Understanding the Cost of Case Conference in Congenital Heart Disease

Background: Congenital heart disease (CHD) management is complex and requires a multidisciplinary team to deliver optimum patient care. Most CHD centers conduct regular case conferences (CC), which bring together the multidisciplinary care team with the purpose of discussing patient care management plans. The structure of CCs vary between institutions and there is no established standard format or frequency for these meetings. Multidisciplinary tumor boards for oncology patients are analogous to CC, and few publications cite significant difference in patient treatment plans and improved overall survival resulting from these meetings. Effectively delivering high-value care requires understanding both outcomes and costs associated with care activities. Even though CC is expected to improve outcomes, the cost of this activity is not known. Time-Driven Activity-Based Costing (TDABC) is a cost accounting method that focuses on the major activities involved in providing a service, the personnel involved, and the time each person contributes in order to generate overall cost. The goal of this study is to determine the cost spent on CHD CC.

Methods: CC at a single institution was evaluated from 2/2021 through 4/2021. Activities of CC were coded as presentation, echocardiography review, catheterization review, image review or discussion and timed by two separate people and averaged. Physical and electronic CC sign-in sheets were collected from 10/2020-1/2021 to determine the distinct specialists present at CC weekly. Salary data for specialists was obtained for physicians through national AAMC median salary estimates, and for non-physicians from hospital averages. Cost per minute was determined by annual salary divided by total minutes of a 50-hour/week, 48-week work year. CHD CC cost was calculated using TDABC by multiplying the time of an activity by cost/minute value of the personnel providing the activity. The cost of one CHD CC was calculated by multiplying the median number of specific specialists at weekly CC by their median cost/minute by 90 minutes to determine the cost of specific specialist(s) at CC, and taking the sum of the specialist costs.

Results: Fifty-five cases were reviewed. Five[IQR:5-5.75] cases were reviewed in each case conference. One patient case took 8[IQR:4.25-15.48] minutes to review. Presentation accounted for 3[IQR:2-4] minutes, echocardiography for 2[IQR:1.25-3.5] minutes and discussion for 3[IQR:1-5] minutes.(Table 1) Sixty-five[IQR:52.75–76.25] providers attended CC, accounting for a cost of $671.29[IQR:356.62-1298.95] per patient and $7552.03[IQR:5875.70–8649.45] for each CC at our institution.(Table 2)

Conclusion: Defining the value of care delivered requires knowledge of both cost and outcomes. CC likely improves outcomes in terms of discrete patient health measures, patient family benefit, heart center culture, multidisciplinary education, and physician decision making. Determining the cost of CC is critical to understanding the cost of overall CHD care and the value that each portion of care delivery contributes to patients, families, providers, and the institution.