scholarly journals Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases

2020 ◽  
Vol 16 (3) ◽  
pp. e271-e279 ◽  
Author(s):  
David Boyce-Fappiano ◽  
Matthew S. Ning ◽  
Nikhil G. Thaker ◽  
Todd A. Pezzi ◽  
Olsi Gjyshi ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Care Delivery ◽  
Treatment Options ◽  
Three Dimensional ◽  
Spinal Metastases ◽  
Activity Based Costing ◽  
Process Maps ◽  
Cost Rate ◽  
Personnel Costs ◽  
Delivery Costs

PURPOSE: Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model. METHODS: Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost. RESULTS: Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively ( P < .001). CONCLUSIONS: Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation.

scholarly journals Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic

2016 ◽  
Vol 12 (3) ◽  
pp. e320-e331 ◽  
Author(s):  
Ryan Y.C. Tan ◽  
Marie Met-Domestici ◽  
Ke Zhou ◽  
Alexis B. Guzman ◽  
Soon Thye Lim ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cancer Care ◽  
Cancer Genetics ◽  
Care Delivery ◽  
Genetic Counselor ◽  
Activity Based Costing ◽  
Improvement Project ◽  
Personnel Costs ◽  
Number Of Patients ◽  
The Impact

Purpose: To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Methods: Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Results: Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. Conclusion: This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery.

Time driven activity-based costing methods used in radiation oncology clinics.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 79-79
Author(s):  
Shalini Moningi ◽  
Shane Mesko ◽  
Amy Catherine Moreno ◽  
Matthew S. Ning ◽  
Thomas A. Aloia ◽  
...  
Keyword(s):  
Patient Care ◽  
Radiation Oncology ◽  
Care Delivery ◽  
Clinical Care ◽  
Physician Assistants ◽  
Cancer Center ◽  
Activity Based Costing ◽  
Process Maps ◽  
Clinical Patient

79 Background: Since 2010 The University of Texas MD Anderson Cancer Center (UTMDACC) has been using Time Driven Activity Based Costing (TDABC) to assist in tracking and quantifying changes made to clinical processes to improve efficiency of patient care delivery. Radiation Oncology (RO) providers have recently utilized this method to assist in the growing clinical patient volumes and increasing enrollment in clinical trials. UTMDACC contains disease specific multi-disciplinary centers with separate clinics for different disciplines. Resources are limited which can affect clinical providers’ ability to meet the needs of increasing patient volumes. Implementing efficient clinic work flow models will allow clinicians to provide excellent quality of clinical care even with limited resources. Methods: Standard disease-site specific note templates were created and implemented throughout the entire RO department. Additionally, standardized roles for medical assistants, residents, physician assistants (PAs), attending physicians and nurses were implemented to minimize duplication of responsibilities. Using TDABC methodology, process maps for pre and post implementation pathways were created to illustrate areas of change and possible benefit. Results: Process maps were compared for new consult and follow up and on treatment patient visits. Process times for these patient care visits were compared pre- and post-implementation of templates and clinical roles. Time savings of 110, 18 and 34 minutes were observed for consult visits, follow up visits and on-treatment visits when comparing current to baseline process maps. Conclusions: Standardization of note templates and roles for all members of the care team has led to improvements in process flow and efficiency in the RO clinic setting. Our findings suggest that further implementation of TDABC methodology by having all providers work at the top of their license could can improve clinical efficiency and patient care. Further metrics with a larger sample size is recommended to validate our results. [Table: see text]

scholarly journals Time-driven activity-based costing of total knee replacements in Karachi, Pakistan

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025258
Author(s):  
Rabia Mansoor Khan ◽  
Katherine Albutt ◽  
Muhammad Abdullah Qureshi ◽  
Zara Ansari ◽  
Gustaf Drevin ◽  
...  
Keyword(s):  
Process Improvement ◽  
Indirect Costs ◽  
Osteoarthritis Of The Knee ◽  
Activity Based Costing ◽  
Process Maps ◽  
Cost Drivers ◽  
Personnel Costs ◽  
Total Knee Replacements ◽  
Institutional Cost ◽  
Total Knee

