1
|
Iachecen F, Dallagassa MR, Portela Santos EA, Carvalho DR, Ioshii SO. Is it possible to automate the discovery of process maps for the time-driven activity-based costing method? A systematic review. BMC Health Serv Res 2023; 23:1408. [PMID: 38093275 PMCID: PMC10720189 DOI: 10.1186/s12913-023-10411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES The main objective of this manuscript was to identify the methods used to create process maps for care pathways that utilized the time-driven activity-based costing method. METHODS This is a systematic mapping review. Searches were performed in the Embase, PubMed, CINAHL, Scopus, and Web of Science electronic literature databases from 2004 to September 25, 2022. The included studies reported practical cases from healthcare institutions in all medical fields as long as the time-driven activity-based costing method was employed. We used the time-driven activity-based costing method and analyzed the created process maps and a qualitative approach to identify the main fields. RESULTS A total of 412 studies were retrieved, and 70 articles were included. Most of the articles are related to the fields of orthopedics and childbirth-related to hospital surgical procedures. We also identified various studies in the field of oncology and telemedicine services. The main methods for creating the process maps were direct observational practices, complemented by the involvement of multidisciplinary teams through surveys and interviews. Only 33% of the studies used hospital documents or healthcare data records to integrate with the process maps, and in 67% of the studies, the created maps were not validated by specialists. CONCLUSIONS The application of process mining techniques effectively automates models generated through clinical pathways. They are applied to the time-driven activity-based costing method, making the process more agile and contributing to the visualization of high degrees of variations encountered in processes, thereby making it possible to enhance and achieve continual improvements in processes.
Collapse
Affiliation(s)
- Franciele Iachecen
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil.
| | - Marcelo Rosano Dallagassa
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | | | - Deborah Ribeiro Carvalho
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | - Sérgio Ossamu Ioshii
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| |
Collapse
|
2
|
Berthelot S, Longtin Y, Margni M, Guertin JR, LeBlanc A, Marx T, Mangou K, Bluteau A, Mantovani D, Mikhaylin S, Bergeron F, Dancause V, Desjardins A, Lahrichi N, Martin D, Sossa CJ, Lachapelle P, Genest I, Schaal S, Gignac A, Tremblay S, Hufty É, Bélanger L, Beatty E. Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e50682. [PMID: 38060296 PMCID: PMC10739239 DOI: 10.2196/50682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. OBJECTIVE To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. METHODS We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4). RESULTS The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. CONCLUSIONS While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. TRIAL REGISTRATION PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50682.
Collapse
Affiliation(s)
- Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | | | - Manuele Margni
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Tania Marx
- Services des urgences, Centre hospitalier universitaire de Besançon, Besançon, France
| | - Khadidiatou Mangou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ariane Bluteau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Diego Mantovani
- Axe Médecine régénératrice, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Sergey Mikhaylin
- EcoFoodLab, Département des sciences de aliments, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, QC, Canada
| | | | | | | | - Nadia Lahrichi
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Danielle Martin
- Fashion Design and Creative Direction, Toronto Metropolitan University, Toronto, ON, Canada
| | | | | | | | | | - Anne Gignac
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Éric Hufty
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Erica Beatty
- Département de médecine d'urgence, Hôpital Montfort, Ottawa, ON, Canada
| |
Collapse
|
3
|
Ali A, Phillips J, Ljuboja D, Shehab S, Pisano ED, Kaplan RS, Sarwar A. Prospective Evaluation of the Cost of Performing Breast Imaging Examinations Using a Time-Driven Activity-Based Costing Method: A Single-Center Study. JOURNAL OF BREAST IMAGING 2023; 5:546-554. [PMID: 38416918 DOI: 10.1093/jbi/wbad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Measuring the cost of performing breast imaging is difficult in healthcare systems. The purpose of our study was to evaluate this cost using time-driven activity-based costing (TDABC) and to evaluate cost drivers for different exams. METHODS An IRB-approved, single-center prospective study was performed on 80 female patients presenting for breast screening, diagnostic or biopsy exams from July 2020 to April 2021. Using TDABC, data were collected for each exam type. Included were full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), US and MRI exams, and stereotactic, US-guided and MRI-guided biopsies. For each exam type, mean cost and relative contributions of equipment, personnel and supplies were calculated. RESULTS Screening MRI, CEM, US, DBT, and FFDM costs were $249, $120, $83, $28, and $30. Personnel was the major contributor to cost (60.0%-87.0%) for all screening exams except MRI where equipment was the major contributor (62.2%). Diagnostic MRI, CEM, US, and FFDM costs were $241, $123, $70, and $43. Personnel was the major contributor to cost (60.5%-88.6%) for all diagnostic exams except MRI where equipment was the major contributor (61.8%). Costs of MRI-guided, stereotactic and US-guided biopsy were $1611, $826, and $356. Supplies contributed 40.5%-49.8% and personnel contributed 30.7%-55.6% to the total cost of biopsies. CONCLUSION TDABC provides assessment of actual costs of performing breast imaging. Costs and contributors varied across screening, diagnostic and biopsy exams and modalities. Practices may consider this methodology in understanding costs and making changes directed at cost savings.
