Time-driven Activity-based Costing Research Articles

HEALTH SERVICE EFFICIENCY: COST ANALYSIS OF TIME DRIVEN ACTIVITY BASED COSTING METHODS IN CAESAR SURGERY SERVICES IN PKU MUHAMMADIYAH HOSPITAL, YOGYAKARTA

Negative difference between the fee for cesarean surgery services provided by the hospital and the tariff claimed by BPJS resulted in the hospital bearing the cost difference. This study aims to determine the level of inefficiency in cesarean surgery healthcare services through cost calculation using the Time Driven Activity Based Costing (TDABC) method at PKU Muhammadiyah Yogyakarta Hospital. This study uses a qualitative approach with a case study strategy. The subjects of this research were determined using purposive sampling approach, involving 5 informants as personnel in each cost pool. In-depth interviews and documentation of internal financial data were used as data collection techniques. The results of this study show the presence of inefficiency in the Accommodation cost pool and the Cleaning service cost pool. Inefficiency in cesarean surgery services can be determined after analyzing the utilization of capacity, which is the end result of cost calculation using the TDABC method. The stages of cost analysis using the TDABC method in this study include: 1) Identification of Cost Pools, 2) Identification of total costs for each cost pool, 3) Determination of practical capacity and capacity cost rate for each cost pool, 4) Determination of time estimates for each cost pool, 5) Cost calculation, and 6) Analysis of capacity utilization to determine the level of inefficiency by calculating the percentage of available capacity compared to idle capacity. The results of this study are expected to provide input regarding the optimization of idle capacity, cost efficiency, and improvement of healthcare service processes in the hospital.

Cost of Ownership of Spare Parts under Uncertainty: Integrating Reliability and Costs

In capital-intensive organizations, decisions regarding capital costs play an important role due to the significant amount of investment required and the expected return on investment. Spare parts management is crucial to those ends, as spare parts management can constitute a significant portion of OPEX. Companies must implement a trade-off analysis between stock levels and assets’ availability. Decision-making supports mechanisms such as the Level of Repair Analysis (LORA), Integrated Logistics Systems (ILS), and life-cycle costing (LCC) models have been developed to aid in equipment selection, implementation, and decommissioning. Nowadays, these mechanisms appear to be integrated with risk-management models and standards. This paper proposes a long-term costing model that integrates a capacity analysis, reliability functions, and risk considerations for the cost management of logistics activities, particularly in MRO structures. The model is built upon Time-Driven Activity-Based Costing (TD-ABC) and incorporates the volume of activities generated by MRO needs. It also addresses uncertainty through the integration of a cost-at-risk model. By integrating spare parts, activity-based cost models, and risk measurement through Monte Carlo simulation, this study offers powerful insights into optimizing spare parts logistics activities. The proposed model is a novel approach to include the risk of cost in spare parts management, and its matrix-activity-based structure makes possible the development of sophisticated mathematical models for costing and optimization purposes in different domains.

Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal

BackgroundThe number of people with chronic diseases has increased globally, as has the number of chronic diseases per person. Faced with this reality, the term “complex patient” is current and actual.The healthcare costs associated with these patients are high and are expected to increase since most healthcare systems are not yet ready to provide integrated long-term care. In Portugal, several health institutions have made efforts to provide integrated care: case management models have been implemented to complex patients follow-up. However, studies related to cost of these programs are still limited. Therefore, a qualitative investigation was conducted, approaching the design criteria of a case study research, to design a case management program for complex patients and determine its direct costs, following the Time-Driven Activity-Based Costing methodology, in Local Health Unit setting.MethodThe direct costs of providing care to a complex patient involved in a case management program were determined, using the Time-Driven Activity-Based Costing methodology.A map of the complex patient was drawn, considering a standard flow in the program. Times and costs were allocated to the activities on the map, following Portuguese and international practices of case management models.ResultsA total of 684,45€/year is spent for each new patient in the case management program, of which 452,65€ corresponds to cost of remuneration of professionals involved; and 663,85€/year, for each patient who is in the case management program (over 1 year), where 432,05€ corresponds to cost of the remuneration of the professionals involved.Follow-up is the most costly phase (80.82%) and where more time is spent (85.62%).ConclusionThe time spent by professionals and resources involved and the costs associated with each patient were obtained. The economic impact of the analysed activities was not studied, however, according to international authors, when well applied and selected, integrated care models lead to cost reduction and improved health outcomes.

