An analysis of healthcare processes through an activity-based

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An analysis of healthcare processes through an activity-based

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Micro-costing studies still deserving for methods orientation that contribute to achieve a patient-specific resource use level of analysis. Time-driven activity-based costing TDABC is often employed by health organizations in micro-costing studies with that objective. However, the literature shows many deviations in the implementation of TDABC, which might compromise the accuracy of the results obtained. One reason for that can be attributed to the non-existence of a step-by-step orientation to conduct cost analytics with the TDABC specific for micro-costing studies in healthcare.

This article aimed at exploring the literature and practical cases to propose an eight-step framework to apply TDABC in micro-costing studies for health care organizations. The 8-step TDABC framework is presented and detailed exploring online spreadsheets already coded to demonstrate data structure and math formula building. A list of analyses that can be performed is suggested, including an explanation about the information that each analysis can provide to increase the organization capability to orient decision making.

The case study developed show that actual micro-costing of health care processes can be achieved with the 8-step TDABC framework and its use in future researches can contribute to increase the number of studies that achieve high-quality level in cost information, and consequently, in health resource evaluation.

This is a preview of subscription content, log in to check access. Rent this article via DeepDyve. Donovan, C. Google Scholar. Kaplan, R. Porter, M. Haas, D. Harvard Business Review, October 22 Yu, Y. Value-based healthcare: a global assessment.

Van, Lier L. Health Econ. Tan, S. Najjar, P. JAMA Surg. Oklu, R. Boston: Harvard Business School Press, pp.

Martin, J. Tseng, P. JAMA J. Cooper, R. McBain, R. BMJ Glob. Kaplan, A. Keel, G. Health Policy 7— Ruof, J. HEPAC64—69 Carreras, M. Erhun, F. BMJ Open 5 8e Chen, A.Activity-based costing ABC is a costing method that assigns overhead and indirect costs to related products and services.

This accounting method of costing recognizes the relationship between costs, overhead activities, and manufactured products, assigning indirect costs to products less arbitrarily than traditional costing methods.

However, some indirect costs, such as management and office staff salaries, are difficult to assign to a product. Activity-based costing ABC is mostly used in the manufacturing industry since it enhances the reliability of cost data, hence producing nearly true costs and better classifying the costs incurred by the company during its production process. ABC is used to get a better grasp on costs, allowing companies to form a more appropriate pricing strategy.

This costing system is used in target costing, product costing, product line profitability analysis, customer profitability analysis, and service pricing. Activity-based costing is used to get a better grasp on costs, allowing companies to form a more appropriate pricing strategy.

The formula for activity-based costing is the cost pool total divided by cost driver, which yields the cost driver rate. The cost driver rate is used in activity-based costing to calculate the amount of overhead and indirect costs related to a particular activity.

The ABC calculation is as follows:. The number of labor hours has a direct impact on the electric bill. For the year, there were 2, labor hours worked, which in this example is the cost driver. For Product XYZ, the company uses electricity for 10 hours.

an analysis of healthcare processes through an activity-based

Activity-based costing benefits the costing process by expanding the number of cost pools that can be used to analyze overhead costs and by making indirect costs traceable to certain activities. The ABC system of cost accounting is based on activities, which are any events, units of work, or tasks with a specific goal, such as setting up machines for production, designing products, distributing finished goods, or operating machines.

Activities consume overhead resources and are considered cost objects. Under the ABC system, an activity can also be considered as any transaction or event that is a cost driver. A cost driver, also known as an activity driver, is used to refer to an allocation base. Examples of cost drivers include machine setups, maintenance requests, consumed power, purchase orders, quality inspections, or production orders.

There are two categories of activity measures: transaction drivers, which involves counting how many times an activity occurs, and duration drivers, which measure how long an activity takes to complete.

These levels include batch-level activity, unit-level activity, customer-level activity, organization-sustaining activity, and product-level activity.Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come.

The pressures may well be even more acute as the impact of the economic crisis of continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis.

These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund.

The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members.

Program budgeting and marginal analysis PBMAmulti-criteria decision analysis MCDAand accountability for reasonableness A4R are commonly used approaches for healthcare priority setting.

