Cost Assessment Tool Improves Efficiency of MR Enterography
Thursday, Dec. 01, 2016
Use of a cost assessment tool helped the Mayo Clinic reduce time and expense associated with an MRI procedure, according to research presented at RSNA 2016.
Time-Driven Activity-Based Costing (TDABC) is a cost accounting methodology developed by two professors at the Harvard Business School to help businesses better understand their costs.
Applied to a healthcare setting, TDABC measures the time and cost of providing patient care services, taking into account personnel and equipment costs per minute. Overhead expenses and profit margins are also factored in to determine the true cost.
"In this era of declining reimbursements, it's particularly important to understand how much a procedure costs and how much you're getting paid," said Stacy Schultz, project manager and former quality improvement specialist at the Mayo Clinic in Rochester, Minn. "TDABC helps by taking every piece of the exam and putting a value on it."
Schultz and her Mayo Clinic colleagues recently employed TDABC to better understand and improve their practice of MR enterography, commonly used to examine the small intestine for signs of Crohn's disease.
Though the imaging portion of the procedure only takes about half an hour, patient preparation can be time-consuming. The exam at the Mayo Clinic once involved eight different care providers and required a patient to spend an average of three hours in the department.
"We picked MR enterography for this study because it was something we knew a lot about," Schultz said. "It's been a frustrating exam for all the staff, with an extensive number of process steps, and prior attempts at improving the process had been disappointing."
Eliminating Delay in MRE Procedures
A multidisciplinary team of patient-care personnel and radiology management staff worked together to analyze the various steps in the procedure and the associated costs and develop new approaches.
For instance, MRE procedures at Mayo once required a nurse to deliver an injection of glucagon, a medication that reduces the normal contractions of the intestine that can blur the images on MRI. This step interrupted work flow and had the potential to delay the exam for as long as 25 minutes. The team shifted responsibility for the glucagon injection to the technologist, eliminating the delay.
"The nurses were frustrated at being interrupted from other duties to prepare and perform the injection and technologists were frustrated waiting on the nurses, so this change not only cut time but really helped reduce frustration among staff members," Schultz said.
The organization applied the TDABC methodology to MRE starting in January 2015 and ended the implementation and data collection by October of that year. They were able to gather process observation data from more than 30 exams to validate previous data from over 1,000 patient chart reviews.
Analysis showed that TDABC methodology led to improvements in the daily workflow. In more than 1,000 MRE procedures, the modifications reduced non-value-added waste and cost by 13 percent. Staff time was reduced 16 percent, from an average of 198 minutes to 165. Patient process time dropped from an average of 102 minutes to 85, a reduction of 17 percent. Surveys showed a high level of staff satisfaction.
"Everybody loved it," Schultz said. "The nurses and technologists were happy and complaints from radiologists went down."
With the success of this initiative, Mayo Clinic teams are applying the TDABC methodology to other areas within the radiology practice, including ultrasound and MRI of the head.