Net Revenue Analysis of Inpatient and Emergency Department Thyroid Ultrasound at a US Quaternary Care Center From 2012 to 2015

Abstract

Purpose: The aim of this study was to understand the financial ramifications of performing nonemergent inpatient and emergency department (ED) adult thyroid ultrasound studies at a US quaternary care center.

Methods: A HIPAA-compliant, institutional review board-exempt retrospective review of 10,334 thyroid ultrasound studies performed between February 2012 and December 2015 was conducted. Demographic, imaging, clinical, and financial data were reviewed. Labor cost analysis was calculated using national salary data and local scheduling practices. Professional and technical reimbursement and utilization trends were compared across 149 payers, multiple time spans, and visit settings (outpatient, ED, and inpatient).

Results: Most thyroid ultrasound studies were performed on outpatients (97.4% [10,069 of 10,334]), with a minority performed on inpatients (2.1% [217 of 10,334]) or in the ED (0.5% [48 of 10,334]). Man-hour cost of performing thyroid ultrasound was higher in the inpatient and ED settings ($15.30) compared with the outpatient setting ($7.65). Professional reimbursement was highest in the outpatient setting (mean, $37.39) and varied by payer (proprietary data; SD, $21.36 per examination). Technical reimbursement loss due to diagnosis-related group billing for inpatients and admitted-via-ED patients was $44,376; this was partly compensated ($9,309) by technical reimbursement from discharged-from-ED patients (mean technical reimbursement loss, $746 per month). Utilization increased year by year and correlated with Medicare volumes. Inpatient utilization was highest in Medicare patients; outpatient and ED utilization was highest for patients with private payers.

Conclusions: Net revenue loss from and imaging volumes of inpatient and ED nonemergent adult thyroid ultrasound studies are low.

Keywords: Cost; diagnosis-related group; reimbursement; revenue; thyroid ultrasound.