Subacromial Balloon Spacer Versus Partial Rotator Cuff Repair in the Treatment of Massive Irreparable Rotator Cuff Tears: Facility Personnel Allocation and Procedural Cost Analysis.

Background The subacromial balloon is a novel technology that has shown promise in managing a select patient population with massive irreparable rotator cuff tears. The purpose of this study was to quantify the true facility cost difference between subacromial balloon placement (SBP) and partial rotator cuff repair (PCR). Methodology A prospective cohort of patients with massive irreparable rotator cuff tears randomized to SBP versus PCR between2015 and 2018 was retrospectively reviewed. Demographic variables, medical comorbidities, and range-of-motion (ROM) outcomes for all patients were recorded. True facility costs with respect to personnel were calculated using a time-driven activity based-costing (TDABC) algorithm and were classified into personnel costs and supply costs. Results Seven patients were treated with PCR compared to nine treated with SBP. No significant differences were observed with respect to demographic characteristics. Postoperative mean external rotation was 37° in SBP patients significantly higher than that of PCR patients at 8° (P= 0.023). Personnel time and cost differences while in the operating room (OR) were significantly less for the SBP ($605.58) compared to PCR ($1362.76) (P< 0.001). Implant costs were higher for SBP when compared to PCR, whereas disposable equipment costs were higher for PCR when compared to SBP. The total mean true facility cost was $7658.00 for SBP, significantly higher than that of PCR at $3429.00 (P< 0.001). Conclusions Despite the substantial reduction in personnel costs seen with SBP, the true facility cost of SBP was significantly higher than that of PCR. As this novel technology is used more ubiquitously and its price is negotiated down, the cost savings seen in personnel and OR time will become more significant. Future prospective cost analyses should follow up on the changes in implant costs and account for potential anesthesia cost savings.

Poster 317: Preoperative and Operative Characteristics in the Context of Patient-Reported Outcomes for ACLR in Patients Aged 40 or Older: Allograft versus Autograft

Poster 317: Preoperative and Operative Characteristics in the Context of Patient-Reported Outcomes for ACLR in Patients Aged 40 or Older: Allograft versus Autograft

The Cost of Standard and Complex Pars Plana Vitrectomy for Retinal Detachment Repair Exceeds Its Reimbursement

To measure the total costs and reimbursements associated with standard and complex pars plana vitrectomy using time-driven activity-based costing (TDABC). Economic analysis at a single academic institution. Patients who underwent standard or complex pars plana vitrectomy (PPV; Current Procedural Terminology codes 67108 and 67113) at the University of Michigan in the calendar year2021. Process flow mapping for standard and complex PPVs was used to determine the operative components. The internal anesthesia record system was used to calculate time estimates, and financial calculations were constructed from published literature and internal sources. A TDABC analysis was used to determine the costs of standard and complex PPVs. Average reimbursement was based on Medicare rates. The primary outcomes were the total costs for standard and complex PPVs and the resulting net margin at current Medicare reimbursement levels. The secondary outcomes were the differential in surgical times, costs, and margin for standard and complex PPV. Over the 2021 calendar year, a total of 270 standard and 142 complex PPVs were included in the analysis. Complex PPVs were associated with significantly increased anesthesia time (52.28 minutes; P < 0.001), operating room time (51.28 minutes; P < 0.0001), surgery time (43.64 minutes; P < 0.0001), and postoperative time (25.95 minutes; P < 0.0001). The total day-of-surgery costs were $5154.59 and $7852.38 for standard and complex PPVs, respectively. Postoperative visits incurred an additional cost of $327.84 and $353.86 for standard and complex PPV, respectively. The institution-specific facility payments were $4505.50 and $4935.14 for standard and complex PPV, respectively. Standard PPV yielded a net negative margin of-$976.93, whereas complex PPV yielded a net negative margin of-$3271.10. This analysis demonstrated that Medicare reimbursement is inadequate in covering the costs of PPV for retinal detachment, with a particularly large negative margin for more complex cases. These findings demonstrate that additional steps may be necessary to mitigate adverse economic incentives so that patients continue to have timely access to care to achieve optimal visual outcomes after retinal detachment. The authors have no proprietary or commercial interest in any materials discussed in this article.

