Case Study Instructions
Please have your partners, associates, interns, or technicians (whoever charges out
cases) independently develop an invoice for the case outlined in the following pages, including
all services for which your practice would normally charge. (Yes, you can be one of the doctors
submitting data if you practice clinical medicine in your hospital.) The case will direct you on all
estimate preparations. Use your hospital’s usual invoices and procedures. Please be consistent
in entering the same doctor under the same letter for each worksheet.
Everything in red in the case study instructions below needs to have data input in the
Excel Case Study Workbook. This Excel workbook contains four worksheets which correspond to
the four parts of the case study: Initial Workup, PYO Surgery, Overnight Care and Post Op. They
can be accessed on the labeled tabs at the bottom left of the workbook pages. The workbook is
locked so that you cannot alter the format which makes comparisons more accurate. If you
cannot find a cell in the excel sheet for the service that your practice would provide for the case,
please use an existing cell that is as close to what you use as possible. If that is not realistic,
place the fee in the miscellaneous category. However, the more items you place in the
miscellaneous category, or if you try to edit the spreadsheet, the less valid your comparison with
the others will be for the case report. The final invoices should be comparable to what your
clients would receive. Please DO NOT read ahead when doing the estimate preparation. Please
ask your staff to NOT COLLABORATE on the estimate preparation.
When complete, you will have your doctors’ fees for the cases on a spreadsheet for
comparison. In most cases you will see variations within your practice in charging for the same
medical problems.
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Complete Each Section before reading on.
Please create itemized estimates that you would normally give to clients in your practice.
Day 1:
A six-year-old intact 20-pound female Schnauzer was presented for signs of anorexia of 36
hours, lethargy, vomiting of 12 hours duration and PU/PD. She was in season approximately 4
to 6 weeks ago. Her physical exam and vital stats were unremarkable other than a tense
abdomen which made palpation difficult, scleral injection, and 5 percent dehydration. Client
authorizes whatever is medically best for the patient. She was an early morning unscheduled
urgent care visit. (Assume that she was not hospitalized until the results of the lab work were
known. Probably not how it would be handled in your practice but allows for easier comparison
of fees for our exercise.) The excel spreadsheet has options for multiple different methods of
charging for services that some may combine into a bundled fee. Just use the method that the
doctor outlines in their estimate.
-----------------------------------------------------------------------------------------------------------1.) Create an estimate titled “DAY ONE WORKUP” including at least the following services:
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Examination unscheduled standard exam
CBC
Chemistry Profile
o Or CBC/Chem profile (If you bill them together)
Electrolytes (if not included with Chem Profile above)
Blood collection fee if you charge separately for blood collection
Urinalysis lab fee (if bill separately)
Urine collection (cystocentesis/ultrasound guided if you bill separately)
Urine collection (catheterize if you bill separately for catheterized sample)
Urinalysis and collection fee billed together
Urine culture & Sensitivity Submitted
X-ray of the abdomen (2 views)
o Film (2 views)
o Interpretations of two views
X-ray for two plates and interpretation if you do not break out the charge separately
Abdominal ultrasound if available
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Findings of above diagnostic workup:
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X ray: uterine enlargement
Ultrasound: Large tubular hypoechoic mass is abdomen
Chem profile: Increased BUN 120 and Creatinine 3.3, Moderate Leukocytosis and
neutrophilia with a left shift and a mild macrocytic normochromic anemia
Urinalysis: 1.014 SG, 300 proteinuria, +2 white blood cells (WBC), and RBCs TNTC.
TDx: pyometra, uremia, dehydration, anemia, renal disease, possible UTI
-----------------------------------------------------------------------------------------------------------2.) Create a second estimate titled “PYOMETRA SURGERY” for a Pyometra surgery that would
be done by 2:00 PM on the day of admission. Please create a surgery estimate for the surgery
and for post op intensive care of the patient for the rest of the day until 7:00 PM. Assume the
surgery was completed by 3:00 PM.
-----------------------------------------------------------------------------------------------------------3.) Create a third estimate titled “OVERNIGHT CARE"
On a separate invoice include all services for overnight care for this patient until 7:00 AM the
next morning. Assume the patient is still uremic post op but is surgically stable. If your hospital
provided the overnight care please itemize your fees. If you decided to ship the patient to a
critical care facility for overnight monitoring, include what they would charge the client for the
overnight care of this patient until 7:00 AM. Please indicate if the overnight care was by your
hospital or an outside critical care facility!!
-----------------------------------------------------------------------------------------------------------4.) Create a fourth estimate titled “POSTOP FOLLOW-UP CARE”
Assume and create an estimate as if the patient remains hospitalized for an additional 48 hours
to correct her uremia and become stable enough to be discharged. Please create a separate
invoice which would include hospital services, labs and all meds administered during the
additional 48 hour hospital stay, daily CBC/ Chem panels and then those dispensed for
immediate and long term home care of this patient. .
****After you have completed the estimates please have someone from your office enter the
data from the invoices into the attached excel spreadsheets. We have included spreadsheets
for each estimate that should enable you to itemize most of your usual fees in one of the
available cells. Any fees that cannot fit in one of the similar available cells please place in the
miscellaneous categories but please try to find a service that is close to what your staff charged
and use that service rather than use miscellaneous. Try to minimize use of miscellaneous, as it
will diminish the value of the exercise.
Most likely you will have many blank cells as we have tried to give you multiple options for
entering fees in the spreadsheet to accommodate how your practices charges for services.
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