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Jacob A Martin, Christopher R Mayhew, Amanda J Morris, Angela M Bader, Mitchell H Tsai, Richard D Urman
Background: Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. Methods: In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology...
April 2018: Journal of Clinical Medicine Research
John A Palsis, Thomas S Brehmer, Vincent D Pellegrini, Jacob M Drew, Barton L Sachs
BACKGROUND: In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. METHODS: We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods...
February 21, 2018: Journal of Bone and Joint Surgery. American Volume
Aaron A Laviana, Hung-Jui Tan, Jim C Hu, Alon Z Weizer, Sam S Chang, Daniel A Barocas
PURPOSE OF REVIEW: To perform a bicenter, retrospective study of perioperative outcomes of retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) and assess costs using time-driven activity-based costing (TDABC). We identified 355 consecutive patients who underwent RALPN at University of California Los Angeles and the University of Michigan during 2009-2016. We matched according to RENAL nephrometry score, date, and institution for 78 retroperitoneal versus 78 transperitoneal RALPN...
December 22, 2017: Current Opinion in Urology
Kimberly G Blumenthal, Yu Li, Aleena Banerji, Brian J Yun, Aidan A Long, Rochelle P Walensky
BACKGROUND: Unverified penicillin allergy leads to adverse downstream clinical and economic sequelae. Penicillin allergy evaluation can be used to identify true, IgE-mediated allergy. OBJECTIVE: To estimate the cost of penicillin allergy evaluation using time-driven activity-based costing (TDABC). METHODS: We implemented TDABC throughout the care pathway for 30 outpatients presenting for penicillin allergy evaluation. The base-case evaluation included penicillin skin testing and a 1-step amoxicillin drug challenge, performed by an allergist...
September 22, 2017: Journal of Allergy and Clinical Immunology in Practice
Dylan Isaacson, Tessnim Ahmad, Ian Metzler, David T Tzou, Kazumi Taguchi, Manint Usawachintachit, Samuel Zetumer, Benjamin Sherer, Marshall Stoller, Thomas Chi
PURPOSE: Careful decontamination and sterilization of reusable flexible ureteroscopes used in ureterorenoscopy cases prevent the spread of infectious pathogens to patients and technicians. However, inefficient reprocessing and unavailability of ureteroscopes sent out for repair can contribute to expensive operating room (OR) delays. Time-driven activity-based costing (TDABC) was applied to describe the time and costs involved in reprocessing. MATERIALS AND METHODS: Direct observation and timing were performed for all steps in reprocessing of reusable flexible ureteroscopes following operative procedures...
October 2017: Journal of Endourology
Ryan K McBain, Gregory Jerome, Jonathan Warsh, Micaela Browning, Bipin Mistry, Peterson Abnis I Faure, Claire Pierre, Anna P Fang, Jean Claude Mugunga, Joseph Rhatigan, Fernet Leandre, Robert Kaplan
Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery...
November 2016: BMJ Global Health
Gerardine Doyle, Shane O'Donnell, Etáin Quigley, Kate Cullen, Sarah Gibney, Diane Levin-Zamir, Kristin Ganahl, Gabriele Müller, Ingrid Muller, Helle Terkildsen Maindal, Wushou Peter Chang, Stephan Van Den Broucke
OBJECTIVES: The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. SETTING: Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. PARTICIPANTS: Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes...
June 4, 2017: BMJ Open
George Keel, Carl Savage, Muhammad Rafiq, Pamela Mazzocato
Health care organizations around the world are investing heavily in value-based health care (VBHC), and time-driven activity-based costing (TDABC) has been suggested as the cost-component of VBHC capable of addressing costing challenges. The aim of this study is to explore why TDABC has been applied in health care, how its application reflects a seven-step method developed specifically for VBHC, and implications for the future use of TDABC. This is a systematic review following the PRISMA statement. Qualitative methods were employed to analyze data through content analyses...
