Understanding The Cost Of Multidisciplinary Congenital Heart Disease Case Conference
Catherine C. Dawson, MD MSc1, Scott Wallace, JD MBA1, Elizabeth Teisberg, PhD1, Christopher Born, MBA CPA2, Andrew Well, MD MPH MSHCT1, Kathleen Carberry, RN MPH1, Dudley Byron Holt, MD1, Erin Gottlieb, MD MHCM1, Charles D. Fraser, Jr., MD1, Carlos M. Mery, MD MPH1.
1Dell Medical School at University of Texas at Austin, AUSTIN, TX, USA, 2Dell Children's Medical Center, AUSTIN, TX, USA.
Background: Congenital heart disease (CHD) management requires a multidisciplinary team. Many CHD centers conduct case conferences (CC) to discuss management plans. This study seeks to gain a better understanding of CHD CC activities, including time spent and costs associated with each activity. Methods: A single institution's CC was reviewed from 2/2021-4/2021. Activities were coded as presentation, echocardiography review, catheterization review, image review or discussion, timed by two individuals and averaged. Cost-per-minute for personnel was determined by annual salary divided by estimated total minutes worked per year. CHD CC cost was calculated using Time-Driven Activity-Based Costing, multiplying the time of an activity by cost/minute of personnel. Non-parametric and multivariable regression analyses were utilized. Results: Sixty-six cases were evaluated with 5[IQR:5-6.3] cases reviewed each CC. One case review took 14[IQR:8.3-20.3] minutes. Complex diagnoses took 16[IQR:13-21.3] minutes and adults took 25[IQR:18-39.8] minutes to review. Complex diagnoses have 61.4%(95%CI: 20.1%-116.7%, p=0.002) increase in review time after adjusting for age group and inpatient status. Sixty-five[IQR:52.8-76.3] providers attended CC. One case review costs $1063.20[IQR:626.50-1537.80] and total CC costs $6834.53[IQR:5203.05-8111.33]. Conclusion: Defining the value of care delivered requires knowing both costs and outcomes. CC likely improves outcomes in terms of patient health measures, patient family benefit, heart center culture, multidisciplinary education, and physician decision-making. Defining the cost of CC is important in order to understand the overall cost and value of CHD care. 
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