title: The effect of repair costs on the profitability of a ureteroscopy program.
abstract: OBJECTIVE
  Ureteroscopy (URS) is a common treatment for patients with stone disease. One of the disadvantages of this approach is the great capital expense associated with the purchase and repair of endoscopic equipment. In some cases, these costs can outpace revenues and lead to an unprofitable and unsustainable enterprise. We sought to characterize the profitability of our URS program when accounting for endoscope maintenance and repair costs.
  
  
  METHODS
  We identified all URS cases performed at a single hospital during fiscal year 2013 (FY2013). Charges, collection rates, and fixed and variable costs including annual equipment repair costs were obtained. The net margin and break-even point of URS were derived on a per-case basis.
  
  
  RESULTS
  For 190 cases performed in FY2013, total endoscope repair costs totaled $115,000, resulting in an average repair cost of $605 per case. The vast majority of cases (94.2%) were conducted in the outpatient setting, which generated a net margin of $659 per case, while inpatient cases yielded a net loss of $455. URS was ultimately associated with a net positive margin approaching $600 per case. On break-even analysis, URS remained profitable until repair costs reached $1200 per case.
  
  
  CONCLUSIONS
  Based on these findings, an established URS program can sustain profitability even with large equipment repair costs. Nonetheless, our findings serve to emphasize the importance of controlling costs, particularly in the current setting of decreasing reimbursement. A multifaceted approach, based on improving endoscope durability and exploring digital and disposable platforms, will be critical in maintaining the sustainability of URS.
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine , Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tosoian
authors.forename: Wesley
authors.initials: W
authors.lastname: Ludwig
authors.forename: Nikolai
authors.initials: N
authors.lastname: Sopko
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Mullins
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
mesh_terms: D003365:Costs and Cost Analysis; D017721:Hospital Costs; D006801:Humans; D007182:Income; D008283:Maintenance / Q000191:economics*; D012189:Retrospective Studies; D020709:Ureteroscopes / Q000191:economics*; D018666:Ureteroscopy / Q000191:economics*; D052878:Urolithiasis / Q000601:surgery*