IntroductionOsteoarthritis of the knee has been identified as the most common disability in Pakistan. Total knee replacement (TKR) surgery is the curative treatment for advanced osteoarthritis of the knee; however, cost remains one of the barriers to effective and timely service delivery.ObjectiveWe conducted a time-driven activity-based costing (TDABC) analysis of TKR to identify major cost drivers and areas for process improvement.Methods and analysisWe performed a prospective TDABC analysis of patients who underwent bilateral TKR at The Indus Hospital (TIH) during a 14-month period from October 2015 to December 2016. Detailed process maps were developed for each phase of the care cycle. Time durations and costs were allocated to each resource utilised and aggregated across the care cycle, including personnel, direct and indirect costs.ResultsWe identified seven care phases for a complete TKR care cycle and created their detailed process maps. Major time contributors were ward stay and discharge (20 160 min), TKR surgery (563 min) and surgical admission (333 min). Overall, 92.10% of time is spent during the ward stay and discharge phase of care. Patients remain hospitalised for an average of 14 days postoperatively. Overall institutional cost of a TKR at TIH was US$4360.51 (Pakistani rupees 456 981.17) per bilateral TKR surgery. The overall primary cost drivers for the full bundle of care were consumables used during TKR surgery itself, consumables utilised in the wards and personnel costs contributing 57.64%, 27.45% and 12.03% of total costs, respectively.ConclusionUtilising TDABC allowed us to obtain a granular analysis of time and cost that was subsequently used to inform quality process improvement initiatives. In low-resource settings, such as Pakistan, TDABC has the potential to be a useful tool to guide resource allocation and process improvement.

Evaluation of resource utilization using time-derived, activity-based costing (TDABC) to result in more effective processes and cost reduction.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 22-22 ◽  
Author(s):  
Pamela T. Soliman ◽  
Elizabeth A. Garcia ◽  
Kai E. Lang ◽  
Valerie Villanueva ◽  
Shannon Neville Westin ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Care ◽  
Cancer Surveillance ◽  
Personnel Cost ◽  
Health Care Economics ◽  
Activity Based Costing ◽  
Process Maps ◽  
Personnel Costs ◽  
Outpatient Center ◽  
Low Efficiency

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. Methods: In 2014, a multidisciplinary team developed process maps for each visit type in the outpatient center. Maps included each step of clinical care from registration to check out and the personnel associated with that care. Total personnel costs were based on the estimated time spent with each patient and the average salary of the care provider. In 9/2014, we instituted an advanced practice provider (APP) independent practice initiative where CSV were done by either faculty or APP, no longer both. Billing codes were used to determine the % of CSV seen by APPs only. Patient and staff satisfaction were assessed pre- and post-implementation with validated measures. Results: At baseline, the estimated patient time and personnel cost for a CSV was 98 min and $380.79. The estimated patient time and personnel cost for an APP only CSV was 53 min and $132.60.; resulting in a potential savings of $249/CSV. Prior to 9/14 less than 21% were seen by APP’s only. After implementation of the initiative, the number of APP only visits increased each quarter to Q1 27%, Q2 38%, Q3 40% and Q4 41%. The estimated cost savings based on 4000 CSV/year was $354,000. Patient satisfaction remained the same (Press-Ganey). APP and physician engagement/satisfaction increased by 30% (Gallup Employee Survey). Conclusions: Evaluation of our outpatient clinic using TDABC allowed us to identify low efficiency, high cost processes. After implementation of a new process, patient wait times and personnel costs were significantly reduced resulting in better value care and improved provider satisfaction.

scholarly journals A time-driven activity-based costing approach for identifying variability in costs of childbirth between and within types of delivery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathia Dubron ◽  
Mathilde Verschaeve ◽  
Filip Roodhooft
Keyword(s):  
Health Care Providers ◽  
Care Providers ◽  
Education Attainment ◽  
Activity Based Costing ◽  
Process Maps ◽  
Process Improvements ◽  
Personnel Costs ◽  
Parity Number ◽  
Cohort Study Design ◽  
The Cost

