1997 OPEN FORUM Abstracts
EFFECT OF A PROTOCOL ON THE DIRECT COSTS OF PROVIDING BRONCHODILATOR THERAPY
Robert Messenger BS, RRT, Daniel Pavlik MEd, RRT Respiratory Care Division - Pulmonary Services Department, MetroHealth Medical Center, Cleveland, OH.
Introduction: One of the potential benefits of patient driven protocols is their ability to reduce costs by eliminating unnecessary care. We sought to determine the effect that a bronchodilator (BD) protocol would have on treatment volume and the direct costs of providing BD therapy. Method: We compared the number of BD treatments (MDI & SVN) for the 6 month period preceding the initiation of the protocol (Jan - June, 1995) with the number of treatments for the 6 months following protocol initiation (July - Dec., 1995). The following formula was used to correct for the effect that variations in hospital census would have on the number of treatments identified for the period following implementation of the protocol: Pre protocol census x BD treatments post protocol/Post protocol census = Corrected BD treatments post protocol The overall effect on costs was then determined in two steps. First, the number of treatments in each period were multiplied by the direct cost for BD treatment administration as identified by the Hospital Accounting Department. Next, the total number of initial and follow-up assessments, associated with the implementation of the protocols, were each multiplied by the average RCP hourly wage and then by the fraction of an hour associated with each respective type of assessment. The assessment costs in the protocol period were added to the treatment administration direct costs and the sum was then subtracted from the treatment direct cost in the period prior to the protocol. The hospital Accounting Department identified that the cost per treatment did not change over the study period. Indirect costs and direct cost associated with staff training were not included in the analysis. Results: Treatments for the pre and post protocol periods were 38,539 and 23,229 respectively, a difference of 15,310 treatments. Following correction for census variation, the number of BD treatments in the protocol period was 24,251. The difference between the two periods was 14,288 treatments. 2,560 initial and 1,535 follow-up assessments were performed during the protocol period with an average direct cost of $7.30 and $3.48 respectively. Corrected for census variation, the direct cost reduction was calculated as $67,986 for the 6 month period.
6 months Before Protocol After Protocol
Hospital census 12,860 12,318
Patients receiving BD therapy 1,909 1,331 (1,390)
Treatments 38,539 23,229 (24,251)
Therapy administration costs $248,191 $149,595 ($156,176)
Patient assessment costs 0 $24,029
Total costs $248,191 $173,624 ($180,205)
Values in parenthesis are corrected for variation in hospital census
Conclusion: Implementation of a patient driven bronchodilator protocol can decrease the volume of treatments and result in cost savings. Seasonal variation and the potential for differences in group severity may account for some of the savings identified in this analysis. Start-up costs associated with staff education and competency are a required component of a protocol program, however, are considered as a single major investment with minor maintenance costs. Although this study identified calculated cost savings, actual savings may vary from the calculated amount as staffing patterns and supply orders are adjusted.