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Yoshimi Anzai, Marta E Heilbrun, Derek Haas, Luca Boi, Kirk Moshre, Satoshi Minoshima, Robert Kaplan, Vivian S Lee
RATIONALE AND OBJECTIVES: The lack of understanding of the real costs (not charge) of delivering healthcare services poses tremendous challenges in the containment of healthcare costs. In this study, we applied an established cost accounting method, the time-driven activity-based costing (TDABC), to assess the costs of performing an abdomen and pelvis computed tomography (AP CT) in an academic radiology department and identified opportunities for improved efficiency in the delivery of this service...
December 14, 2016: Academic Radiology
Samir El Alaoui, Nils Lindefors
BACKGROUND: A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT)...
2016: PloS One
Annette M Ilg, Aaron A Laviana, Mitchell Kamrava, Darlene Veruttipong, Michael Steinberg, Sang-June Park, Michael A Burke, Douglas Niedzwiecki, Patrick A Kupelian, Christopher Saigal
PURPOSE: Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center. METHODS AND MATERIALS: We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup...
October 3, 2016: Brachytherapy
Yangyang R Yu, Paulette I Abbas, Carolyn M Smith, Kathleen E Carberry, Hui Ren, Binita Patel, Jed G Nuchtern, Monica E Lopez
PURPOSE: As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. METHODS: Process maps were created using medical record time stamps...
December 2016: Journal of Pediatric Surgery
Kamran S Hamid, Andrew P Matson, Benedict U Nwachukwu, Daniel J Scott, Richard C Mather, James K DeOrio
BACKGROUND: Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR)...
January 2017: Foot & Ankle International
Katy E French, Alexis B Guzman, Augustin C Rubio, John C Frenzel, Thomas W Feeley
BACKGROUND: With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of 11 common oncologic outpatient surgical procedures. METHODS: Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures...
September 2016: Healthcare
Hasan Özyapıcı, Veyis Naci Tanış
Objective The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting.Methods A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA.Results The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA...
June 2, 2016: Australian Health Review: a Publication of the Australian Hospital Association
Ralph Crott, Georges Lawson, Marie-Cécile Nollevaux, Annick Castiaux, Bruno Krug
Head and neck cancer (HNC) is predominantly a locoregional disease. Sentinel lymph node (SLN) biopsy offers a minimally invasive means of accurately staging the neck. Value in healthcare is determined by both outcomes and the costs associated with achieving them. Time-driven activity-based costing (TDABC) may offer more precise estimates of the true cost. Process maps were developed for nuclear medicine, operating room and pathology care phases. TDABC estimates the costs by combining information about the process with the unit cost of each resource used...
September 2016: European Archives of Oto-rhino-laryngology
Matthew E Schutzer, Douglas W Arthur, Mitchell S Anscher
PURPOSE: Value in health care is defined as outcomes achieved per dollar spent, and understanding cost is critical to delivering high-value care. Traditional costing methods reflect charges rather than fundamental costs to provide a service. The more rigorous method of time-driven activity-based costing was used to compare cost between whole-breast radiotherapy (WBRT) and accelerated partial-breast irradiation (APBI) using balloon-based brachytherapy. MATERIALS AND METHODS: For WBRT (25 fractions with five-fraction boost) and APBI (10 fractions twice daily), process maps were created outlining each activity from consultation to post-treatment follow up...
May 2016: Journal of Oncology Practice
Nikhil G Thaker, Thomas J Pugh, Usama Mahmood, Seungtaek Choi, Tracy E Spinks, Neil E Martin, Terence T Sio, Rajat J Kudchadker, Robert S Kaplan, Deborah A Kuban, David A Swanson, Peter F Orio, Michael J Zelefsky, Brett W Cox, Louis Potters, Thomas A Buchholz, Thomas W Feeley, Steven J Frank
PURPOSE: Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework. METHODS AND MATERIALS: Patients with low-risk PCa treated with low-dose-rate PBT between 1998 and 2009 were included. Outcomes were recorded according to the International Consortium for Health Outcomes Measurement standard set, which includes acute toxicity, patient-reported outcomes, and recurrence and survival outcomes...