Abstract Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is the application of a time-driven activity-based method in order to estimate the cost of childbirth at a maternal department. Moreover, this study shows how this costing method can be used to outline how childbirth costs vary according to considered patient and disease characteristics. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost. Methods A prospective cohort study design is performed in a maternity department. Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly. Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+ 33,3 min) and monitoring (+ 775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >  25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks. Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.

scholarly journals A Time-Driven Activity-Based Costing Approach for Identifying Variability in Costs of Childbirth Between and within Types of Delivery

2021 ◽  
Author(s):  
Kathia Dubron ◽  
Mathilde Verschaeve ◽  
Filip Roodhooft
Keyword(s):  
Health Care Providers ◽  
Care Providers ◽  
Education Attainment ◽  
Activity Based Costing ◽  
Process Maps ◽  
Process Improvements ◽  
Personnel Costs ◽  
Parity Number ◽  
The Cost ◽  
Capacity Cost

Abstract Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is to demonstrate how the overall cost of childbirth at the maternity department can be calculated by implementing a TDABC analysis. In addition, this study outlines how this costing method can be utilized to provide insights into how patient and disease characteristics drive variability within childbirth cost. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost.Methods Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly. Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+33,3 min) and monitoring (+775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks.Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.

scholarly journals Drivers of Cost in Primary Single-Level Lumbar Fusion Surgery

2021 ◽  
pp. 219256822110091
Author(s):  
Raymond W. Hwang ◽  
Samuel W. Golenbock ◽  
David H. Kim
Keyword(s):  
Lumbar Fusion ◽  
Disease Process ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Total Hospital Cost ◽  
Activity Based Costing ◽  
Process Maps ◽  
Single Level ◽  
Personnel Costs ◽  
Fusion Type

Study Design: Retrospective cohort. Objectives: Allocating cost is challenging with traditional hospital accounting. Time-driven activity-based costing (TDABC) is an efficient method to accurately assign cost. We sought to characterize the variation in direct total hospital cost (THC) among both lumbar fusion approaches and surgeons. Methods: Patients were treated with single-level anterior interbody (ALIF), lateral interbody (LLIF), transforaminal interbody (TLIF), instrumented posterolateral (PLF) or in-situ fusion (ISF) for degenerative disease. Process maps were developed for preoperative, intraoperative and postoperative care. THC was composed of implant, medication, other supply, and personnel costs. Linear regression and descriptive statistics were used to analyze THC variation. Results: A total of 696 patients underwent surgery by 8 surgeons. Approximately 50% of THC variation was associated with procedure choice while patient characteristics explained 10%. Implants (including biologics) accounted for 45% of cost. With reference to PLF, THC ranged from 0.6x (ISF) to 1.7x (LLIF). Implant cost ranged from 2.5x reference (LLIF) to 0.1x (ISF). There was a 1.7x difference between the highest THC surgeon and the lowest. The fusion type with the highest THC variation was TLIF. The surgeon with the highest TLIF THC was 1.5x more expensive than the surgeon with the lowest. Conclusions: Surgeon-based choices have the greatest effect on THC variation and represent the largest opportunities for cost savings. Primary single-level lumbar fusion THC is driven primarily by fusion type. Implants, including biologics, account for nearly half this cost. Future work should incorporate outcomes data to characterize the differential value conferred by higher THC fusions.

A Case Study on the Un-Used Capacity Assessment Using Time Driven Activity Based Costing for Magnetic Components

2020 ◽  
Vol 6 (1) ◽  
pp. 18-39
Author(s):  
Areena Zaini ◽  
Haryantie Kamil ◽  
Mohd Yazid Abu
Keyword(s):  
Historical Data ◽  
Manufacturing Sector ◽  
Type I ◽  
Activity Based Costing ◽  
Cost Rate ◽  
Continuous Innovation ◽  
Magnetic Components ◽  
Alignment Process ◽  
Capacity Cost

