What Is the Inpatient Cost of Hip Replacement? A Time-Driven Activity Based Costing Pilot Study in an Italian Public Hospital

Abstract

The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA.

Could Short Stems THA Be a Good Bone-Saving Option Even in Obese Patients?

“…Although the literature on the post-operative risk of thromboembolic events documents an increasing risk in obesity, this is not consistently replicated in the orthopaedic literature [ 44 , 45 , 46 ]. Similarly, it has been empirically shown that the risk of dislocation increases with extreme excursions of the joint angle and fat tissues around the hip [ 47 ].…”

Aplicação do TDABC na avaliação da lucratividade de exames e do nível de ociosidade da tomografia computadorizada do setor de oncologia ginecológica

“…Ao considerar tal índice, se faz uma simplificação do contexto produtivo do Centro de Diagnósticos por Imagens (CDI) abrangido. Portanto, é necessário um entendimento acurado da configuração e dos tempos das atividades inerentes como mecanismo para evitar (ou minimizar) a simplificação de medições a respeito, especialmente porque podem comprometer a qualidade informacional dos resultados, como mencionado por Thaker et al (2022), Fidanza et al (2022) e Bernstein et al (2023). No caso do Centro de Diagnóstico de Imagem (CDI) investigado, a estimativa de uso efetivo foi empregada como forma de descontar eventuais horas não trabalhadas, que no cotidiano do CDI costumam ocorrer por motivos diversos (intervalos para alimentação, paradas para ajustes ou manutenção de equipamentos, não comparecimento de pacientes etc.…”

“…Ou seja, pode complementar as iniciativas gerenciais tradicionais de redução de gastos ao quantificar as etapas com custos mais elevados, o que facilita a priorização das iniciativas para reduzir gastos e melhorar a eficiência. Fidanza et al (2022) aduzem que o TDABC pode ser considerado uma abordagem inovadora para medir custos com maior precisão, pois estima a quantidade de tempo e o custo por unidade de tempo dos recursos utilizados durante um atendimento ou exame. Além disso, de acordo com Bernstein et al (2023), o TDABC proporciona um instrumento capaz de calcular os custos associados aos procedimentos médicos de modo mais preciso.…”

The Role of Platelet-Rich Plasma on the Chondrogenic and Osteogenic Differentiation of Human Amniotic-Fluid-Derived Stem Cells

“…Osteoarthritis (AO) is currently one of the most frequently diagnosed chronic diseases, affecting an estimated 10% of men and 18% of women over 60 years of age, and with the increase in life expectancy, both its prevalence and incidence are expected to rise. This condition is degenerative until the loss of function and disability leads to important healthcare and social costs [ 1 , 2 ]. In addition to chondral pathologies, skeletal diseases, such as nonunion and bone defects due to trauma, infections, or tumors, represent a great challenge for orthopedic surgeons.…”