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These approaches can be used to improve the fairness and legitimacy of priority setting within healthcare organizations whilst ensuring that resources are allocated in the best manner possible. Health technology assessment is often viewed as a one-off activity, whereas it should be seen as an input into a formal process for priority setting at the local or regional level. Key elements for high performance have been identified that can be used to improve priority setting practice in health service organizations.

an analysis of healthcare processes through an activity-based

Examining investments and disinvestments, and thus opportunities for re-allocation, should be a part of an ongoing resource management strategy regardless of the external fiscal climate.

Public sector budgets have been under enormous pressure since the economic crisis of [ 12 ]. Of course it is not to say that there are no efficiency gains that can be made, but it would be atypical to identify a plethora of low-hanging fruit in this day and age. Acknowledging this, researchers and policy makers have turned attention to pulling resources from areas of ineffective care.

Furthermore, work in Australia has identified over areas of care that health service delivery organizations could potentially stop doing based on the latest evidence [ 4 ]. The important point is that it is clear that there are tangible service areas from which resources should be released, thereby freeing resources to go towards government bottom lines or for re-investment elsewhere in the system. The answer to this question will depend on the context. However, in most countries today, following the current extended economic downturn and limited hope for a near-term recovery, there is really only one option.

Decision makers must look at releasing resources from areas of care that are in fact producing some benefit [ 5 ].

an analysis of healthcare processes through an activity-based

This clearly is no easy task, as those in charge of the system would need to stare down their political paymasters and stand firm in saying that to fund more of some things resources will have to be taken from existing lower value yet still benefit-producing services. This short paper focuses on several of these tools including program budgeting and marginal analysis or PBMAand along with it, a common method for benefit measurement known as multi-criteria decision analysis MCDA.A major challenge of mental health care is to provide safe and effective treatment with limited resources.

The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing TDABC method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies.

The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy ICBT. Data was collected from adult patients treated with ICBT for depression during — The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used.

Clinical outcomes were measured using the Patient Health Questionnaire depression scale PHQ-9 before and after treatment and at 6-month follow-up. Cost-effectiveness analyses CEA was performed and the results presented as incremental net benefits INBcost-effectiveness acceptability curves CEACs and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention. Confidence ellipses occupied the south-east SE and south-west SW quadrants of the incremental cost-effectiveness plane at both post-treatment and at follow-up, indicating that the ICBT treatment was less costly and equally effective after staff reallocation.

Treating patients to the target of full remission using psychologists instead of medical specialists for post-treatment assessment is cost-saving and consequently a more valuable use of limited resources. TDABC may be a useful tool for measuring resource costs, identifying quality improvement opportunities and evaluating the consequences of such initiatives. Combining TDABC with clinical outcome measures in CEA is potentially a useful approach in mental healthcare to estimate the value of process improvement initiatives.

This is an open access article distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: We have uploaded a minimal dataset as Supporting Information files. NL received the funding. Competing interests: The authors have declared that no competing interests exist. The social and economic effects of the growing global burden of mental disorders—notably, depression—are monumental.

The Global Burden of Disease GBD study identified depression as the second-leading cause of disability worldwide, concluding that depressive disorders are a public-health priority requiring cost-effective interventions. An innovative solution, with the potential to bridge the gap between demand and accessibility of qualified treatment for mental health problems, is the recent development of internet-based psychotherapies, which use established evidence-based treatment programs, such as cognitive behavioral therapy CBT [ 2 ], in combination with online therapist support.

Because ICBT is less resource demanding than conventional face-to-face interventions—and does not compromise treatment effectiveness—it could greatly increase access to evidence-based and cost-effective care, complementing traditional forms of delivery.

With an increased emphasis on mental health care in both assuring the quality of care while also managing costs, there is a corresponding need for a management system that can accurately and routinely estimate these factors.Lack of understanding about how much it costs to provide patient care, and lack of knowledge about how those costs compare to the outcomes achieved, lead to the cost increases.

To build sustainability, healthcare organizations must identify and address waste in healthcare and reduce the total cost of care. UPMC recognized that the common denominator to addressing threats to sustainability is to fully understand and effectively manage costs.

