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- February, 2022
- Article
Costs Without Value When Treating Pediatric Behavioral Patients in the ED
By: Robert S. Kaplan, Marcella Jewell, Syed S. Shehab, Jack Fanton and Joeli Hettler
The demand on pediatric EDs to provide behavioral health care has increased over the past decade. Thus, an accurate cost analysis of providing this care in pediatric ED settings could inform the design of the most appropriate care model for these patients and identify...
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- Article
Time-Driven Activity-Based Costing in Breast Cancer Care Delivery
By: Navraj S. Nagra, Elena Tsangaris, Jessica Means, Michael J. Hassett, Laura S. Dominici, Jennifer R. Bellon, Justin Broyles, Robert S. Kaplan, Thomas W. Feeley and Andrea L. Pusic
We used time-driven activity-based costing (TDABC) to calculate the complete cost of breast cancer care—initial treatment planning, chemotherapy, radiation therapy, surgical resection and reconstruction, and ancillary services (psychosocial oncology, physical therapy....
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- November–December 2021
- Article
Successfully Implementing TDABC in Health-Care Provider Organizations
By: Susanna Gallani and Gregory Sabin
This article describes some of the common obstacles that challenge the success of TDABC implementation in health-care provider organizations and suggests potential remedies and preventive measures.
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- November 2021
- Article
Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-driven Activity-based Costing
By: Tyler R. McClintock, David F. Friedlander, Aiden Y. Feng, Mahek A. Shah, Daniel J. Pallin, Steven L. Chang, Angela M. Bader, Thomas W. Feeley, Robert S. Kaplan and George E. Haleblian
Objective. To characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing.
Methods. We defined all phases of care for patients presenting with an acute ureteral stone and built an... View Details
Methods. We defined all phases of care for patients presenting with an acute ureteral stone and built an... View Details
- Article
A Cost Comparison of Cataract Surgeries in Three Countries—United States, India, and Nepal
By: Jiayin Xue, John Hinkle, Mary-Grace Reeves, Luo Luo Zheng, Vengadesan Natarajan, Shyam Vyas, Radhika Upreti Oli, Matt Oliva, Robert S. Kaplan, Arnold Milstein, Geoff Tabin, Jeffrey L. Goldberg and Kevin Schulman
U.S.-based cataract surgeries are costly compared with those performed in high-quality Indian and Nepalese eye centers. The authors used time-driven activity-based costing to evaluate phacoemulsification surgery across four sites: a U.S.-based academic hospital...
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- 2021
- Working Paper
How to Fix ESG Reporting
By: Robert S. Kaplan and Karthik Ramanna
Investors, advocacy groups, academics, and the 200 CEOs of the US Business Roundtable have asked corporations to take on an added purpose beyond a narrow pursuit of shareholder value. In response, many companies now issue ESG (Environmental, Societal, and Governance)...
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Keywords:
ESG Reporting;
Sustainability;
Corporate Purpose;
Greenhouse Gas;
Activity-Based Costing;
Environmental Sustainability;
Environmental Management;
Corporate Social Responsibility and Impact;
Measurement and Metrics;
Goals and Objectives;
Agreements and Arrangements;
Corporate Accountability
- July 2021 (Revised October 2021)
- Case
Brigham & Women's Hospital: Using Patient Reported Outcomes to Improve Breast Cancer Care
By: Robert S. Kaplan, Navraj S. Nagra and Syed S. Shehab
Dr. Andrea Pusic, breast cancer reconstruction surgeon, wants to extend outcomes measurement beyond traditional surgical metrics of infections, complications, and survival rates. The case describes her development of a new mobile phone app, which collects patients’...
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- May 2021
- Article
Value-Based Healthcare in Urology: A Collaborative Review
By: Chanan Reitblat, Paul A. Bain, Michael E. Porter, David N. Bernstein, Thomas W. Feeley, Markus Graefen, Santosh Iyer, Matthew J. Resnick, C.J. Stimson, Quoc-Dien Trinh and Boris Gershman
Context:
In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and... View Details
In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and... View Details
- Article
A Feasibility Study Using Time-driven Activity-based Costing as a Management Tool for Provider Cost Estimation: Lessons from the National TB Control Program in Zimbabwe in 2018
By: J. Chirenda, B. Nhlema Simwaka, C. Sandy, K. Bodnar, S. Corbin, P. Desai, T. Mapako, S. Shamu, C. Timire, E. Antonio, A. Makone, A. Birikorang, T. Mapuranga, M. Ngwenya, T. Masunda, M. Dube, E. Wandwalo, L. Morrison and R. S. Kaplan
Background: This study used process maps and time-driven activity-based costing to document TB service delivery processes. The analysis identified the resources required to sustain TB services in Zimbabwe, as well as several opportunities for more effective and...