The Electrical & Electronic (E&E) company is one of Malaysia’s leading industries that has 24.5% in manufacturing sector production. With a continuous innovation of E&E company, the current costing being used is hardly to access the complete activities with variations required for each workstation to measure the un-used capacity in term of resources and cost. The objective of this work is to develop a new costing structure using time-driven activity-based costing (TDABC) at . This data collection was obtained at E&E company located at Kuantan, Pahang that focusing on magnetic component. The historical data was considered in 2018. TDABC is used to measure the un-used capacity by constructing the time equation and capacity cost rate. This work found three conditions of un-used capacity. Type I is pessimistic situation whereby according to winding toroid core, the un-used capacity of time and cost are -14820 hours and -MYR2.60 respectively. It means the system must sacrifice the time and cost more than actual apportionment. Type II is most likely situation whereby according to assembly process, the un-used capacity of time and cost are 7400 hours and MYR201575.45 respectively. It means the system minimize the time and cost which close to fully utilize from the actual apportionment. Type III is optimistic situation whereby according to alignment process, the un-used capacity of time and cost are 4120 hours and MYR289217.15 respectively. It means the system used small amount of cost and time from the actual apportionment.

scholarly journals Epidemiology of spinal cord and column tumors

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. i5-i9
Author(s):  
Joshua T Wewel ◽  
John E O’Toole
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Survival Rates ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Severe Form ◽  
Spinal Instability ◽  
Treatment Cascade ◽  
Tumor Pathology ◽  
Pathologic Fractures

Abstract The spine is a frequent location for metastatic disease. As local control of primary tumor pathology continues to improve, survival rates improve and, by extension, the opportunity for metastasis increases. Breast, lung, and prostate cancer are the leading contributors to spinal metastases. Spinal metastases can manifest as bone pain, pathologic fractures, spinal instability, nerve root compression, and, in its most severe form, spinal cord compression. The global extent of disease, the spinal burden, neurologic status, and life expectancy help to categorize patients as to their candidacy for treatment options. Efficient identification and workup of those with spinal metastases will expedite the treatment cascade and improve quality of life.

scholarly journals Gynecology Meets Big Data in the Disruptive Innovation Medical Era: State-of-Art and Future Prospects

2021 ◽  
Vol 18 (10) ◽  
pp. 5058
Author(s):  
Rola Khamisy-Farah ◽  
Leonardo B. Furstenau ◽  
Jude Dzevela Kong ◽  
Jianhong Wu ◽  
Nicola Luigi Bragazzi
Keyword(s):  
Big Data ◽  
Information And Communication Technologies ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Wearable Sensors ◽  
Three Dimensional ◽  
Disruptive Innovation ◽  
Healthcare Management ◽  
The Internet ◽  
Big Data Visualization

Tremendous scientific and technological achievements have been revolutionizing the current medical era, changing the way in which physicians practice their profession and deliver healthcare provisions. This is due to the convergence of various advancements related to digitalization and the use of information and communication technologies (ICTs)—ranging from the internet of things (IoT) and the internet of medical things (IoMT) to the fields of robotics, virtual and augmented reality, and massively parallel and cloud computing. Further progress has been made in the fields of addictive manufacturing and three-dimensional (3D) printing, sophisticated statistical tools such as big data visualization and analytics (BDVA) and artificial intelligence (AI), the use of mobile and smartphone applications (apps), remote monitoring and wearable sensors, and e-learning, among others. Within this new conceptual framework, big data represents a massive set of data characterized by different properties and features. These can be categorized both from a quantitative and qualitative standpoint, and include data generated from wet-lab and microarrays (molecular big data), databases and registries (clinical/computational big data), imaging techniques (such as radiomics, imaging big data) and web searches (the so-called infodemiology, digital big data). The present review aims to show how big and smart data can revolutionize gynecology by shedding light on female reproductive health, both in terms of physiology and pathophysiology. More specifically, they appear to have potential uses in the field of gynecology to increase its accuracy and precision, stratify patients, provide opportunities for personalized treatment options rather than delivering a package of “one-size-fits-it-all” healthcare management provisions, and enhance its effectiveness at each stage (health promotion, prevention, diagnosis, prognosis, and therapeutics).

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