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Through its analytics platform and best-of-breed, ABC models, UPMC is improving quality and safety, reducing costs, and increasing value across service lines. For example:. Healthcare costs are climbing disproportionately to gross domestic product GDPand are predicted to account for Major factors contributing to increased healthcare costs are a lack of understanding about how much it costs to provide patient care, and a lack of knowledge about how those costs compare with the outcomes achieved.

Meanwhile, the average hospital operating margin is 2. For the American healthcare system to be sustainable, healthcare organizations must be able to identify and address waste in healthcare, and reduce the total cost of care.

To create these internal efficiencies, hospitals must have timely and actionable data that can identify unnecessary variation in care routines and supply usage, and enable appropriate corrective action.

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Healthcare reimbursement is being driven by growth in government programs, changes in employer plans, and growth of alternative payment models, requiring hospitals to shift their revenue strategies from volume to value, and improve patient outcomes at a lower cost.

Exacerbating this challenge, payment system reforms will increasingly require providers to bear greater population-based financial risk. Price transparency is critical in this new healthcare environment to effectively manage payer contracting, but to provide this information, hospitals need reliable and defensible data. UPMC is a large integrated healthcare delivery system with over 30 hospitals accounting for more than 6, licensed beds andinpatient admissions and observation cases, in addition to 4.

UPMC was aware that a changing environment required it to take on more risk, moving from payment for volume to payment for value. This forward-thinking healthcare organization began to analyze the industry and implemented a strategic and effective way to position the organization for success while improving care for patients.

UPMC determined several underlying problems making the current U. UPMC recognized that the common denominator to addressing these threats to sustainability is the ability to fully understand and effectively manage costs—knowledge that is essential to eliminate waste and improve patient outcomes, both of which are made possible by eliminating unnecessary clinical variation.

UPMC determined that the traditional cost accounting methods used most often in healthcare—relative value units RVU and ratio of costs-to-charge RCC —did not provide the level of detail and accuracy necessary to inform decisions that would enable it to overcome industry threats to its sustainability. Activity-based costing ABCused in manufacturing for decades, has been deemed impossible or not worth the effort in healthcare due to challenges with data integrity, integration, and access.

UPMC allocates remaining expenses to patients using the best available driver, such as minutes in the operating room, time on the MRI machine, or scheduled minutes for a procedure. Detailed and actionable cost data across the analytics environment supports service line reporting, contract modeling, clinical process improvement, and more see Figure 1enabling UPMC to do the following:.

Figure 1: Cost management improvement progression enabled by analytics. A good example of how UPMC leveraged analytics to successfully improve both clinical and financial performance is its approach to surgical services. In the current healthcare environment of declining surgical volume and increasing cost, it has become imperative for any health system to gain solid, data-driven insight into its use of operating room OR resources.

One of the largest areas of opportunity is the efficient deployment of OR labor, both anesthesia and hospital staff, in reacting to changing volumes. Using cost allocation methodologies developed with Health Catalyst, UPMC sought to understand the correlation of labor costs for anesthesia and hospital resources to surgical case time, which resulted in a transparent view of labor cost per OR hour across the system. By understanding the intersection and interaction of volume and cost, UPMC has been able to identify operational variation within and across facilities.

As a result, operational and physician leaders have regular insight into the changing cost and volume associated with each OR. Data is actively used to identify best practices related to OR utilization and staffing to deliver the same high-quality patient care, using fewer resources.Activity-based budgeting ABB is a system that records, researches, and analyzes activities that lead to costs for a company.

Every activity in an organization that incurs a cost is scrutinized for potential ways to create efficiencies. Budgets are then developed based on these results. Activity-based budgeting ABB is more rigorous than traditional budgeting processes, which tend to merely adjust previous budgets to account for inflation or business development. Keeping costs to a minimum is a crucial part of business management. When done effectively and not too excessively, companies should be able to maintain and keep growing their revenueswhile squeezing out higher profits from them.

Using activity-based budgeting ABB can help companies to reduce the activity levels required to generate sales. Eliminating unnecessary costs should boost profitability.

The activity-based budgeting ABB process is broken down into three steps. Activity-based budgeting ABB is an alternative budgeting practice. Traditional methods are more simplistic, adjusting prior period budgets to account for inflation or revenue growth.