Collapse
Affiliation(s)
- Aamir Ali
- McGovern Medical School at University of Texas Health Houston, Department of Radiology, Houston, Texas, USA
| | - Jordana Phillips
- Boston Medical Center at Boston University Chobanian & Avedisian School of Medicine, Department of Radiology, Boston, MA, USA
| | - Damir Ljuboja
- McGovern Medical School at University of Texas Health Houston, Department of Radiology, Houston, Texas, USA
| | | | - Etta D Pisano
- American College of Radiology, Reston, VA, USA
- Beth Israel Deaconess Medical Center at Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Robert S Kaplan
- Harvard Business School, Boston, MA, USA
- Leadership Development, Harvard Business School, Boston, MA, USA
| | - Ammar Sarwar
- Beth Israel Deaconess Medical Center at Harvard Medical School, Department of Radiology, Boston, MA, USA
| |
Collapse
|
4
|
Pediatric Outpatient Noncontrast Brain MRI: A Time-Driven Activity-Based Costing Analysis at Three U.S. Hospitals. AJR Am J Roentgenol 2023; 220:747-756. [PMID: 36541593 DOI: 10.2214/ajr.22.28490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND. MRI utilization and the use of sedation or anesthesia for MRI have increased in children. Emerging alternative payment models (APMs) require a detailed understanding of the health system costs of performing these examinations. OBJECTIVE. The purpose of this study was to use time-driven activity-based costing (TDABC) to assess health system costs for outpatient noncontrast brain MRI examinations across three children's hospitals. METHODS. Direct costs for outpatient noncontrast brain MRI examinations at three academic free-standing pediatric hospitals were calculated using TDABC. Examinations were categorized as sedated MRI (i.e., sedation or anesthesia), nonsedated MRI, or limited MRI. Process maps were created to describe patient workflows based on input from key personnel and direct observation. Time durations for each process activity were determined; time stamps from retrospective EMR review were used when possible. Capacity cost rates were calculated for resource types within three cost categories (labor, equipment, and space); cost was calculated in a fourth category (supplies). Resources were allocated to each activity, and the cost of each process step was determined by multiplying step-specific capacity costs by the time required for each step. The costs of all steps were summed to yield a base-case total examination cost. Sensitivity analysis for sedated MRI was performed using minimum and maximum time duration inputs for each activity to yield minimum and maximum costs by hospital. RESULTS. The mean base-case cost for a sedated brain MRI examination was $842 (range, $775-924 across hospitals), for a nonsedated brain MRI examination was $262 (range, $240-285), and for a limited brain MRI examination was $135 (range, $127-141). For all examination types, the largest cost category as well as the largest source of difference in cost between hospitals was labor. Sensitivity analysis found that the greatest influence on overall cost at each hospital was the duration of the MRI acquisition. CONCLUSION. The health system cost of performing a sedated MRI examination was substantially greater than that of performing a nonsedated MRI examination. However, the cost of each individual examination type did not vary substantially among hospitals. CLINICAL IMPACT. Health systems operating within APMs can use this comparative cost information for purposes of cost reduction efforts and establishment of bundled prices.
Collapse
|
5
|
Cardoso RB, Marcolino MAZ, Marcolino MS, Fortis CF, Moreira LB, Coutinho AP, Clausell NO, Nabi J, Kaplan RS, Etges APBDS, Polanczyk CA. Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital. BMC Health Serv Res 2023; 23:198. [PMID: 36829122 PMCID: PMC9955521 DOI: 10.1186/s12913-023-09049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. METHODS This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. RESULTS A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p < 0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient. CONCLUSIONS This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.
Collapse
Affiliation(s)
- Ricardo Bertoglio Cardoso
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Milena Soriano Marcolino
- grid.8430.f0000 0001 2181 4888Internal Medicine Division, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Camila Felix Fortis
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Leila Beltrami Moreira
- grid.8532.c0000 0001 2200 7498School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Ana Paula Coutinho
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Nadine Oliveira Clausell
- grid.8532.c0000 0001 2200 7498School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Junaid Nabi
- grid.38142.3c000000041936754XHarvard Business School, Boston, MA USA
| | - Robert S. Kaplan
- grid.38142.3c000000041936754XHarvard Business School, Boston, MA USA
| | - Ana Paula Beck da Silva Etges
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.412519.a0000 0001 2166 9094School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| |
Collapse
|
6
|
Anzai Y, Moy L. Point-of-Care Low-Field-Strength MRI Is Moving Beyond the Hype. Radiology 2022; 305:672-673. [PMID: 35916681 DOI: 10.1148/radiol.221278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yoshimi Anzai
- From the Department of Radiology and Imaging Science, University of Utah, 30N 1900 E, 1A 71, Salt Lake City, UT 84102 (Y.A.); and Department of Radiology, Center for Biomedical Imaging, Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology and Imaging Science, University of Utah, 30N 1900 E, 1A 71, Salt Lake City, UT 84102 (Y.A.); and Department of Radiology, Center for Biomedical Imaging, Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| |
Collapse
|
7
|
Berthelot S, Mallet M, Blais S, Moore L, Guertin JR, Boulet J, Boilard C, Fortier C, Huard B, Mokhtari A, Lesage A, Lévesque É, Baril L, Olivier P, Vachon K, Yip O, Bouchard M, Simonyan D, Létourneau M, Pineault A, Vézo A, Stelfox HT. Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12778. [PMID: 35865131 PMCID: PMC9292471 DOI: 10.1002/emp2.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/20/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of this study was: (1) to adapt the time‐driven activity‐based costing (TDABC) method to emergency department (ED) ambulatory care; (2) to estimate the cost of care associated with frequently encountered ambulatory conditions; and (3) to compare costs calculated using estimated time and objectively measured time. Methods TDABC was applied to a retrospective cohort of patients with upper respiratory tract infections, urinary tract infections, unspecified abdominal pain, lower back pain and limb lacerations who visited an ED in Québec City (Canada) during fiscal year 2015–2016. The calculated cost of care was the product of the time required to complete each care procedure and the cost per minute of each human resource or equipment involved. Costing based on durations estimated by care professionals were compared to those based on objective measurements in the field. Results Overall, 220 care episodes were included and 3080 time measurements of 75 different processes were collected. Differences between costs calculated using estimated and measured times were statistically significant for all conditions except lower back pain and ranged from $4.30 to $55.20 (US) per episode. Differences were larger for conditions requiring more advanced procedures, such as imaging or the attention of ED professionals. Conclusions The greater the use of advanced procedures or the involvement of ED professionals in the care, the greater is the discrepancy between estimated‐time‐based and measured‐time‐based costing. TDABC should be applied using objective measurement of the time per procedure.
