title: Cost Analysis of a Multidisciplinary Aerodigestive Clinic: Are Such Clinics Financially Feasible?
abstract: OBJECTIVE
  Multidisciplinary clinics offer important value to pediatric patients with complex conditions that overlap specialties; however, such labor-intensive clinics are difficult to facilitate. We performed a cost analysis of our pediatric multidisciplinary aerodigestive clinic (MADC) to assess its financial feasibility at our tertiary care institution.
  
  
  METHODS
  Revenue was based on net collections for clinic, professional, and hospital setting charges generated during 12 consecutive monthly MADCs beginning August 2013. Clinic charges included facility and speech pathologist fees. Professional charges included clinic and operative fees generated by providers and anesthesiologist. Hospital setting fees included facility and material charges for technical procedures. Direct expense calculations included all providers and staff salaries, benefits, and supply costs.
  
  
  RESULTS
  Charge capture for 54 consecutive patients seen during the study time included new visits 99203-99205 (n = 63), consults 99243-99245 (n = 60), and follow-up visits 99212-99215 (n = 196). Sixty percent of patients underwent a clinic nasopharyngeal or laryngeal endoscopy (92511 or 31575), and 60% underwent subsequent intraoperative procedures with 1 (n = 8) or 2 to 3 services (n = 24). Program net revenue totaled $828 136 and direct costs $518 867, accounting for a net positive margin of $309 269.
  
  
  CONCLUSIONS
  When including direct downstream revenue, our MADC operates on a net positive margin, making it financially feasible.
authors.affiliation: 1 Department of Otolaryngology, Head and Neck Surgery, Children's National Health Services, Washington, DC, USA.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Mudd
authors.affiliation: 2 Joseph E. Roberts, Jr. Center for Surgical Care, Children's National Health Services, Washington, DC, USA.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Silva
authors.affiliation: 2 Joseph E. Roberts, Jr. Center for Surgical Care, Children's National Health Services, Washington, DC, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Callicott
authors.affiliation: 1 Department of Otolaryngology, Head and Neck Surgery, Children's National Health Services, Washington, DC, USA.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bauman
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D004066:Digestive System Diseases / Q000175:diagnosis / Q000628:therapy; D005240:Feasibility Studies; D006801:Humans; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D010372:Pediatrics / Q000191:economics / Q000379:methods; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States
keywords: aerodigestive clinic; clinic revenue; multidisciplinary clinic; value based care