1540. Determining the True Cost to Deliver Minimally Invasive ACDF across the Full Episode of Care

Authors: Daniel Bu; Samuel Overley, MD; Aakash Keswani; Todd Albert, MD; Steven McAnany, MD; Sravisht Iyer, MD; Catherine Himo Gang, MPH (New York, NY)

Introduction: Even as value-based payment systems like the CMS Bundled Payments for Care Improvement program (BPCI) aim to decrease cost by piloting bundles for cervical spinal fusion, the full cost of an MIS ACDF to the health system remains opaque. We apply the time-driven activity-based costing system (TDABC) to gauge the true cost of the procedure across the full cycle of care: from the first clinic visit through the last visit 1-year post-surgery. Methods: The ACDF care cycle at a tertiary care medical center was broken down into process maps. Timing data were obtained from the time stamp data records of 152 patients, and the direct time study of 10 patients. Capacity cost rates (CCR) for personnel were calculated using US Labor numbers adjusted using fully loaded labor rates. The CCR for equipment and space was calculated using direct and amortized purchase prices, and vendor-published maintenance contracts. Results: Of the total TDABC derived cost (>$10,442), combined consumables accounted for the greatest portion of costs (51%), of which implants drove 39% of the true total cost over the entire cycle. The most expensive individual step was the procedure on the day of procedure (52%). Personnel costs were another major cost-driver (44%), and space costs were the least costly (5%). Modeling the optimization of the care cycle yielded combined savings of >$1002 (7.8%), with the elimination of unnecessary practice variation, and improved resource capacity utilization (PACU, OR, imaging) contributing the most (3.5% and 3.4%). Conclusion: TDABC allowed us to uncover both the true total cost, and the cost of individual processes and evaluated resource capacity utilization at every point. Although optimization of the care cycle yielded significant cost-savings, the significant role of implants needs to be further investigated. Furthermore, TDABC offered insights into cost drivers over the full cycle of care.