Collapse
Affiliation(s)
- Simon Berthelot
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine familiale et de médecine d'urgence Faculté de médecine Québec Canada
| | | | | | - Lynne Moore
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine sociale et préventive Faculté de médecine Université Laval Québec Canada
| | - Jason R. Guertin
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine sociale et préventive Faculté de médecine Université Laval Québec Canada
| | | | | | | | | | | | | | | | - Laurence Baril
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine familiale et de médecine d'urgence Faculté de médecine Québec Canada
| | | | | | - Olivia Yip
- CHU de Québec‐Université Laval Québec Canada
| | | | | | | | | | - Adrien Vézo
- CHU de Québec‐Université Laval Québec Canada
| | - Henry T. Stelfox
- Department of Critical Care and the O'Brien Institute for Public Health McCaig Tower University of Calgary Calgary Alberta Canada
| |
Collapse
|
8
|
Hoda D, Richards R, Faber EA, Deol A, Hunter BD, Weber E, DiFilippo H, Henderson-Clark T, Meaux L, Crivera C, Riccobono C, Garrett A, Jackson CC, Fowler J, Theocharous P, Stewart R, Lorden AL, Porter DL, Berger A. Process, resource and success factors associated with chimeric antigen receptor T-cell therapy for multiple myeloma. Future Oncol 2022; 18:2415-2431. [PMID: 35583358 DOI: 10.2217/fon-2022-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Chimeric antigen receptor T-cell (CAR-T) therapy represents a new frontier in multiple myeloma. It is important to understand critical success factors (CSFs) that may optimize its use in this therapeutic area. Methods: We estimated the CAR-T process using time-driven activity-based costing. Information was obtained through interviews at four US oncology centers and with payer representatives, and through publicly available data. Results: The CAR-T process comprises 13 steps which take 177 days; it was estimated to include 46 professionals and ten care settings. CSFs included proactive collaboration, streamlined reimbursement and CAR-T administration in alternative settings when possible. Implementing CSFs may reduce episode time and costs by 14.4 and 13.2%, respectively. Conclusion: Our research provides a blueprint for improving efficiencies in CAR-T therapy, thereby increasing its sustainability for multiple myeloma.
Collapse
Affiliation(s)
- Daanish Hoda
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Robert Richards
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward A Faber
- Transplant & Cellular Therapy Program, Oncology/Hematology Care, USA.,Adult BMT & Cellular Therapy Program, University of Cincinnati, 2600 Clifton Ave, Cincinnati, OH 45221, USA
| | - Abhinav Deol
- Karmanos Cancer Center, 4100 John R St, Detroit, MI 48201, USA
| | | | - Elizabeth Weber
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Heather DiFilippo
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Linda Meaux
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Concetta Crivera
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Carrie Riccobono
- US Medical Affairs, Legend Biotech, 2101 Cottontail Lane Somerset, NJ 08873, USA
| | - Ashraf Garrett
- US Medical Affairs, Legend Biotech, 2101 Cottontail Lane Somerset, NJ 08873, USA
| | - Carolyn C Jackson
- Janssen Pharmaceutical Research & Development, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Jessica Fowler
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | | | - Raj Stewart
- Evidera
- PPD, 7101 Wisconsin AvenueSuite 1400Bethesda, MD 20814, USA
| | - Andrea L Lorden
- Evidera
- PPD, 7101 Wisconsin AvenueSuite 1400Bethesda, MD 20814, USA
| | - David L Porter
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ariel Berger
- Evidera
- PPD, 7101 Wisconsin AvenueSuite 1400Bethesda, MD 20814, USA
| |
Collapse
|
9
|
Checchi KD, Goljan C, Rooney AS, Calvo RY, Benham DA, Prieto JM, Badiee J, Krzyzaniak A, Sise MJ, Martin MJ, Bansal V. Why Trauma Care is Not Expensive: Detailed Analysis of Actual Costs and Cost Differences of Patient Cohorts. Am Surg 2022; 88:2440-2444. [PMID: 35549732 DOI: 10.1177/00031348221101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Trauma patients are resource intensive, requiring a variety of medical and procedural interventions during hospitalization. These expenses often label trauma care as "high cost" based on gross hospital charges. We hypothesized that a financial metric built on actual costs and clinically relevant trauma patient cohorts would demonstrate a lower true cost of trauma care than the standardly reported gross hospital charges. METHODS We examined all trauma patients (≥16 yr) treated in 2017 from a single institution and matched them to the institution's detailed financial accounting data. The organization's Financial Operations Division is uniquely able to allocate total operating costs across patient encounters to include medications, procedures, and salaries/fees from medical professionals and administrators. Patient subgroups were identified by Trauma Quality Improvement Program (TQIP) criteria for cost comparisons. RESULTS Overall median cost per patient was $6,544 [IQR $4,975-14,532] for 2,548 patients. The median cost per patient increased with Injury Severity Score (ISS) ranging from $5,457(ISS ≤ 7) to $34,898(ISS ≥ 21), each accompanied by an average 548% increase in gross charges. Costs also varied widely from $13,498 [IQR $8,247-26,254] to $45,759 [IQR $22,186-113,993] across TQIP patient cohorts. Of the total cost, 91% was attributed to personnel alone. DISCUSSION Measuring the true cost of trauma care is feasible. As hypothesized, the true cost of trauma care is lower than charges. True cost increased with injury severity with variable cost across subgroups. Non-physician staff and administration are the largest component of the cost of trauma care.
