Chest radiography in patients with early stage prostatic carcinoma. Effect on treatment planning and cost analysis

The costs of CT procedures in an academic radiology department determined by an activity-based costing (ABC) method

PURPOSE

The purpose of this work was to determine the costs of computed tomography (CT) procedures in a large academic radiology department, including both professional (PC) and technical (TC) components, by analyzing actual resource consumption using an activity-based costing (ABC) method and comparing them with Medicare payments.

METHOD

Over a 12 month period from July 1, 1996, to June 30, 1997, 1,011 CT procedures, representing 16 Physicians' Current Procedural Terminology (CPT) codes and 98.3% of CT studies performed, were carefully observed by a research assistant trained in ABC methodology. Information collected during these time and motion studies included personnel/machine time and direct materials used. Actual resource units used during the different activities in each CT procedure were valued using appropriate cost drivers. Unit values for both direct and overhead costs were calculated: the cost of an individual procedure equaled the sum of component costs. Costs were compared with PC and TC payments according to the 1997 Medicare Fee Schedule.

RESULTS

Total costs of CPT codes 70450 (CT Head unenhanced), 71260 (CT Chest enhanced), and 74160 (CT Abdomen enhanced), which represented 71.2% of CT studies performed, were $189.19, $273.53, and $343.20, respectively. For all 16 nonmodified CPT codes analyzed, Medicare's professional reimbursement was less than the professional cost, whereas its technical reimbursement exceeded respective cost in 14 of the 16 codes.

CONCLUSION

In the setting and time period studied, Medicare underreimbursed professional costs while overreimbursing technical costs.

The prostate: diagnostic evaluation of metastatic disease

One of the single most important considerations in clinical management of the patient with prostate cancer is whether or not metastatic disease is present. The identification of metastatic disease in a patient with newly diagnosed prostate cancer represents an absolute contraindication to definitive local therapies such as radial prostatectomy or radiation therapy. Similarly, the identification of metastatic disease in a patient with disease recurrence after definitive local therapy represents an absolute contraindication to salvage radiotherapy or cryosurgery. Patients with metastatic disease do not benefit from definitive therapy, and the cost and morbidity associated with such treatment should therefore be avoided in these patients. Because of the significance of metastatic disease to clinical management, it is important for the diagnostic radiologist to be aware of important considerations in the metastatic work-up of patients with newly diagnosed prostate cancer and patients with suspected cancer recurrence after definitive local therapy.

Utility of chest radiography and cystoscopy in the evaluation of patients with localized prostate cancer

OBJECTIVES

Candidates for radical prostatectomy have been frequently evaluated with chest radiography and occasionally with cystoscopy. The utility of these studies was assessed.

METHODS

A retrospective review of 236 cases of radical prostatectomy performed over 5 years was conducted. Chest x-ray results were correlated with certain comorbidities believed to be risk factors for radiographic abnormalities, including hypertension, cardiac disease, pulmonary problems, and tobacco use. Cystoscopic findings were analyzed with regard to urologic history and urinalysis results.

RESULTS

Chest radiography was normal in 208 (88.1%) and abnormal in 28 (11.9%) patients. All 28 patients with abnormalities had one or more of the aforementioned risk factors. Sixty-two individuals (26.3%) had no risk factors, and chest radiography was uniformly normal in this group. Cystoscopy was performed in 91 patients. State Ta transitional cell carcinoma of the bladder was detected in 6 of these patients (6.6%); these 6 patients all had either a history of this problem or hematuria. One individual had a mild bladder-neck contracture that did not warrant treatment. Endoscopic findings were normal in the remaining patients.

CONCLUSIONS

Chest radiography is not routinely needed to evaluate radical prostatectomy candidates. It should only be performed in patients who have or are at risk for cardiopulmonary disease. Cystoscopy is not warranted in this setting unless there is clinical suspicion of other urologic pathology.