Rather than using past budgets to calculate how much a firm will spend in the current year, activity-based budgeting ABB digs deeper. Activity-based budgeting ABB is not necessary for all companies.

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In these types of cases, historical information may no longer be a useful basis for future budgeting. This figure may be compared to a traditional approach to budgeting. Activity-based budgeting ABB systems allow for more control over the budgeting process. ABB allows for management to have increased control over the budgeting process and to align the budget with overall company goals. Unfortunately, these benefits come at a cost. Activity-based budgeting ABB is more expensive to implement and maintain than traditional budgeting techniques and more time consuming as well.

Moreover, ABB systems need additional assumptions and insight from management, which can, on occasion, result in potential budgeting inaccuracies. Financial Statements. Your Money.

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Personal Finance. Your Practice. Popular Courses. Key Takeaways Activity-based budgeting ABB is a method of budgeting where activities that incur costs are recorded, analyzed and researched. It is more rigorous than traditional budgeting processes, which tend to merely adjust previous budgets to account for inflation or business development.

Using activity-based budgeting ABB can help companies to reduce costs and, as a result, squeeze more profits from sales. This method is particularly useful for newer companies and firms undergoing material changes.

Compare Accounts. The offers that appear in this table are from partnerships from which Investopedia receives compensation. Underapplied Overhead Underapplied overhead refers to the amount of actual factory overhead costs that are not allocated to units of production.

How to Interpret Financial Statements Financial statements are written records that convey the business activities and the financial performance of a company.

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Financial statements include the balance sheet, income statement, and cash flow statement.Listen to an interview with Robert S. Download this podcast. Other countries spend less of their GDP on health care but have the same increasing trend. Explanations are not hard to find. The aging of populations and the development of new treatments are behind some of the increase. Perverse incentives also contribute: Third-party payors insurance companies and governments reimburse for procedures performed rather than outcomes achieved, and patients bear little responsibility for the cost of the health care services they demand.

8 Pros and Cons of Activity Based Costing

But few acknowledge a more fundamental source of escalating costs: the system by which those costs are measured. To put it bluntly, there is an almost complete lack of understanding of how much it costs to deliver patient care, much less how those costs compare with the outcomes achieved. Instead of focusing on the costs of treating individual patients with specific medical conditions over their full cycle of care, providers aggregate and analyze costs at the specialty or service department level.

Making matters worse, participants in the health care system do not even agree on what they mean by costs. Providers share in this confusion. They often allocate their costs to procedures, departments, and services based not on the actual resources used to deliver care but on how much they are reimbursed. But reimbursement itself is based on arbitrary and inaccurate assumptions about the intensity of care. Poor costing systems have disastrous consequences.

It is a well-known management axiom that what is not measured cannot be managed or improved. Since providers misunderstand their costs, they are unable to link cost to process improvements or outcomes, preventing them from making systemic and sustainable cost reductions. Instead, providers and payors turn to simplistic actions such as across-the-board cuts in expensive services, staff compensation, and head count.

But imposing arbitrary spending limits on discrete components of care, or on specific line-item expense categories, achieves only marginal savings that often lead to higher total systems costs and poorer outcomes. Poor cost measurement has also led to huge cross-subsidies across services. Providers are generously reimbursed for some services and incur losses on others.

These cross-subsidies introduce major distortions in the supply and efficiency of care. The inability to properly measure cost and compare cost with outcomes is at the root of the incentive problem in health care and has severely retarded the shift to more effective reimbursement approaches.

Finally, poor measurement of cost and outcomes also means that effective and efficient providers go unrewarded, while inefficient ones have little incentive to improve.

Indeed, institutions may be penalized when the improvements they make in treatments and processes reduce the need for highly reimbursed services. Without proper measurement, the healthy dynamic of competition—in which the highest-value providers expand and prosper—breaks down. Instead we have zero-sum competition in which health care providers destroy value by focusing on highly reimbursed services, shifting costs to other entities, or pursuing piecemeal and ineffective line-item cost reductions.

Current health care reform initiatives will exacerbate the situation by increasing access to an inefficient system without addressing the fundamental value problem: how to deliver improved outcomes at a lower total cost. The remedy to the cost crisis does not require medical science breakthroughs or new governmental regulation.


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