Collapse
Affiliation(s)
- Kyle D Checchi
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | | | | | - Richard Y Calvo
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | - Derek A Benham
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | - James M Prieto
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | - Jayraan Badiee
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | - Andrea Krzyzaniak
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | - Michael J Sise
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | - Matthew J Martin
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| | - Vishal Bansal
- Trauma Service, 24144Scripps Mercy Hospital, San Diego, CA, 92103, USA
| |
Collapse
|
10
|
Pachito DV, Etges APBDS, Oliveira PRBPD, Basso J, Bagattini ÂM, Riera R, Gehres LG, Mallmann ÉDB, Rodrigues ÁS, Gadenz SD. Micro-Costing of a Remotely Operated Referral Management System to Secondary Care in the Unified Health System in Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:2035-2043. [PMID: 35544829 DOI: 10.1590/1413-81232022275.07472021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Referral of cases from primary to secondary care in the Brazilian public healthcare system is one of the most important issues to be tackled. Telehealth strategies have been shown effective in avoiding unnecessary referrals. The objective of this study was to estimate cost per referred case by a remotely operated referral management system to further inform the decision making on the topic. Analysis of cost by applying time-driven activity-based costing. Cost analyses included comparisons between medical specialties, localities for which referrals were being conducted, and periods of time. Cost per referred case across localities ranged from R$ 5.70 to R$ 8.29. Cost per referred case across medical specialties ranged from R$ 1.85 to R$ 8.56. Strategies to optimize the management of referral cases to specialized care in public healthcare systems are still needed. Telehealth strategies may be advantageous, with cost estimates across localities ranging from R$ 5.70 to R$ 8.29, with additional observed variability related to the type of medical specialty.
Collapse
Affiliation(s)
- Daniela Vianna Pachito
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| | - Ana Paula Beck da Silva Etges
- Faculdade de Tecnologia, Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre RS Brasil.,Instituto de Avaliação de Tecnologia em Saúde. Porto Alegre RS Brasil
| | | | - Josué Basso
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| | - Ângela Maria Bagattini
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês. São Paulo SP Brasil
| | - Rachel Riera
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês. São Paulo SP Brasil.,Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | | | | | | | - Sabrina Dalbosco Gadenz
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| |
Collapse
|
11
|
McClintock TR, Friedlander DF, Feng AY, Shah MA, Pallin DJ, Chang SL, Bader AM, Feeley TW, Kaplan RS, Haleblian GE. Determining variable costs in the acute urolithiasis cycle of care through time-driven activity-based costing. Urology 2021; 157:107-113. [PMID: 34391774 DOI: 10.1016/j.urology.2021.05.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. METHODS We defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces. This facilitated calculation of cost per minute for all aspects of care delivery, which were multiplied by associated process times. These were added to consumable costs to determine cost for each specific step and later aggregated to determine total cost for each sub-process. We compared costs of eight common clinical pathways for acute stone management, defining total cycle of care cost as the sum of all sub-processes that comprised each pathway. RESULTS Cost per sub-process included $920 for emergency department (ED) care, $1665 for operative stent placement, $2368 for percutaneous nephrostomy tube placement, $106 for urology clinic consultation, $238 for preoperative center visit, $4057 for ureteroscopy with laser lithotripsy (URS), $2923 for extracorporeal shock wave lithotripsy, $169 for clinic stent removal, $197 for abdominal x-ray, and $166 for ultrasound. The lowest cost pathway ($1388) was for medical expulsive therapy, whereas the most expensive pathway ($8002) entailed a repeat ED visit prompting temporizing stent placement and interval URS. CONCLUSION We found a high degree of cost variation between care pathways common to management of acute ureteral stone episodes. Reliable cost accounting data and an understanding of variability in clinical pathway costs can inform value-based care redesign as payors move away from pure fee-for-service reimbursement.
Collapse
Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Harvard Business School, Boston, MA.
| | - David F Friedlander
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aiden Y Feng
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Angela M Bader
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas W Feeley
- Harvard Business School, Boston, MA; The Institute for Cancer Care Innovation and Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - George E Haleblian
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
12
|
Zimmerman ME, Batlle JC, Biga C, Blankstein R, Ghoshhajra BB, Rabbat MG, Wesbey GE, Rubin GD. The direct costs of coronary CT angiography relative to contrast-enhanced thoracic CT: Time-driven activity-based costing. J Cardiovasc Comput Tomogr 2021; 15:477-483. [PMID: 34210627 DOI: 10.1016/j.jcct.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) and contrast-enhanced thoracic CT (CECT) are distinctly different diagnostic procedures that involve intravenous contrast-enhanced CT of the chest. The technical component of these procedures is reimbursed at the same rate by the Centers for Medicare and Medicaid Services (CMS). This study tests the hypothesis that the direct costs of performing these exams are significantly different. METHODS Direct costs for both procedures were measured using a time-driven activity-based costing (TDABC) model. The exams were segmented into four phases: preparation, scanning, post-scan monitoring, and image processing. Room occupancy and direct labor times were collected for scans of 54 patients (28 CCTA and 26 CECT studies), in seven medical facilities within the USA and used to impute labor and equipment cost. Contrast material costs were measured directly. Cost differences between the exams were analyzed for significance and variability. RESULTS Mean CCTA duration was 3.2 times longer than CECT (121 and 37 min, respectively. p < 0.01). Mean CCTA direct costs were 3.4 times those of CECT ($189.52 and $55.28, respectively, p < 0.01). Both labor and capital equipment costs for CCTA were significantly more expensive (6.5 and 1.8-fold greater, respectively, p < 0.001). Segmented by procedural phase, CCTA was both longer and more expensive for each (p < 0.01). Mean direct costs for CCTA exceeded the standard CMS technical reimbursement of $182.25 without accounting for indirect or overhead costs. CONCLUSION The direct cost of performing CCTA is significantly higher than CECT, and thus reimbursement schedules that treat these procedures similarly undervalue the resources required to perform CCTA and possibly decrease access to the procedure.
Collapse
Affiliation(s)
- Michael E Zimmerman
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Juan C Batlle
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Cathleen Biga
- Cardiovascular Management of Illinois, 900 S. Frontage Road, Suite 325, Woodridge, IL 60517, USA.