May 10, 2017: Health Policy
Martin Ridderstråle
BACKGROUND: Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. METHODS: Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location...
July 2017: Journal of Diabetes Science and Technology
Yangyang R Yu, Paulette I Abbas, Carolyn M Smith, Kathleen E Carberry, Hui Ren, Binita Patel, Jed G Nuchtern, Monica E Lopez
OBJECTIVES: Healthcare reform policies are emphasizing value-based healthcare delivery. We hypothesize that time-driven activity-based costing (TDABC) can be used to appraise healthcare interventions in pediatric appendicitis. METHODS: Triage-based standing delegation orders, surgical advanced practice providers, and a same-day discharge protocol were implemented to target deficiencies identified in our initial TDABC model. Post-intervention process maps for a hospital episode were created using electronic time stamp data for simple appendicitis cases during February to March 2016...
June 2017: Journal of Pediatric Surgery
Kimberly M Daniels, Michael D Lappi, Susan Flath Sporn, Catherine Noonan Caillouette, Ronald Heald, John G Meara
The purpose of this study was to understand the true cost of administering prophylactic antibiotics postoperatively to patients undergoing cleft lip and lip adhesion procedures for which the rate of infection is historically low. Using time-driven activity-based costing (TDABC) methodologies, the plastic surgery department of one hospital created a process map with related time intervals and personnel cost rates for administering the antibiotic. The cost for each provider, based on standard salary information, was multiplied by the time required to complete his or her stage of the process, and this outcome was added to the supply costs...
July 2016: Journal of Healthcare Management / American College of Healthcare Executives
Nikhil G Thaker, Peter F Orio, Louis Potters
Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process...
July 2017: Brachytherapy
Karen H Lu, John D Calhoun, Anuja Jhingran, Isidora Arzu, Pamela T Soliman
9 Background: Value-based and quality health care delivery has become an important focus for many health care systems. The purpose of this study was to assess the cost differences in treating low and intermediate risk endometrial cancer using time-derived activity based costing (TDABC) in a large regional cancer network model. METHODS: Process mapping and TDABC was performed in treating endometrial cancer patients at a large tertiary cancer center (main) with a regional cancer network program...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Alexis B Guzman, Yu-Ting Huang, Monica DelValle-Garza, Christian C Kolom, Xin Zhao, Danson N Mutua, Krishan Dhingra, Thomas W Feeley
25 Background: Poor costing systems and measurement have led to cross-subsidies and cost-shifting in health care. A large academic cancer center has adopted Robert Kaplan's bottom-up cost accounting methodology called time-driven, activity-based costing (TDABC). TDABC in health care has been proven to be an effective cost accounting tool to measure and improve care delivery by standardizing and creating transparency around patient care processes. The project aims to process map and identify event triggers associated with each process map, use a software applications to compute the costs and resource capacities...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Elizabeth A Garcia, Kai E Lang, Valerie Villanueva, Shannon Neville Westin, Nicole D Fleming, Thomas W Feeley, Karen H Lu, Larissa Meyer
22 Background: Current changes in health care economics have led to a focus on value-based health care. TDABC is a systematic method to assess personnel utilization and the associated cost in the delivery of medical care. Based on baseline process maps and cost estimates in our outpatient center, cancer surveillance visits (CSV) were identified as inefficient, lengthy and high cost. The purpose of this study was to determine if reallocation of personnel was feasible, resulted in decrease cost and better value care...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Signe E Andreasen, Henriette B Holm, Mira Jørgensen, Kirill Gromov, Per Kjærsgaard-Andersen, Henrik Husted
BACKGROUND: Fast-track total hip and knee arthroplasty (THA and TKA) has been shown to reduce the perioperative convalescence resulting in less postoperative morbidity, earlier fulfillment of functional milestones, and shorter hospital stay. As organizational optimization is also part of the fast-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare this between 2 departments with different logistical set-ups...
December 29, 2016: Journal of Arthroplasty
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...
February 2017: 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...
November 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
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