Cost analysis of robot-assisted versus open transthoracic esophagectomy for resectable esophageal cancer. Results of the ROBOT randomized clinical trial

BackgroundThe previously published ROBOT trial demonstrated that robot assisted minimally invasive esophagectomy (RAMIE) is associated with a lower percentage of postoperative complications compared to open esophagectomy (OTE) for patients with esophageal cancer. The implications of these results on healthcare costs are important given the increased attention for cost-reduction in healthcare. Therefore the aim of this study was to report the hospital costs of RAMIE compared to OTE as treatment for esophageal cancer. MethodsThe ROBOT trial randomized 112 patients with esophageal cancer between RAMIE and OTE through January 2012 and August 2016 in a single tertiary care academic centre in the Netherlands. The primary outcome of the current study was hospital costs from the day of esophagectomy until 90 days after discharge based on Time-Driven Activity-Based Costing methodology. Secondary outcomes included the incremental cost-effectiveness ratio per complication prevented and risk factors for increased hospital costs. ResultsOf the 112 included patients, 109 patients underwent an esophagectomy, of whom 54 RAMIE and 55 OTE. The mean total hospital costs were comparable between RAMIE €40211 and OTE €39495 (mean difference €-715; bias-corrected and accelerated confidence interval € −14831 to 14783, p = 0.932). At a willingness-to-pay threshold of €20.000 to €25.000 (i.e. estimated additional costs to the hospital to treat patients with a complication) RAMIE had a probability 62%–70% of being cost effective to prevent postoperative complications. In multivariable regression analysis, major postoperative complications were the main driver of hospital costs after esophagectomy (€31839, p = 0.009). ConclusionIn this randomized trial RAMIE resulted in fewer postoperative complications compared to OTE without increasing total hospital costs.

Determinants of High Facility Costs in Total Joint Arthroplasty Patients: A Time-driven Activity-based Costing Analysis.

Although several studies identify risk factors for high-cost patients in an episode of care for total hip (THA) and knee arthroplasty (TKA), few have looked at cost outliers from a facility perspective. The purpose of this study was to use time-driven activity-based costing (TDABC) to identify characteristics of high-cost patients. We reviewed a consecutive series of primary THA and TKA patients by 22 different surgeons at two hospitals between 2015 and 2020. Facility costs were calculated using a TDABC algorithm for their entire hospital stay. Patients in the top decile of costs were considered to be high-cost patients. Multivariate regression was done to identify independent patient factors that predicted high costs. Of the 8,647 patients we identified, 60.5% underwent THA and 39.5% underwent TKA. Implant purchase price accounted for 49.5% of total inpatient costs (mean $2,880), followed by intraoperative (15.9%, mean $925) and postoperative personnel costs (16.8%, mean $980). Implant price demonstrated the highest variation between high-cost and low-cost groups (4.4 times). Patient-related factors associated with high costs were female sex (OR = 1.332), Hispanic ethnicity (OR = 1.409), American Society of Anesthesiology score (OR = 1.658), need for transfusion (OR = 2.008), and lower preoperative HOOS/KOOS Jr (OR = 1.009). This study identifies several variables for patients at risk to have high facility costs after primary THA and TKA. From the hospital's perspective, efforts to reduce implant purchase prices may translate into substantial cost savings. At the patient level, multidisciplinary initiatives to optimize medical comorbidities, decrease transfusion risk, and control medication expenses in high-risk patients may narrow the existing variation in costs.

Evaluation of operation cost and energy consumption of ports: comparative study on different container terminal layouts

Automatic container terminals (ACTs) have emerged as the development direction of upgrading and transformation for traditional manual container terminals. A number of terminal layouts are devised and implemented. However, it is the lack of a comprehensive comparison of different container terminal layouts from aspects of operation cost and energy consumption. In view of this, a Time-Driven Activity-Based Costing approach is used to identify the ACT profitability bottlenecks. A multi-agent based simulation model considering four main terminal layouts is established. The multi-level handling of ACTs is simulated and the corresponding operation time and energy consumption are calculated. Simulation results show that automated guided vehicles (AGVs) are the key to improving the cost-effectiveness of ACTs. The cost-effectiveness of ACTs with non-cantilever automated rail-mounted gantries (ARMGs) is more vulnerable than that of ACTs with bilateral cantilever ARMGs. On average, ACTs with bilateral-cantilever ARMGs consume less energy per container task than ACTs with non-cantilever ARMGs. This study provides management insights into resource allocation, layout design, and sustainable development.