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA
| | - George E Wesbey
- Scripps Clinic Medical Group, Divisions of Cardiovascular Diseases and Radiology, LaJolla, CA, USA
| | - Geoffrey D Rubin
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Group 1670 E Drachman Street, PO Box 245067, Tucson, AZ 85724-5067, USA.
| |
Collapse
|
13
|
Choudhery S, Stellmaker JA, Hanson AL, Ness J, Chida L, Johnson B, Conners AL. Utilizing Time-Driven Activity-Based Costing to Increase Efficiency in Ultrasound-Guided Breast Biopsy Practice. J Am Coll Radiol 2021; 17:131-136. [PMID: 31918869 DOI: 10.1016/j.jacr.2019.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE In this study, we used time-driven activity-based costing to increase efficiency in our ultrasound-guided breast biopsy practice by understanding costs associated with this procedure. METHODS We assembled a multidisciplinary team of all relevant stakeholders involved in ultrasound-guided breast biopsies, including a radiologist, a lead technologist, a clinical assistant, a licensed practical nurse, and a procedural support assistant. The team mapped each step in an ultrasound-guided breast biopsy from the time of scheduling a biopsy to patient checkout. We completed on average 20 time observations of each step involved in these biopsies from a provider's perspective. Using capacity cost rate, we calculated the cost of all resources including personnel, supply, room, and equipment costs. Several costly steps were identified in the process, which led to the intervention of changing our overlapping biopsy times to staggered biopsy times. Time observations for each step and cost calculations were repeated postintervention. RESULTS Our postintervention data showed that the total time spent by the radiologist in an ultrasound breast biopsy decreased by 28%, accounting for 56% of the total cost in comparison with 63% pre-intervention. The radiologist's wait time decreased by 38%, accounting for 28% of the total cost in comparison with 35% pre-intervention. Our total cost of the procedure decreased by 20%, and the personnel cost decreased by 25%. CONCLUSIONS Time-driven activity-based costing is a practical way to calculate costs and identify non-value-added steps, which can foster strategies to improve efficiency and minimize waste.
Collapse
Affiliation(s)
| | | | - Amber L Hanson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jaysen Ness
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Linda Chida
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Bryana Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
14
|
Hayatghaibi SE, Sammer MBK, Varghese V, Seghers VJ, Sher AC. Prospective cost implications with a clinical decision support system for pediatric emergency head computed tomography. Pediatr Radiol 2021; 51:2561-2567. [PMID: 34435225 PMCID: PMC8386893 DOI: 10.1007/s00247-021-05159-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/11/2021] [Accepted: 07/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Unnecessary imaging is a potential cost driver in the United States health care system. OBJECTIVE Using a clinical decision support tool, we determined the percentage of low-utility non-contrast head computed tomography (CT) examinations on emergency patients and calculated the prospective cost implications of providing low-value imaging using time-driven activity-based costing at an academic quaternary pediatric hospital. MATERIALS AND METHODS A clinical decision support tool for imaging, CareSelect (National Decision Support Co., Madison, WI), was integrated in silent mode into the electronic health record from September 2018 through August 2019. Each non-contrast head CT order received a score from the clinical decision support tool based on the American College of Radiology Appropriateness Criteria. Descriptive statistics for all levels of appropriateness scores were compiled with an emphasis on low-utility exams. A micro-costing assessment was conducted using time-driven activity-based costing on head CT without contrast examinations. RESULTS Within the 11-month time period, 3,186 head CT examinations without contrast were ordered for emergency center patients. Among these orders, 28% (896/3,186) were classified as low-utility studies. The base case CT pathway time was 43 min and base case total cost was $193.35. The base case opportunity cost of these low-utility exams extrapolated annually amounts to $188,902 for our institution. CONCLUSION Silent mode implementation of a clinical decision support tool resulted in 28% of head CT non-contrast exams on emergency patients being graded as low-utility studies. Prospective cost implications resulted in an annual base case cost of $188,902 to Texas Children's Hospital.
Collapse
Affiliation(s)
- Shireen E. Hayatghaibi
- Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030 USA ,University of Texas, School of Public Health, Houston, TX USA
| | - Marla B. K. Sammer
- Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030 USA ,Department of Radiology, Baylor College of Medicine, Houston, TX USA
| | | | - Victor J. Seghers
- Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030 USA ,Department of Radiology, Baylor College of Medicine, Houston, TX USA
| | - Andrew C. Sher
- Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030 USA ,Department of Radiology, Baylor College of Medicine, Houston, TX USA
| |
Collapse
|
15
|
Parikh KD, Smith DA, Kasprzak TP, Stovicek B, Pandya H, Ramaiya NH. A Foundational Guide to Understanding Radiology Department Business Operations for Trainees. J Am Coll Radiol 2020; 18:868-876. [PMID: 33326756 DOI: 10.1016/j.jacr.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
The financial success of a radiology department is crucial to the well-being of both the hospital and the community it serves. Radiology trainees should therefore be conscious of how the department maintains its value within the health system. The purpose of this review is to provide a concise foundational resource for contemporary radiology residents and fellows to understand the basic financial operations of a hospital-based radiology department and to demonstrate its importance in supporting clinical activities. The radiology report is at the heart of reimbursement. Coders use this tool to assign International Classification of Diseases and Current Procedural Terminology codes to file reimbursement claims. Medicare, commanding the highest market share for third-party payers, sets algorithmic standards for compensation practices. Private insurers contract with hospitals, and providers use these systems or create their own contractual framework. Radiology leaders strategically balance these revenue streams with various departmental costs utilizing tools such as budgets and forecasts to ensure long-term organizational viability. Notably, payment practices in the United States are transforming from fee-for-service to value-based care. The roles of the radiologist and the radiology report are evolving with it. Examples of value-based payment models are accountable care organizations and bundled payments. Radiologists participating in these models are increasingly expected to be stewards of imaging utilization and effectively manage health care resources. Within this context of a globally changing incentive structure, trainees must reconceptualize their educational experience to equip themselves for both current and future types of clinical practice.
