-led in-person, physician assistant-led in-person, physician-led virtual, and physician assistant-led virtual. The time associated with each visit type was generated by direct observation. The cost associated with each visit type was calculated from representative salary information and estimation of resource costs. Virtual visits took on average less time (25.3 minutes for physician-led visits and 24.4 minutes for physician assistant-led visits), compared to in-person visits (48.2 minutes for physician-led and 41.1 minutes for physician-assistant-led visits) (p<0.001). Virtual visits were also cheaper, at $52.80 for physician-led visits and $20.70 for physician assistant-led visits, compared to in-person visits ($261.13 for physician-led and $236.00 for physician assistant-led visits). Non-provider activities made up the majority of traditional in-person visits (75.7% of the visit for physician-led and 77.6% for physician assistant-led visits), which contributed to higher overall cost of in-person visits for both groups of providers. Virtual clinic visits can produce time and cost savings without reducing the amount of face-to-face time between providers and patients. Virtual visits can be a useful adjunct to traditional in-person visits.