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- June 2022
- Article
A New Initiative to Track HIV Resource Allocation and Costs
By: Ryan McBain, AK Nandakumar, Michael Ruffner, Carlyn Mann, Mai Hijazi, Susanna Baker, Linden Morrison, Kalipso Chalkidou, Shufang Zhang, Iris Semini, Fern Terris-Prestholt, Steven Forsythe, Sarah Byakika, Joshua Musinguzi and Robert S. Kaplan
In early 2020, several global health institutions – including the Global Fund to Fight AIDS, Tuberculosis and Malaria; Joint United Nations Program on HIV/AIDS (UNAIDS); United States Agency for International Development; and Office of the Global AIDS Coordinator at...
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- October 2022
- Article
It’s Not Just the Prices: Time-Driven Activity-Based Costing for Initiation of Veno-Venous Extracorporeal Membrane Oxygenation at Three International Sites—A Case Review
By: Michael Nurok, Vin Pellegrino, Marc Pineton de Chambrun, Jonathan Warsh, Meredith Young, Erik Dong, Neil Parrish, Syed Shehab, Alain Combes and Robert S. Kaplan
The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of extracorporeal membrane oxygenation (ECMO) for respiratory failure to estimate...
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- September 2022
- Article
Cost of Cardiac Stereotactic Body Radioablation Therapy versus Catheter Ablation for Treatment of Ventricular Tachycardia
By: Chen Wei, Michelle Boeck, Pierre C. Qian, Todd Vivenzio, Zoe Elizee, Jeremy S. Bredfeldt, Robert S. Kaplan, Usha Tedrow, Raymond Mak and Paul C. Zei
Cardiac SBRT is a novel way of treating refractory ventricular tachycardia (VT) that may be less costly than catheter ablation, owing to its noninvasive, outpatient nature. We applied time-driven activity-based costing to both procedures. The direct and total...
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- July, 2022
- Article
Telehealth Visits After Shoulder Surgery: Higher Patient Satisfaction and Lower Costs
By: Evan A. O'Donnell, Jillian E. Haberli, Andres Muniz Martinez, Daniel Yagoda, Robert S. Kaplan and Jon J.P. Warner
Purpose and Methods: The study compared the cost of telemedicine visits with in-person clinic visits for routine follow-up after common shoulder surgeries. It also evaluated the safety and patient experience with telemedicine visits. Time-driven activity-based costing...
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- May 2022
- Article
Variance Analysis: New Insights from Health Care Applications
By: Robert S. Kaplan and Susanna Gallani
We use a health care application to illustrate how variance analysis can be used to benchmark costs across similar service delivery sites. Variances for personnel costs, typically the largest cost component in service organizations, are calculated for price, quantity,...
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- February 8, 2022
- Article
Time-Driven Activity-Based Cost Comparison of Treating Five Acute, Low-Severity Conditions
By: Alan Yang, Andy Hung-Yi Lee, Joseph W. Kopp, Katherine D. Rose, Adam M. Licurse, Philip D. Anderson and Robert S. Kaplan
In 2017, patients made 145 million visits to emergency departments (EDs), generating $76.3 billion in charges. About a third of ED visits, however, were for conditions that were treatable in lower-resourced settings. We used time-driven activity-based costing (TDABC)...
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- Article
Costs Without Value When Treating Pediatric Behavioral Patients in the ED
By: Marcella Jewell, Syed S. Shehab, Robert S. Kaplan, Jack Fanton and Joeli Hettler
Pediatric Emergency Department (ED) visits have greatly increased in recent years. An academic pediatric ED that annually treats about 1,000 behavioral health patients conducted a study to assess the true cost of caring for nonacute behavioral health patients. It...
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- 2022
- Article
Improving Efficiency and Reducing Costs of MRI-Guided Prostate Brachytherapy Using Time-Driven Activity-Based Costing
By: Nikhil G. Thaker, Rajat J. Kudchadker, James R. Incalcaterra, Tharakeswara K. Bathala, Robert S. Kaplan, Ankit Agarwal, Deborah A. Kuban, Benjamin D. Frank, Prajnan Das, Thomas W. Feeley and Steven J. Frank
Integrated quality improvement (QI) and cost reduction strategies can help increase value in cancer care. We applied standard QI and TDABC methods to improve workflow efficiency and reduce costs for MRI-guided prostate brachytherapy. We constructed process maps,...
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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 July 2022)
- 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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