Abstract
Background and Specific Aims: As healthcare institutions transition to value-based payment systems, there is an increasing need to identify the true costs of delivering health services. The costing methodology Time-Driven Activity-Based Costing (TDABC) was established in 2004 with the goal of quantifying the true cost and profitability of a service line or procedure, providing accurate data to support clinical and administrative strategic decisions. The primary objective of the current project was two-fold: to assess the feasibility of implementing TDABC and to determine the accuracy of the costing information provided by TDABC for autologous transplantation (ASCT) for patients with a diagnosis of multiple myeloma. We report results of a pilot study using TDABC to analyze the bone marrow aspirate and biopsy procedure (BMABx), a procedure completed for all patients prior to and during the ASCT process. Methods: The TDABC process involves five distinct steps, including identifying resources used for the specific procedure being reviewed, defining costs of each resource, estimating the practice capacity of the resources, calculating the cost of personnel per time unit, and determining the time units required for the procedure, which result in the calculation of cost per procedure. Results: Process maps were developed for ASCT and the BMABx. A comparative analysis of three distinct models of care delivery was done: 1. Physician (MD) model: entire procedure is completed by an attending physician (current clinical practice); 2. Advanced Practice Provider (APP) model: clinic staffed by APP who completes procedure; and 3. Joint model: MD and APP are present. Reimbursement according to payer mix was included in the analysis. Although the APP model led to reimbursement payment loss per procedure performed, it proved to be the most cost effective model of care. Furthermore, based on 2000 procedures/year, we estimated that switching to an APP clinic would free 500 hours of MD time/year (conservative estimate of approximately 50% of calculated time). Presentation of this research resulted in clinical practice change, with implementation of an APP model within the Adult Bone Marrow Transplant Service. Conclusions: TDABC can be implemented to evaluate clinical processes, and can result in practice change based on accurate cost data. This methodology and findings from this pilot study are being extended to study of the comprehensive ASCT episode of care.
