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"Activity-based costing"
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Enhancing the value of the oncology thoracic surgery care pathway: a TDABC and ABC analysis
Background
Time-driven activity-based costing (TDABC) and activity-based costing (ABC) are methods used in the healthcare sector to assess the costs of patient care pathways. These methods help identify opportunities for optimizing and reducing activity times without compromising the quality of care. TDABC is recommended in the Value-Based Healthcare (VBHC) model to assess the outcomes of care pathways in relation to their associated costs. By focusing on the creation of value for patients, TDABC helps identify the interventions and processes that provide the most value in terms of clinical outcomes and patient satisfaction. This enables healthcare organizations to make informed decisions on improvements that will maximize value for patients. The aim of the study is to evaluate the cost of the oncology thoracic surgery care pathway prior to and following the implementation of digital health solution.
Methods
We have chosen to use the TDABC and ABC methods to calculate the costs of care pathway for oncology patients undergoing thoracic surgery in two healthcare establishments prior to and following the implementation of a digital health solution. By using these methods, we were able to calculate the costs associated with each stage of the patients’ care pathway. This has given us a clearer picture of the costs associated with each activity and a better understanding of the sources of expenditure.
Results
The results show that implementing the digital health solution and applying the principles of the VBHC model have provided tangible benefits in terms of reviewing processes and the roles of the various players involved, eliminating unnecessary or non-value-added activities, automating administrative or repetitive tasks, and improving coordination between the two healthcare establishments and between healthcare professionals. These improvements have contributed to better patient care.
Conclusions
Given the success observed in this pilot project, decision-makers chose to persistently implement this digital health solution for specific care pathways over the long term. Additionally, there is a commitment to further enhance the platform to align closely with the needs and the expectations of healthcare professionals. This proactive approach aims to ensure optimal utilization of resources, ultimately providing the best care to patients.
Journal Article
A Multi-Disciplinary Review of Time-Driven Activity-Based Costing: Practical Considerations for Spine Surgery
Study Design
A multi-disciplinary review.
Objectives
To provide a roadmap for implementing time-driven activity-based costing (TDABC) for spine surgery. This is achieved by organizing and scrutinizing publications in the spine, neurosurgical, and orthopedic literature which utilize TDABC and related methodologies.
Methods
PubMed and Google Scholar were searched for relevant articles. The articles were selected by two independent researchers. After article selection, data was extracted and summarized into research domains. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) systematic review process was followed.
Results
Of the 524 articles screened, thirty-five articles met the inclusion criteria. Each included article was examined and reviewed to define the primary research question and objective. Comparing different procedures was the most common primary objective. Direct observation along with one other strategy (surveys, interviews, surgical database, or EMR) was most commonly employed during process map development. Across all surgical subspecialties (spine, neurologic, and orthopedic surgery), costs were divided into direct cost, indirect cost, cost to patient, and total costs. The most commonly calculated direct costs included personnel and supply costs. Facility costs, hospital overhead costs, and utilities were the most commonly calculated indirect costs. Transportation costs and parental lost wages were considered when calculating cost to patient. The total cost was a sum of direct costs, indirect costs, and costs to the patient.
Conclusion
TDABC provides a common platform to accurately estimate costs of care delivery. Institutions embarking on TDABC for spine surgery should consider the breadth of methodologies highlighted in this review to determine which type of calculations are appropriate for their practice.
Journal Article
Deciding product mix based on time-driven activity-based costing by mixed integer programming
To determine a product mix for a production process, this study proposes a mixed-integer programming (MIP) model, based on the time-driven activity-based costing (TDABC) accounting system. By using a time driver from the resource to the cost objects and simultaneously dealing with numerous resource limitations, the model obtains a global optimal decision. The model highlights the difference between supply and the use of the capacity. It avoids some possible limitations of the programming modeling approach when theory of constraints (TOC) or activity-based-costing (ABC) is used. The model is illustrated using a numerical example. In the form of a budgeted income statement, the results for the formulated MIP models that use TOC, ABC and TDABC are compared, in terms of resource-used-based profit, resource-supplied-based profit and cash flow. The proposed MIP model that uses TDABC is shown to support a product mix decision, on which studies of TDABC seldom focus. Implications for the use of this accounting system adoption to determine product-mix are detailed.