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- Article
Assessing the Value of Pediatric Aerodigestive Care
By: Robert S. Kaplan, Chris Hartnick, Mahek Shah, Steven M. Coppess, Alisa Yamasaki, Kaalan E. Johnson, Jeremy Prager, Christopher T. Wootten, Thomas Gallagher and Evan Propst
Leaders at six hospitals conducted a research study to assess and compare the health outcomes and costs of pediatric aerodigestive care. Four of the hospitals delivered care with an integrated practice unit (IPU) while two delivered care traditionally, with isolated...
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- Article
Quantifying the Benefits from a Care Coordination Program for Tracheostomy Placement in Neonates
By: Christen Caloway, Alisa Yamasaki, Kevin M. Callans, Mahek Shah, Robert S. Kaplan and Christopher Hartnick
Value-based care models are becoming instrumental in structuring clinical care delivery in our healthcare climate. Our objective was to determine the value associated with implementation of a Family-Centered Care Coordination (FCCC) program for neonates undergoing...
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- Article
Are Cost Advantages from a Modern Indian Hospital Transferable to the United States?
By: R. S. Kaplan, F. Erhun, V.G. Narayanan, B. Mistry and K. Brayton, et al
We use time-driven activity-based costing to estimate the cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two U.S. hospitals, Intermountain and Baylor Heart, and Narayana Health (NH), in India. All three hospitals use modern...
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- Article
Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support
By: Michael Nurok, Jonathan Warsh, Erik Dong, Jeffrey Lopez, Mayumi Kharabi and Robert S. Kaplan
We applied a value (outcomes and cost) analysis to extracorporeal life support (ECLS), a relatively rare but very expensive ICU therapy with highly variable outcomes. To address the outcome component of the value approach, we created guidelines for ECLS delivery; to...
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- 2019
- Article
Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance
By: Robert S. Kaplan, Rohit A. Bobade, Richard A. Helmers, Thomas M. Jaeger, Laura J. Odell and Derek A. Haas
Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive, and an analytical approach to estimate direct costs involved in monitoring and...
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- March 2019
- Article
A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes
By: Robert S. Kaplan, Heather A. Heaton, David M. Nestler, William J. Barry, Richard A. Helmers, Mustafa Y. Sir, Deepi G. Goyal, Derek A. Haas and Annie T. Sadosty
Objectives: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes.
Methods: Two research assistants shadowed attending physicians for a total of 64 hours in the... View Details
Methods: Two research assistants shadowed attending physicians for a total of 64 hours in the... View Details
- February 2019
- Teaching Note
Time-Driven Activity-Based Costing at Voray
By: Ethan Rouen
Teaching Note for HBS No. 119-033.
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- Article
Defining, Measuring, and Improving Value in Spine Care
By: Robert S. Kaplan and Derek Haas
This chapter discusses how to measure and improve spine care outcomes and costs. Today’s commonly used outcome metrics, such as readmission and complication rates, are actually process and quality metrics. They are not the outcomes, such as improvement in pain and...
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- Article
Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System
By: Phillip Tseng, Robert S. Kaplan, Barak D. Richman, Mahek A. Shah and Kevin A. Schulman
The federal government mandated adoption of certified electronic health record systems (EHR), at least in part, to reduce administrative costs for physicians. This study used time-driven activity-based costing to determine the administrative costs associated with...
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- January 2018
- Case
Partners In Health: Costing Primary Care in Haiti
By: Robert S. Kaplan and Mahek A. Shah
Partners in Health, a global NGO focused on delivering health care to residents of rural underserved communities, conducts a project on the cost of primary care at five sites in the Central Highlands of Haiti. It devises a simple approach for tracking the resources...
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