Collapse
Affiliation(s)
- Keval D Parikh
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
| | - Daniel A Smith
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Timothy P Kasprzak
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Bart Stovicek
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Himanshu Pandya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
16
|
Kukreja JB, Seif MA, Mery MW, Incalcaterra JR, Kamat AM, Dinney CP, Shah JB, Feeley TW, Navai N. Utilizing time-driven activity-based costing to determine open radical cystectomy and ileal conduit surgical episode cost drivers. Urol Oncol 2020; 39:237.e1-237.e5. [PMID: 33308972 DOI: 10.1016/j.urolonc.2020.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/03/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients undergoing radical cystectomy represent a particularly resource-intensive patient population. Time-driven activity based costing (TDABC) assigns time to events and then costs are based on the people involved in providing care for specific events. To determine the major cost drivers of radical cystectomy care we used a TDABC analysis for the cystectomy care pathway. SUBJECTS AND METHODS We retrospectively reviewed a random sample of 100 patients out of 717 eligible patients undergoing open radical cystectomy and ileal conduit for bladder cancer at our institution between 2012 and 2015. We defined the cycle of care as beginning at the preoperative clinic visit and ending with the 90-day postoperative clinic visit. TDABC was carried out with construction of detailed process maps. Capacity cost rates were calculated and the care cycle was divided into 3 phases: surgical, inpatient, and readmissions. Costs were normalized to the lowest cost driver within the cohort. RESULTS The mean length of stay was 6.9 days. Total inpatient care was the main driver of cost for radical cystectomy making up 32% of the total costs. Inpatient costs were mainly driven by inpatient staff care (76%). Readmissions were responsible for 29% of costs. Surgery was 31% of the costs, with the majority derived from operating room staff costs (65%). CONCLUSION The major driver of cost in a radical cystectomy pathway is the inpatient stay, closely followed by operating room costs. Surgical costs, inpatient care and readmissions all remain significant sources of expense for cystectomy and efforts to reduce cystectomy costs should be focused in these areas.
Collapse
Affiliation(s)
- Janet Baack Kukreja
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX; Division of Urology, Department of Surgery, University of Colorado, Boulder, CO
| | - Mohamed A Seif
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marissa W Mery
- Department of Critical Care, Baylor College of Medicine, Houston, TX
| | - James R Incalcaterra
- Value Measurement and Analysis, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay B Shah
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
17
|
Choudhery S, Hanson AL, Stellmaker JA, Ness J, Chida L, Conners AL. Basics of time-driven activity-based costing (TDABC) and applications in breast imaging. Br J Radiol 2020; 94:20201138. [PMID: 33237826 DOI: 10.1259/bjr.20201138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Time-drive activity-based costing (TDABC) is a practical way of calculating costs, decreasing waste, and improving efficiency. Although TDABC has been utilized in other service industries for years, it has only recently gained attention in healthcare. In this review article, we define the basic concepts and steps of TDABC and provide examples for applications in breast imaging.
Collapse
Affiliation(s)
| | - Amber L Hanson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jaysen Ness
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Linda Chida
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
18
|
Masthoff M, Schneider KN, Schindler P, Heindel W, Köhler M, Schlüchtermann J, Wildgruber M. Value Improvement by Assessing IR Care via Time-Driven Activity-Based Costing. J Vasc Interv Radiol 2020; 32:262-269. [PMID: 33139185 DOI: 10.1016/j.jvir.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate time-driven activity-based costing (TDABC) in interventional radiology for image-guided vascular malformation treatment as an example. MATERIALS AND METHODS Retrospective analysis was performed on consecutive vascular malformation treatment cycles [67 venous malformations (VMs) and 11 arteriovenous malformations (AVMs)] in a university hospital in 2018. All activities were integrated with a process map, and spent resources were assigned accordingly. TDABC uses 2 parameters: (i) practical capacity cost rate, calculated as 80% of theoretical capacity, and (ii) time consumption of each resource determined by interviews (23 items). Thereby, the total costs were calculated. Treatment cycles were modified according to identified resource waste and TDABC-guided negotiations with health insurance. RESULTS Total personnel time required was higher for AVM (1,191 min) than for VM (637 min) treatment. The interventional procedure comprised the major part (46%) of personnel time required in AVM, whereas it comprised 19% in VM treatment. Materials represented the major cost type in AVM (75%) and VM (45%) treatments. TDABC-based treatment process modification led to a decrease in personnel time need of 16% and 30% and a cost reduction of 5.5% and 15.7% for AVM and VM treatments, respectively. TDABC-guided cost reduction and TDABC-informed negotiations improved profit from -56% to +40% and from +41% to +69% for AVM and VM treatments, respectively. CONCLUSIONS TDABC facilitated the precise costing of interventional radiologic treatment cycles and optimized internal processes, cost reduction, and revenues. Hence, TDABC is a promising tool to determine the denominator of interventional radiology's value.
Collapse
Affiliation(s)
- Max Masthoff
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.
| | | | - Philipp Schindler
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Walter Heindel
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Köhler
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Jörg Schlüchtermann
- Faculty of Law, Business and Economics, University of Bayreuth, Bayreuth, Germany
| | - Moritz Wildgruber
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| |
Collapse
|
19
|
Assessing the Training Costs and Work of Diagnostic Radiology Residents Using Key Performance Indicators - An Observational Study. Acad Radiol 2020; 27:1025-1032. [PMID: 31481346 DOI: 10.1016/j.acra.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turn-around time (TAT) as the outcome measure. MATERIALS AND METHODS In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost allocation of faculty effort. The volume of cases reported in the 2015-16 academic year and median and interquartile range (IQR) TAT for a trainee preliminary (Complete to Prelim, C-P) or an attending final (Complete to Final, C-F) radiology report were measured and stratified by time of day and patient location. Wilcoxon rank-sum tests were used (significance, p values < 0.05). RESULTS The annual cost of a DR resident was $99,109, 34% greater than direct salary/benefits and 27% of the direct salary/benefits cost of an attending. The total per minute cost of rendering care was $4.36 with both trainee ($0.70/minute) and faculty ($3.66/minute). Residents participated in 139,084/235,417 (59%) imaging studies. The C-P TAT was 74 (IQR, 27-180) minutes compared to 51 (IQR, 18-129) minutes C-F TAT of faculty working alone and C-F TAT of 213 (IQR, 71-469) minutes with a resident (p < 0.001). The C-P TAT vs C-F TAT between 4 pm-9 am and weekends with residents is 44 (IQR, 18-119) minutes vs 60 (IQR, 18-179) minutes without. CONCLUSION The cost of training DR residents exceeds the salary and benefits allocated to their training. Residents increase the absolute professional labor cost of caring for a patient. Overall TAT is slower with residents but the care delivered by residents after-hours is faster.
