Time driven activity-based costing as a strategy to increase value: a case from cardiac interventional procedure

Abstract

BackgroundAdopting value-based health care management strategies requires monitoring of real costs and care delivered to patients. In unified health systems, recognizing institutions that provide high-quality services, demands understanding their processes of care and costs. This study aimed to evaluate processes and costs of interventional coronary procedures performed in public academic hospitals of a middle-income country.MethodsData from 90 patients submitted to the coronary angioplasties were evaluated in five hospitals in Brazil. Time-driven activity-based costing (TDABC) was used to assess real-world costs and time spent over the care pathway. Descriptive cost analyses were followed by a labor cost-saving estimate potentially achieved by the redesign of the ICP pathway, considering the benchmark of patient care cycle identified in the sample of hospitals studied.ResultsThe mean cost per patient of interventional angioplasties was $1,677 (SD $881). The procedure phase duration per patient was similar between the hospitals, while the post procedure presented the highest length of time variation. However, it was possible to demonstrate that the highest direct cost saving opportunities are concentrated in the procedure phase, due to the way that labor and non-labor resources are consumed. The physician involvement redesign can account for a 51% ICP cost decrease. ConclusionThis study demonstrated how the level of detailing provided by microcosting methods such as TDABC can contribute to driving health care management to value. In a public health system, turning transparent how resources are allocated in an individual level basis along an entire episode of care might allow managers to identify cost-saving opportunities and ways to improve the health service delivery.