The cost of angiography procedures: OHIP gets a bargain.

OBJECTIVE: To determine the costs for 1000 randomized interventional angiographic procedures. METHODS: An 9-page paper form was used to manually record the consumables, technologist time, room occupancy time and recovery room time for 80 different procedures collected over a 2-year period. The average cost for expendables per procedure was calculated for procedures that occurred 5 or more times. RESULTS: Of the 1000 procedures surveyed, there were 20 that had 10 or more occurrences, 9 that occurred 5-9 times and 51 that occurred less than 5 times, of which 32 had only a single occurrence. The total expendables used were $514,008. The total examination time was 1158 hours. The total technologist time was 2493 hours, and the total recovery room time was 1806 hours. Examples of the average cost per procedure are: cerebral angiogram (n = 249), avg. cost $441.24, and transvenous liver biopsy (n = 30), avg. cost $642.89. The coefficient of variation for procedure costs ranged from 15% to 139%. There were no correlations of technician time or procedure technical cost with the date of scan, indicating that there was no systematic increase or decrease in costs over the survey period. There were moderate correlations of the technical cost of a procedure with technologist time (Pearson r = 0.69) and the duration of a procedure (Pearson r = 0.73). The technical costs of interventional procedures were significantly underfunded; the reimbursement from the Ontario Hospital Insurance Plan was $278,446, or 54% of the actual costs. Fourteen procedures were reimbursed at below 50% of their costs. CONCLUSION: This shortfall in funding has serious consequences for the types and numbers of procedures that are possible in radiology departments. Funds must be diverted from other places to prevent serious rationing of these services.