Collapse
|
20
|
Time-Driven Activity-Based Costing in Radiology: An Overview. J Am Coll Radiol 2020; 17:125-130. [DOI: 10.1016/j.jacr.2019.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022]
|
21
|
Cost Comparison of Ultrasound Versus MRI to Diagnose Adolescent Female Patients Presenting with Acute Abdominal/Pelvic Pain Using Time-Driven Activity-Based Costing. Acad Radiol 2019; 26:1618-1624. [PMID: 31064728 DOI: 10.1016/j.acra.2019.03.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022]
Abstract
RATIONALE AND OBJECTIVES To compare the cost of ultrasound (US) versus magnetic resonance imaging (MRI) using time-driven activity-based costing in adolescent female patients with suspected appendicitis. MATERIALS AND METHODS Process maps were created using data from electronic medical record review and patient shadowing for adolescent female patients undergoing US or noncontrast MRI exams of the abdomen and pelvis for suspected appendicitis. Capacity cost rates for all personnel, equipment, facilities, and supplies in each exam pathway were established from institutional accounting data. The cost of each process step was determined by multiplying step-specific capacity cost rates by the mean time required to complete the step. Total pathway costs for US and MRI were computed by summing the costs of all steps through each pathway, and a direct cost comparison was made between the two modalities. RESULTS Process maps for US and MRI pathways were generated from 231 and 52 patient encounters, respectively. Patients undergoing US exams followed one of six pathways depending on exam order (abdomen versus pelvis performed first) and whether additional time was needed for bladder filling. Mean total US pathway time was 91 minutes longer than for MRI (US = 166 minutes; MRI = 75 minutes). Total MRI pathway cost was $209.97 compared to a mean US cost of $258.33 (range = $163.21-$293.24). CONCLUSION MRI can be a faster and less costly alternative to US for evaluating suspected appendicitis in adolescent female patients. While precise costs will vary by institution, MRI may be a viable and at times preferable alternative to US in this patient population.
Collapse
|
22
|
Kissa B, Stavropoulos A, Karagiorgou D, Tsanaktsidou E. Using time-driven activity-based costing to improve the managerial activities of academic libraries. JOURNAL OF ACADEMIC LIBRARIANSHIP 2019. [DOI: 10.1016/j.acalib.2019.102055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Large-Scale Assessment of Scan-Time Variability and Multiple-Procedure Efficiency for Cross-Sectional Neuroradiological Exams in Clinical Practice. J Digit Imaging 2019; 33:143-150. [PMID: 31292770 DOI: 10.1007/s10278-019-00252-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Scheduling of CT and MR exams requires reasonable estimates for expected scan duration. However, scan-time variability and efficiency gains from combining multiple exams are not quantitatively well characterized. In this work, we developed an informatics approach to quantify typical duration, duration variability, and multiple-procedure efficiency on a large scale, and used the approach to analyze 48,766 CT- and MR-based neuroradiological exams performed over one year. We found MR exam durations demonstrated higher absolute variability, but lower relative variability and lower multiple-procedure efficiency, compared to CT exams (p < 0.001). Our approach enables quantification of real-world operational performance and variability to inform optimal patient scheduling, efficient resource utilization, and sustainable service planning.
Collapse
|
24
|
Kang SK. Measuring the value of MRI: Comparative effectiveness & outcomes research. J Magn Reson Imaging 2019; 49:e78-e84. [PMID: 30632255 DOI: 10.1002/jmri.26647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 12/24/2022] Open
Abstract
Magnetic resonance imaging (MRI) now provides diagnostic assessment for numerous clinical indications, including lesion detection, characterization, functional assessment, and response to treatment. To maximize the potential to improve health through the use of MRI, it is critical to investigate the impact of MRI on outcomes, and to compare the effectiveness of MRI with existing standard diagnostic approaches. Outcomes of MRI can include survival but also intermediate steps such as potential reduction in unnecessary therapy, shorter time to the appropriate therapy, or shorter periods of hospital admission. To understand the effectiveness of an imaging test's sensitivity and specificity, the results' consequences are weighed, reflecting the disease type, severity, and treatment effects. In some instances, other modalities may be faster, more readily available, or less costly than MRI but additional disease-related information or better accuracy may translate to greater population level benefit. For health policy decisions and clinical guidelines, studies of comparative outcomes can lend depth to the strength of the evidence, the specific benefits vs. harms of using one test over another, and the most effective use of the test in terms of target population. Cost effectiveness then allows for a direct comparison of approaches in terms of the cost for the projected gain in life expectancy and/or quality adjusted life expectancy. Expanding the literature on improved efficiency, accessibility, clinical effectiveness, and cost effectiveness will support the directive for better quality and value in healthcare. Level of Evidence 5 Technical Efficacy Stage 5 J. Magn. Reson. Imaging 2019.
