Time-Driven Activity-Based Costing (TDABC) in Radiation Oncology: A Method for Implementation

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Time-Driven Activity-Based Costing (TDABC) has gained popularity in the healthcare industry, but little information exists on the benefits and strategies for implementation within Radiation Oncology. Furthermore, the data may provide insight into opportunities for operational improvements. We sought to implement TDABC in a large academic radiation oncology practice using a customized approach and minimal resources. A multidisciplinary team was created to oversee and maintain the project scope, timeline and task list. Adaptability was noted as a key to project success, so a weekly schedule was established for team huddles. The data collection plan was divided into four phases: Process mapping, validation, resource allocation, and final validation. The resulting data were combined and organized into a functional tool allowing for scenario-specific analysis using treatment plan-specific variables (e.g. fractionation, complexity, on-treatment-visit volume, adaptive planning, verification simulation, etc.). The initiative required approximately 1.5 staff to manage over a 6 month period. Overall, 9 disease-site sections were considered. Between 16 and 18 workflow maps were produced within each section, resulting in approximately 44 unique cost profiles per section. Process maps for simulation, treatment planning, physics check and treatment delivery all contained cost profiles for each relevant treatment modality for each section. Initial analyses were performed on the Head and Neck (HN) and Genitourinary (GU) sections following the final phase of data collection. A 30 fraction (Fx) IMRT head and neck plan and a 39 Fx IMRT prostate plan were analyzed. 25% and 46% of total costs were accrued in the treatment delivery phase of the head and neck and prostate plans, respectively. The higher fractionation and additional time needed for patient set-up for the prostate plan were among multiple variables contributing to the difference in cost breakdown. Treatment delivery accounted for the largest proportion of total costs in both scenarios. On-Treatment-Visits (OTV) accounted for 16% and 20% of total costs for head and neck and prostate plans, respectively whereas Initial Consult Visits accounted for 13% and 12%, respectively. 15% of total costs in the head and neck scenario were attributed to head and neck section-specific processes such as joint physical examination and a minimum of one standard verification simulation during treatment. We conclude that TDABC can be implemented and sustained with the strategy outlined in our study. The data can provide insight into process variation and opportunities for operational improvement.