Integrating blockchain, RFID and IoT within a cheese supply chain: A cost analysis

This study aims to estimate the costs of integrating RFID and IoT with blockchain for supply chain management. The study is based on the comparison of two simulation scenarios in a cheese supply chain, the as-is case vs. the integration of the following technologies: blockchain, smart contracts, RFID and IoT. Using the Time-Driven Activity-Based Costing method, costs are allocated for six actors: dairy farm, 3PL, wholesaler and three retailers. In addition, the costs of each player are allocated for each supply chain area: logistics, warehouse and order management. The study shows in which areas and for which actors implementing and integrating different technologies is economically suitable. Different procurement policies are modelled for evaluating the cost impacts for each retailer: Economic Order Quantity, Period Order Quantity and Lot for Lot. Moreover, the costs of non-compliant products are assessed in both scenarios. The results show that specific areas such as warehouse management and logistics in the to-be scenario are not economically optimized, however the entire supply chain cost is optimized. The area with positive economic feasibility for all the participants in the supply chain is order management. The combined use of technologies is economically beneficial when the Economic Order Quantity procurement policy is adopted. Finally, in the to-be scenario the non-compliant products management is economically optimized with economic benefits ranging from 8% to 63%.

Fulfillment costs in online grocery retailing: comparing retail store and warehouse strategies

This study develops a framework that structures the operational costs of online grocery retailing in order to identify which is the most suitable e-fulfillment strategy. The cost framework was designed by applying time-driven activity-based costing (TDABC) and is based on the insights of two large European grocery retailers, which operate retail store and warehouse e-fulfillment strategies respectively. Cost information was collected, and activity-oriented process modeling was carried out in the field to identify the most relevant e-fulfillment cost drivers. For the retail store strategy, picking costs were the highest among e-fulfillment activities and up to twice as high as for the warehouse strategy. For the warehouse strategy, delivery costs were the highest and 50% higher than for the retail store strategy. Less studied logistics activities such as unpacking and reverse logistics all together accounted for up to one third of total expenses for both strategies. In omnichannel, operations and logistics managers must still ensure the profitability of the online channel if they want to succeed in the grocery business. This framework will help managers identify and estimate the most relevant cost drivers, and to allocate them to the main operational activities.

EE450 Assessment of the Quality of Time-Driven Activity-Based Costing (TDABC) Studies on Cardiovascular Diseases and Oncology

To evaluate the quality of published studies on cardiovascular diseases and oncology fields which applied the method Time-driven Activity-based costing (TDABC) method.

The integration of Time Driven-Activity Based Costing (TD-ABC) in a lean Manufacturing System for accurate product unit cost A Case Study in Egypt

The integration of Time Driven-Activity Based Costing (TD-ABC) in a lean Manufacturing System for accurate product unit cost A Case Study in Egypt

HSD60 Determining Costs, Cost Predictors, and Resource Requirements in Assisted Reproductive Technology Care Pathways: A Value-Based Fertility Care Costing Tool Using Time-Driven Activity-Based Costing

The aim of this research was to determine the total costs of fertility care cycles for all patient pathways, identify cost predictors, and to stratify resource use per treatment option.

EE28 Identifying Factors Underlying Variation in the Cost of Acetabular Labral Repair or Debridement during Hip Arthroscopy: A Time-Driven Activity-Based Costing Analysis

Leveraging time-driven activity-based costing (TDABC), this study aims to (1) quantify the cost of arthroscopic acetabular labral repair or debridement and (2) explore variation in costs based on patient-specific characteristics, operative techniques employed, and surgical settings.

PCR114 Utilizing Time-Driven Activity Based Costing to Explore Variation in the Value of Hip Arthroscopy for Acetabular Labral Repair

By integrating postoperative patient-reported outcome measures (PROMs) with time-driven activity-based costing, this study aims to (1) quantify variations in the value of hip arthroscopy (HA) for acetabular labral repair and (2) explore patient-level characteristics (e.g., demographics, comorbidities, preoperative PROMs, and intraoperative variables) that may contribute to this variation.