Collapse
Affiliation(s)
- Stella K Kang
- Department of Radiology, NYU School of Medicine, New York, New York, USA.,Department of Population Health, NYU School of Medicine, New York, New York, USA
| |
Collapse
|
25
|
Shankar PR, Parikh KR, Heilbrun ME, Sweeney BM, Flake AN, Herbstman EA, Hoffman TJ, Havey R, Kronick S, Davenport MS. Cost Implications of Oral Contrast Administration in the Emergency Department: A Time-Driven Activity-Based Costing Analysis. J Am Coll Radiol 2019; 16:30-38. [DOI: 10.1016/j.jacr.2018.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 06/25/2018] [Accepted: 07/20/2018] [Indexed: 12/29/2022]
|
26
|
Lewis SB, Srinivasa RN, Shankar PR, Bundy JJ, Gemmete JJ, Chick JFB. Thoracic Duct Embolization-Value Analysis Using a Time-Driven Activity-Based Costing Approach: A Single Institution Experience. Curr Probl Diagn Radiol 2018; 49:42-47. [PMID: 30655113 DOI: 10.1067/j.cpradiol.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To quantify cost drivers for thoracic duct embolization based on time-driven activity-based costing methods. MATERIALS AND METHODS This was an Institutional Review Board-approved (HUM00141114) and Health Insurance Portability and Accountability Act-compliant study performed at a quaternary care institution over a 14-month period. After process maps for thoracic duct embolization were prepared, staff practical capacity rates and consumable equipment costs were analyzed via a time-driven activity-based costing methodology. Sensitivity analyses were performed to identify primary cost drivers. RESULTS Mean procedure duration was 4.29 hours (range: 2.15-7.16 hours). Base case cost, per case, for thoracic duct embolization was $7466.67. Multivariate sensitivity analyses performed with all minimum and maximum values for cost input variables yielded a cost range of $1001.95 (minimum) to $89,503.50 (maximum). Using local salary information and negotiated prices for materials as cost parameters, the true cost per case of thoracic duct embolization at the study institution was $8038.94. Univariate analysis demonstrated that the primary driver of staffing costs was the length of time the attending anesthesiologist was present. The predominant modifiable cost drivers included cyanoacrylate glue volume used (minimum $4467; maximum $12,467), cost of glue utilized (minimum $5217; maximum $10,467), and cost of coils utilized (minimum $7377; maximum $10,917). Univariate analysis predicted that the use of Histoacryl glue in place of TRUFILL cyanoacrylate glue resulted in a cost savings of $2947.50 per case. CONCLUSIONS The base cost per case for thoracic duct embolization was $7466.67. Costs, namely anesthesia staffing costs, cyanoacrylate glue, and coils were large, potentially modifiable drivers of overall cost for thoracic duct embolization.
Collapse
Affiliation(s)
- Spencer B Lewis
- Department of Radiology Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California Los Angeles, Los Angeles, CA
| | - Prasad R Shankar
- Department of Radiology Division of Abdominal Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Jacob J Bundy
- Department of Radiology Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Joseph J Gemmete
- Department of Radiology Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | | |
Collapse
|
27
|
Anzai Y, Minoshima S, Lee VS. Enhancing Value of MRI: A Call for Action. J Magn Reson Imaging 2018; 49:e40-e48. [PMID: 30431676 DOI: 10.1002/jmri.26239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/06/2018] [Indexed: 12/19/2022] Open
Abstract
As national healthcare spending has spiraled out of control, payment reform that moves from volume to value-based payment has been introduced as a practical solution. Under alternative value-based payment models, physicians and clinical teams must deliver the best care possible at a lower cost. Medical imaging has changed the way we diagnose disease, evaluate severity, assess treatment effects, and provide biological insights for the pathophysiology of many diseases. Over the past 50 years, imaging techniques have become increasingly advanced-from X-ray to computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and multi-modal imaging. Advanced imaging such as MRI has given clinicians remarkable insights into medical conditions and saved innumerable lives. Under the value proposition, however, we must ask if each imaging study changes treatment decisions, improves patient outcomes, and is cost-effective. Imaging research has been focused on developing new technologies and clinical applications to assess diagnostic accuracy. What is needed is the higher-level technology assessment. In this article we review why we need to demonstrate the value of MRI, how we define value, what strategies can enhance MR value through partnership with various stakeholders, and how imaging scientists can contribute to healthcare delivery in the future. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:e40-e48.
Collapse
Affiliation(s)
- Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Vivian S Lee
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
28
|
Sarwar A, Hawkins CM, Bresnahan BW, Carlos RC, Guimaraes M, Krol KL, Kwan SW, Latif W, Liu R, Marder WD, Ray CE, Banovac F. Evaluating the Costs of IR in Health Care Delivery: Proceedings from a Society of Interventional Radiology Research Consensus Panel. J Vasc Interv Radiol 2018; 28:1475-1486. [PMID: 29056189 DOI: 10.1016/j.jvir.2017.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ammar Sarwar
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Brian W Bresnahan
- Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Ruth C Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan Health System, Ann Arbor, Michigan
| | - Marcelo Guimaraes
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Katharine L Krol
- Payment, Research, and Policy Taskforce, Society of Interventional Radiology, Herndon, Virginia
| | - Sharon W Kwan
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Raymond Liu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William D Marder
- Truven Health Analytics, IBM Watson Health, Cambridge, Massachusetts
| | - Charles E Ray
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Filip Banovac
- Department of Radiology, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
29
|
Dobbs P, Warriner D. Value-based health care: the strategy that will solve the NHS? Br J Hosp Med (Lond) 2018; 79:306-307. [DOI: 10.12968/hmed.2018.79.6.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patrick Dobbs
- Consultant Anaesthetist and Associate Medical Director, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF
| | - David Warriner
- Cardiology Registrar, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds
| |
Collapse
|
30
|
Desai V, Cox M, Deshmukh S, Roth CG. Contrast-enhanced or noncontrast CT for renal colic: utilizing urinalysis and patient history of urolithiasis to decide. Emerg Radiol 2018; 25:455-460. [DOI: 10.1007/s10140-018-1604-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/29/2018] [Indexed: 11/29/2022]
|
31
|
Tseng P, Kaplan RS, Richman BD, Shah MA, Schulman KA. Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System. JAMA 2018; 319:691-697. [PMID: 29466590 PMCID: PMC5839285 DOI: 10.1001/jama.2017.19148] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
Importance Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. Objective To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. Design, Setting, and Participants This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Exposures Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Main Outcomes and Measures Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Results Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. Conclusions and Relevance In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.
Collapse
Affiliation(s)
- Phillip Tseng
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Kevin A. Schulman
- Harvard Business School, Boston, Massachusetts
- Duke Clinical Research Institute and Department of Medicine, Durham, North Carolina
| |
Collapse
|
32
|
Affiliation(s)
- Vivian S. Lee
- From the Department of Radiology, University of Utah School of Medicine, 175 N Medical Dr, CNC 5th Floor, Salt Lake City, UT 84132
| |
Collapse
|