medical director, acute pain medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston senior research data coordinator, The University of Texas MD Anderson Cancer Center, Houston project manager, reimbursement strategy, clinical revenue and reimbursement, The University of Texas MD Anderson Cancer Center; senior fellow, Harvard Business School, and professor emeritus, The University of Texas MD Anderson Cancer Center.
J Healthc Manag. 2018 Jul-Aug;63(4):e76-e85. doi: 10.1097/JHM-D-16-00040.
Pain control for patients undergoing thoracic surgery is essential for their comfort and for improving their ability to function after surgery, but it can significantly increase costs. Here, we demonstrate how time-driven activity-based costing (TDABC) can be used to assess personnel costs and create process-improvement strategies.We used TDABC to evaluate the cost of providing pain control to patients undergoing thoracic surgery and to estimate the impact of specific process improvements on cost. Retrospective healthcare utilization data, with a focus on personnel costs, were used to assess cost across the entire cycle of acute pain medicine delivery for these patients. TDABC was used to identify possible improvements in personnel allocation, workflow changes, and epidural placement location and to model the cost savings of those improvements.We found that the cost of placing epidurals in the preoperative holding room was less than that of placing epidurals in the operating room. Personnel reallocation and workflow changes resulted in mean cost reductions of 14% with epidurals in the holding room and 7% cost reductions with epidurals in the operating room. Most cost savings were due to redeploying anesthesiologists to duties that are more appropriate and reducing their unnecessary duties by 30%. Furthermore, the change in epidural placement location alone in 80% of cases reduced costs by 18%. These changes did not compromise quality of care.TDABC can model personnel costs and process improvements in delivering specific healthcare services and justify further investigation of process improvements.
控制接受胸外科手术的患者的疼痛对于提高他们的舒适度和术后功能恢复能力至关重要，但这会显著增加成本。在这里，我们展示了如何使用时间驱动作业成本法（TDABC）来评估人员成本并制定流程改进策略。我们使用 TDABC 来评估为接受胸外科手术的患者提供疼痛控制的成本，并估计特定流程改进对成本的影响。回顾性医疗保健利用数据，重点是人员成本，用于评估这些患者急性疼痛药物治疗整个周期的成本。TDABC 用于确定人员分配、工作流程更改以及硬膜外放置位置的可能改进，并对这些改进的节省成本进行建模。我们发现，在术前等候室放置硬膜外的成本低于在手术室放置硬膜外的成本。人员重新分配和工作流程更改导致在等候室放置硬膜外时平均成本降低 14%，在手术室放置硬膜外时成本降低 7%。大部分节省成本是由于将麻醉师重新分配到更合适的职责，并将他们的不必要职责减少 30%。此外，80%的情况下仅改变硬膜外放置位置就可降低 18%的成本。这些变化不会影响护理质量。TDABC 可以对提供特定医疗服务的人员成本和流程改进进行建模，并证明进一步调查流程改进是合理的。
