Time-driven activity-based costing as a strategy to increase value: the case of interventional procedures

Abstract

Background: Adopting value-based health care management strategies requires monitoring the real costs and care delivered to patients. This study aimed to evaluate the cost-saving opportunities of interventional coronary procedures (ICPs) by assessing patients’ processes of care and costs in five public academic hospitals.Methods: Data from 90 patients submitted to elective ICP were evaluated in five hospitals in Brazil. Time-driven activity-based costing (TDABC) was used to assess real-world costs and the time spent over the care pathway. Descriptive cost analyses were followed by a labour cost-saving estimate potentially achieved by the redesign of the ICP pathway, considering the benchmark of the patient care cycle identified in the sample of hospitals studied.Results: The mean cost per patient of interventional angioplasty was $1,677 (SD $881). The length of the procedure phase per patient was similar among the hospitals, while the post- procedure phase presented the highest variation in length. However, it was possible to demonstrate that the highest direct cost saving opportunities are concentrated in the procedure phase in which labour and non-labour resources are more consumed. Physician involvement redesign can account for a 51% decrease in procedure cost.Conclusion: This study demonstrated how the level of detailing on cost information provided by the TDABC can contribute to driving health care management to value by identifying cost-saving opportunities in health service delivery.