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• Article | Journal of Medical Economics | 2019

  Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance

  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 management of anticoagulation therapy for outpatients in an academic primary care clinic setting, post-initiation of therapy.
  
  Methods: Time-Driven Activity-Based Costing (TDABC) was applied in a population-based cross-sectional study at Mayo Clinic’s warfarin anticoagulation clinic. The study measured the personnel and supplies costs to monitor and manage anticoagulation therapy for 5,526 patients.
  
  Results: The cost of warfarin management for patients who display unstable International Normalized Ratio (INR) is more than three times those who display stable INR over time. For complex anticoagulation patients, the total cost of medication and monitoring for warfarin anticoagulation therapy is similar to that for NOACs.
  
  Conclusion: Despite warfarin being significantly less expensive to purchase than NOACs, overall warfarin management incurs higher costs due to laboratory monitoring and provider time than NOACs. NOAC treatment, therefore, may not be more expensive than warfarin therapy management for complex anticoagulation patients.

  Keywords: Time-Driven Activity-Based Costing; Activity Based Costing and Management; Health Care and Treatment; Analysis;

  Citation:

  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.  View Details

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• Article | Mayo Clinic Proceedings: Innovations, Quality & Outcomes | March 2019

  A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes

  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 adult emergency department. A tablet-based time recorded was used to obtain estimates for physician documentation time on both control (no scribe) and intervention (scribe) shifts.
  
  Results: Control shifts yielded approximately 3 hours of documentation time per 8 hours of clinical time. When paired with a scribe, attending physician documentation decreased to 1 hour and 45 minutes during a shift and 15 minutes of post-shift documentation. The physician cost estimate for documentation without and with a scribe is 644 and 488 dollars, respectively.
  
  Conclusions: TDABC methodology demonstrated that scribes afford a cost-effective solution to ED clinical documentation. The costing approach enables clinicians to understand utilization and cost of medical resource at a more granular level.

  Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Analysis;

  Citation:

  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.  View Details

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• Article | Anesthesia & Analgesia

  Extracorporeal Membrane Oxygenation Appropriateness: An Interdisciplinary Consensus-Based Approach

  Robert S. Kaplan, Michael Nurok, Jonathan Warsh, Todd Griner, Mayumi Kharabi, Joseph Castongia, Cali Overbeck, Lisa Krueger, Bernice Coleman, Danny Ramzy, Joshua Chung, Alice Chan, Eric Ley, Sindhu Kubendran, Neil Parrish, Zhe Yu, Michael Landberg, Stuart Finder, Bradley T. Rosen, Harry Sax and Francisco Arabia

  We describe a quality improvement initiative aimed at achieving interdisciplinary consensus about the appropriate delivery of extracorporeal membrane oxygenation (ECMO). Interdisciplinary rounds were implemented for all patients on ECMO and addressed whether care was consistent with a patient’s minimally acceptable outcome, maximally acceptable burden, and relative likelihood of achieving either. The rounding process was associated with decreased days on venoarterial ECMO, from a median of six days in 2014 to 5 days in 2015 and in 2016.

  Keywords: Health Care and Treatment; Quality; Performance Improvement;

  Citation:

  Kaplan, Robert S., Michael Nurok, Jonathan Warsh, Todd Griner, Mayumi Kharabi, Joseph Castongia, Cali Overbeck, Lisa Krueger, Bernice Coleman, Danny Ramzy, Joshua Chung, Alice Chan, Eric Ley, Sindhu Kubendran, Neil Parrish, Zhe Yu, Michael Landberg, Stuart Finder, Bradley T. Rosen, Harry Sax, and Francisco Arabia. "Extracorporeal Membrane Oxygenation Appropriateness: An Interdisciplinary Consensus-Based Approach." Anesthesia & Analgesia 128, no. 3 (March 2019).  View Details

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