A Micro-Costing Analysis of Flexible Bronchoscopic Intubation in a Korean Tertiary Hospital

Abstract

Objectives: To evaluate the per-procedure cost of flexible bronchoscopic intubation in relation to the monetary value of the practice expense relative value units (RVUs) of the procedure. Methods: A micro-costing analysis of flexible bronchoscopic intubation was performed in the anesthesiology and pain medicine department of a Korean tertiary hospital over the fiscal year 2019. Cost records were collected and then categorized into three cost components: depreciation of reusable flexible bronchoscopes and video equipment, reprocessing, and repairs. The per-procedure cost was calculated by dividing the total annual cost by the annual number of flexible bronchoscopic intubations performed. The resulting per-procedure cost was then compared to the monetary value of the practice expense RVUs of the procedure. Considering that the annual procedural volume would significantly impact per-procedure costs and overall profitability, a deterministic sensitivity analysis (DSA) was conducted. Results: In total, 748 flexible bronchoscopic intubations were performed during the fiscal year. Total annual costs for depreciation of the bronchoscopes and video equipment, reprocessing, and repair were US$ 31,921, US$ 22,268, and US$ 22,948 respectively. The calculated per-procedure cost of the flexible bronchoscopic intubation in the period was US$ 103.1 while the fee listed in the fee schedule and the monetary value of the practice expense RVUs of the procedure were US$ 69.9 and US$ 52.2 respectively. Therefore, the procedure was performed at a loss over the period: the amount that the subject department lost with respect to the practice expense RVUs totaled as much as US$ 38,039. The DSA demonstrated that the procedure would remain unprofitable even if twice the volume of procedures were performed over the same duration (n=1,500). Conclusion: The findings suggest that HIRA’s determination of the practice expense RVUs of the procedure may have been underestimated and thus in need of review and recalculation to achieve adequate compensation. The per-procedure cost would vary by procedural volume and site of practice which indicates that a further multicenter study is required to confirm the study’s findings.