May 2016: Brachytherapy
S Sabharwal, A W Carter, A Rashid, A Darzi, P Reilly, C M Gupte
AIMS: The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost. METHODS: A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost RESULTS: The mean cost of the different surgical treatments was estimated to be £3282...
February 2016: Bone & Joint Journal
Aaron A Laviana, Annette M Ilg, Darlene Veruttipong, Hung-Jui Tan, Michael A Burke, Douglas R Niedzwiecki, Patrick A Kupelian, Chris R King, Michael L Steinberg, Chandan R Kundavaram, Mitchell Kamrava, Alan L Kaplan, Andrew K Moriarity, William Hsu, Daniel J A Margolis, Jim C Hu, Christopher S Saigal
BACKGROUND: Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer. METHODS: Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS)...
February 1, 2016: Cancer
Steven A Kaplan
No abstract text is available yet for this article.
November 2015: Journal of Urology
João Gregório, Giuliano Russo, Luís Velez Lapão
BACKGROUND: The current financial crisis is pressing health systems to reduce costs while looking to improve service standards. In this context, the necessity to optimize health care systems management has become an imperative. However, little research has been conducted on health care and pharmaceutical services cost management. AIM: Pharmaceutical services optimization requires a comprehensive understanding of resources usage and its costs. This study explores the development of a time-driven activity-based costing (TDABC) model, with the objective of calculating the cost of pharmaceutical services to help inform policy-making...
May 2016: Research in Social & Administrative Pharmacy: RSAP
Morgan Mandigo, Kathleen O'Neill, Bipin Mistry, Bryan Mundy, Christophe Millien, Yolande Nazaire, Ruth Damuse, Claire Pierre, Jean Claude Mugunga, Rowan Gillies, Franciscka Lucien, Karla Bertrand, Eva Luo, Ainhoa Costas, Sarah L M Greenberg, John G Meara, Robert Kaplan
BACKGROUND: In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters...
April 27, 2015: Lancet
F Erhun, B Mistry, T Platchek, A Milstein, V G Narayanan, R S Kaplan
INTRODUCTION: Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease--a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32, 201 ± $23,059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery...
2015: BMJ Open
Katy E French, Heidi W Albright, John C Frenzel, James R Incalcaterra, Augustin C Rubio, Jessica F Jones, Thomas W Feeley
BACKGROUND: The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. PROBLEM: Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). GOALS: Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment...
December 2013: Healthcare
Alvin Chen, Sanjeeve Sabharwal, Kashif Akhtar, Navnit Makaram, Chinmay M Gupte
INTRODUCTION: The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. METHODS: The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5...
December 2015: Knee
A L Kaplan, N Agarwal, N P Setlur, H J Tan, D Niedzwiecki, N McLaughlin, M A Burke, K Steinberg, K Chamie, C S Saigal
BACKGROUND: Determining '"value'" in health care, defined as outcomes per unit cost, depends on accurately measuring cost. We used time-driven activity-based costing (TDABC) to determine the cost of care in men with benign prostatic hyperplasia (BPH) - a common urologic condition. METHODS: We implemented TDABC across the entire care pathway for BPH including primary and specialist care in both inpatient and outpatient settings. A team of expert stakeholders created detailed process maps, determined space and product costs, and calculated personnel capacity cost rates...
March 2015: Healthcare
Paul A Merguerian, Richard Grady, John Waldhausen, Arlene Libby, Whitney Murphy, Lilah Melzer, Jeffrey Avansino
INTRODUCTION: Value in healthcare is measured in terms of patient outcomes achieved per dollar expended. Outcomes and cost must be measured at the patient level to optimize value. Multidisciplinary clinics have been shown to be effective in providing coordinated and comprehensive care with improved outcomes, yet tend to have higher cost than typical clinics. We sought to lower individual patient cost and optimize value in a pediatric multidisciplinary reconstructive pelvic medicine (RPM) clinic...
August 2015: Journal of Pediatric Urology
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