Journal Article
Simulation study integrated with activity-based costing for an electronic device re-manufacturing system
This paper presents a simulation study of a re-manufacturing system for electronic devices, which applies an activity-based costing (ABC) method to evaluate different system configurations. Unlike the typical metrics such as resource utilization and throughput used for simulations of processes to guide system improvements, the utilization of the cost aspect has been explicitly considered in this paper, as it is directly related to practice. A real data set obtained from actual re-manufacturing operations has been used for our case study. We quantitatively show how utilizing the concept of ABC to capture the direct labor cost and material labor cost can help make better decisions in selecting re-manufacturing system configurations.
Journal Article
Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department
AbstractObjectivesThe 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. MethodsTDABC 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. ResultsOverall, 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. ConclusionsThe 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.
Journal Article
Integration of Mahalanobis-Taguchi System and Time-Driven Activity-Based Costing in a Production Environment
System integration is the act of combining numerous distinct subsystems into one bigger system that allows the subsystems to work together. The integrated system removes necessity of repeating operations. The purpose of this work was to investigate the best system integration in the production environment. A few methods were tested such as conventional, Mahalanobis-Taguchi System (MTS), Activity-Based Costing (ABC) and Time-Driven Activity-Based Costing (TDABC). As a result, critical activities may now be completed more effectively while reducing expenses. The organization should define the relation between cost and quality through system integration. As a consequence of system integration, four forms of integration are described, namely, integration A (conventional-ABC), integration B (conventional-TDABC), integration C (MTS-ABC), and integration D (MTS-TDABC). Integration D is the best in the production environment when compared to others because MTS recognizes the degree of contribution for each parameter that impacts the increase or decline in the final cost. Moreover, TDABC determines capacity cost rate from the costs associated with capacity provided, and time equations with versatility to dissipate the product’s complex nature. As a result of the integration of MTS and TDABC, various degrees of parameter contributions impact the time equations and capacity cost rate to generate a lower cost of product in the production environment.
Journal Article
Is Time-Driven Activity-Based Costing Coming out on Top? A Comparison with Activity-Based Costing in the Health Field
The cost of health is a recurrent topic that has generated much research, as it affects all of society. Both public and private agents need to know the real cost of treatments, services, and products for decision-making. This article aims to compare the use and research impact of two cost systems widely used in health: ABC and TDABC, which is an evolution of ABC. For doing so, a bibliometric review in Scopus and Medline was carried out encompassing the years 2009–2019. The results show a great increase in publications using TDABC, while publications on ABC stabilized. On the other hand, the TDABC articles presented higher research impacts in traditional and alternative metrics. Articles on TDABC are more frequently cited, published in better journals, and more visible in academic social networks. The findings suggest that scholars and practitioners should focus on TDABC rather than ABC for addressing cost in health for its simplicity, projection, and research opportunities.
Journal Article
A pragmatic method for costing implementation strategies using time-driven activity-based costing
Background
Implementation strategies increase the adoption of evidence-based practices, but they require resources. Although information about implementation costs is critical for decision-makers with budget constraints, cost information is not typically reported in the literature. This is at least partly due to a need for clearly defined, standardized costing methods that can be integrated into implementation effectiveness evaluation efforts.
Methods
We present a pragmatic approach to systematically estimating detailed, specific resource use and costs of implementation strategies that combine time-driven activity-based costing (TDABC), a business accounting method based on process mapping and known for its practicality, with a leading implementation science framework developed by Proctor and colleagues, which guides specification and reporting of implementation strategies. We illustrate the application of this method using a case study with synthetic data.
Results
This step-by-step method produces a clear map of the implementation process by specifying the names, actions, actors, and temporality of each implementation strategy; determining the frequency and duration of each action associated with individual strategies; and assigning a dollar value to the resources that each action consumes. The method provides transparent and granular cost estimation, allowing a cost comparison of different implementation strategies. The resulting data allow researchers and stakeholders to understand how specific components of an implementation strategy influence its overall cost.
Conclusion
TDABC can serve as a pragmatic method for estimating resource use and costs associated with distinct implementation strategies and their individual components. Our use of the Proctor framework for the process mapping stage of the TDABC provides a way to incorporate cost estimation into implementation evaluation and may reduce the burden associated with economic evaluations in implementation science.
Journal Article