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Publications

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    • All HBS Web  (210)
      • Faculty Publications  (109)

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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,...  View Details
      Keywords: Variance Analysis; Benchmarking; Time-Driven Activity-Based Costing; Health Care; Activity Based Costing and Management; Health Care and Treatment; Service Delivery; Service Industry
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      Kaplan, Robert S., and Susanna Gallani. "Variance Analysis: New Insights from Health Care Applications." Issues in Accounting Education 37, no. 2 (May 2022): 27–36.
      • 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)...  View Details
      Keywords: Time-Driven ABC; Health Care Costs; Activity Based Costing and Management; Health Care and Treatment
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      Yang, Alan, Andy Hung-Yi Lee, Joseph W. Kopp, Katherine D. Rose, Adam M. Licurse, Philip D. Anderson, and Robert S. Kaplan. "Time-Driven Activity-Based Cost Comparison of Treating Five Acute, Low-Severity Conditions." NEJM Catalyst (February 8, 2022).
      • 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...  View Details
      Keywords: Costs; Value; Healthcare; Health Care and Treatment; Cost Management
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      Jewell, Marcella, Syed S. Shehab, Robert S. Kaplan, Jack Fanton, and Joeli Hettler. "Costs Without Value When Treating Pediatric Behavioral Patients in the ED." NEJM Catalyst Innovations in Care Delivery 3, no. 2 (February 2022).
      • 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,...  View Details
      Keywords: Brachytherapy; Quality Improvement; Prostate; Time-Driven Activity-Based Costing; Cost Accounting; Health Care and Treatment; Performance Efficiency; Health Industry
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      Thaker, Nikhil G., 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. "Improving Efficiency and Reducing Costs of MRI-Guided Prostate Brachytherapy Using Time-Driven Activity-Based Costing." Brachytherapy 21, no. 1 (2022): 49–54.
      • 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....  View Details
      Keywords: Healthcare; Time-Driven Activity-Based Costing; Health Care and Treatment; Cost
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      Nagra, Navraj S., 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. "Time-Driven Activity-Based Costing in Breast Cancer Care Delivery." Annals of Surgical Oncology 29, no. 1 (January 2022): 510–521.
      • 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.  View Details
      Keywords: Time-Driven Activity-Based Costing; Implementation; Health Care and Treatment; Activity Based Costing and Management
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      Gallani, Susanna, and Gregory Sabin. "Successfully Implementing TDABC in Health-Care Provider Organizations." Cost Management 35, no. 6 (November–December 2021): 29–33. (Commissioned Article.)
      • 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
      Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Cost; Activity Based Costing and Management
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      McClintock, Tyler R., 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. "Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-driven Activity-based Costing." Urology 157 (November 2021): 107–113.
      • 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...  View Details
      Keywords: Time-Driven Activity-Based Costing; Cost Accounting; Health Care and Treatment; Health Industry; India; Nepal; United States
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      Xue, Jiayin, 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. "A Cost Comparison of Cataract Surgeries in Three Countries—United States, India, and Nepal." NEJM Catalyst Innovations in Care Delivery 2, no. 9 (September 2021).
      • 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)...  View Details
      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
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      Kaplan, Robert S., and Karthik Ramanna. "How to Fix ESG Reporting." Harvard Business School Working Paper, No. 22-005, July 2021.
      • 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’...  View Details
      Keywords: Health Care and Treatment; Outcome or Result; Cost Management; Activity Based Costing and Management; Mobile Technology; Health Industry; Boston
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      Kaplan, Robert S., Navraj S. Nagra, and Syed S. Shehab. "Brigham & Women's Hospital: Using Patient Reported Outcomes to Improve Breast Cancer Care." Harvard Business School Case 122-010, July 2021. (Revised October 2021.)
      • 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
      Keywords: Value-based Healthcare; Integrated Practice Units; Outcome Measurement; Time-Driven Activity-Based Costing; Health Care and Treatment; Value; Cost Management; Strategy; Outcome or Result; Measurement and Metrics
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      Reitblat, Chanan, 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. "Value-Based Healthcare in Urology: A Collaborative Review." European Urology 79, no. 5 (May 2021): 571–585.
      • 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...  View Details
      Keywords: Time-Driven Activity-Based Costing; Provider Cost; Health Care and Treatment; Cost Management; Activity Based Costing and Management; Zimbabwe
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      Chirenda, J., 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. "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." BMC Health Services Research 21, no. 242 (2021).
      • 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...  View Details
      Keywords: Time-Driven Activity-Based Costing; Value-based Health Care; Integrated Practice Unit; Health Care and Treatment; Cost Management; Performance Improvement
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      Kaplan, Robert S., Chris Hartnick, Mahek Shah, Steven M. Coppess, Alisa Yamasaki, Kaalan E. Johnson, Jeremy Prager, Christopher T. Wootten, Thomas Gallagher, and Evan Propst. "Assessing the Value of Pediatric Aerodigestive Care." NEJM Catalyst Innovations in Care Delivery 1, no. 4 (July–August 2020).
      • 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...  View Details
      Keywords: Family-centered Care; Value-based Healthcare; Time-Driven Activity-Based Costing; Health Care and Treatment; Value; Activity Based Costing and Management
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      Caloway, Christen, Alisa Yamasaki, Kevin M. Callans, Mahek Shah, Robert S. Kaplan, and Christopher Hartnick. "Quantifying the Benefits from a Care Coordination Program for Tracheostomy Placement in Neonates." International Journal of Pediatric Otorhinolaryngology 134 (July 2020).
      • 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...  View Details
      Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Cost; Organizational Structure; Performance Efficiency; India; United States
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      Kaplan, R. S., F. Erhun, V.G. Narayanan, B. Mistry, and K. Brayton, et al. "Are Cost Advantages from a Modern Indian Hospital Transferable to the United States?" American Heart Journal 224 (June 2020): 148–155.
      • 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...  View Details
      Keywords: Health Care and Treatment; Cost Management; Value; Analysis
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      Nurok, Michael, Jonathan Warsh, Erik Dong, Jeffrey Lopez, Mayumi Kharabi, and Robert S. Kaplan. "Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support." NEJM Catalyst (October 31, 2019).
      • 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...  View Details
      Keywords: Time-Driven Activity-Based Costing; Activity Based Costing and Management; Health Care and Treatment; Analysis
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      Kaplan, Robert S., Rohit A. Bobade, Richard A. Helmers, Thomas M. Jaeger, Laura J. Odell, and Derek A. Haas. "Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance." Journal of Medical Economics 22, no. 5 (2019): 471–477.
      • 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
      Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Analysis
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      Kaplan, Robert S., 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. "A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes." Mayo Clinic Proceedings: Innovations, Quality & Outcomes 3, no. 1 (March 2019): 30–34.
      • February 2019
      • Teaching Note

      Time-Driven Activity-Based Costing at Voray

      By: Ethan Rouen
      Teaching Note for HBS No. 119-033.  View Details
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      Rouen, Ethan. "Time-Driven Activity-Based Costing at Voray." Harvard Business School Teaching Note 119-077, February 2019.
      • September 2018 (Revised July 2019)
      • Case

      Time-Driven Activity-Based Costing at Voray

      By: Ethan Rouen
      Keywords: Cost Accounting; Time-Driven ABC; Entrepreneur
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      Rouen, Ethan. "Time-Driven Activity-Based Costing at Voray." Harvard Business School Case 119-033, September 2018. (Revised July 2019.)
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