EE335 A Multicenter Microcosting Study for COVID-19 in Brazil

This study aims to evaluate COVID-19 in-hospital costs and identify predictors at a patient-level in Brazil. This is multicenter, prospective cohort study that applied time-driven activity-based costing (TDABC) method in five Brazilian reference centers for COVID-19 treatment. Patients hospitalized between March and August 2020 (first wave of the disease) and had their COVID-19 status confirmed by reverse transcription-polymerase chain reaction (RT–PCR) at arrival were included in our sample. The cost information was calculated at the patient level and multivariable analyses were applied to identify clinical predictors of cost variability, considering ICU admissions and patient’s comorbidities. 830 patients were included into the analysis. The median cost per patient was I$4,428 (IQR 2,019; 11,464), and patients hospitalized in ICU demonstrated significative higher costs (p<0.001). Patients hospitalized in ICU the median was I$11,596 (IQR 6,016; 23,374), while for those who were hospitalized in ward was 1,895 (IQR 1,050; 3,317). Median cost per day was I$ 455 (IQR 308; 711) for the total sample, I$690 (IQR I,528; 1,046) for ICU patients and I$350 (IQR 255; 449) for non-ICU. Gender (p<0.001), Obesity (p = 0.005) and Chronic pulmonary diseases (p = 0.044) were identified as clinical predictors for hospital costs. By developing a multicenter microcosting study for COVID-19 this study allowed to measure the variability in resource consumption per patients’ according their clinical characteristics. These findings can sustain the development of financially sustainable health policies in middle-income countries such as Brazil.

Time-Driven Activity-Based Costing in service companies: a comparative case study: FRENCH, BELGIAN, TURKISH AND THAI

Time-Driven Activity-Based Costing in service companies: a comparative case study: FRENCH, BELGIAN, TURKISH AND THAI

A New Scenario-Based Simulation Model for Cost Management of Healthcare Services through Improving the Efficiency of the Health Centers

There is a need for an appropriate decision-making approach and a precise costing method in order to make appropriate decisions that result in managing the resource utilization, improving the efficiency of healthcare systems and processes, increasing the patient consent, and reducing the costs of healthcare services. Therefore, this study is to develop a new method for estimating and reducing the services’ costs by assessing the scenarios intended for the improvement of departments using time-driven activity-based costing (TDABC) and simulation model with conditions of uncertainty. To investigate the application of this method, the lithotripsy department of a kidney center has been studied and attempted to investigate the effects of different scenarios of scheduling the technicians’ presence and scheduling patients’ appointments, alongside the effects of controlling the factors of patient cancellation in different stages of the treatment process on lowering the healthcare costs and waiting time and on improving the hospital efficiency. The results showed that significant improvements in costs, waiting time, human resource utilization, and overall system efficiency were emerged. The impact of patient appointment scheduling scenarios on the abovementioned indexes was found to be far more than other scenarios. Furthermore, the results from the costs determined indicate a difference of 0.60, 0.61, 0.67, 0.67, and 0.63 percent between these costs and the costs determined by the traditional approaches. Such differences among the costs determined by these two approaches mainly occur due to different methods of allocating indirect costs and existence of uncertainty in the costs and time of therapeutic activities.

Design of Using Activity Based Budgeting Methods for Controlling Employee Overtime Costs

This study aims to design and propose using overtime budgets in companies. This type of research is descriptive exploratory, and the research object is data related to employee overtime in July-December 2021. The financing method used is time-driven activity-based costing (TDABC). This study suggests that companies follow up on departments with over-capacity status to evaluate employee activities during overtime so that it does not affect company performance. The application of the activity-based budgeting method can increase the effectiveness of employee overtime costs because it can prove that there are savings in overtime costs and can increase profits. So that the ABB method can control the overtime budget more efficiently and better. The ABB method can control employee overtime budgets more efficiently. The ABB method can be proposed to companies to control their employees' overtime costs. This research has implications for identifying the need for overtime, purchasing efficient budget allocations, evaluating the impact on financial companies.