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  • September 2016
  • Article
  • Healthcare: The Journal of Delivery Science and Innovation

Value Based Care and Bundled Payments: Anesthesia Care Costs for Outpatient Oncology Surgery Using Time-driven Activity-based Costing

By: Katy E. French, Alexis B. Guzman, Augustin C. Rubio, John C. Frenzel and Thomas Feeley
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Abstract

Background: With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of the costs of 11 common oncologic outpatient surgical procedures. Methods: Personnel cost was calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures. Using the anesthesia record, drugs, supplies and equipment costs were identified and calculated. The current staffing model was used to determine baseline personnel costs for each procedure. Using the costs identified through TDABC analysis, the effect of different staffing ratios on anesthesia costs could be predicted. Results: Costs for each of the procedures were determined. Process time and costs are linearly related. Personnel represented 79% of overall cost while drugs, supplies, and equipment represented the remaining 21%. Changing staffing ratios shows potential savings between 13% and 28% across the 11 procedures. Conclusions: TDABC can be used to estimate the costs of anesthesia care. This costing information is critical to assessing the anesthesiology component in a bundled payment. It can also be used to identify areas of cost savings and model costs of anesthesia care. Certified Registered Nurse Anesthetist (CRNA) to anesthesiologist staffing ratios profoundly influence the cost of care. This methodology could be applied to other medical specialties to help determine costs in the setting of bundled payments.

Keywords

Cost; Insurance; Health Care and Treatment; Insurance Industry; Health Industry

Citation

French, Katy E., Alexis B. Guzman, Augustin C. Rubio, John C. Frenzel, and Thomas Feeley. "Value Based Care and Bundled Payments: Anesthesia Care Costs for Outpatient Oncology Surgery Using Time-driven Activity-based Costing." Healthcare: The Journal of Delivery Science and Innovation 4, no. 3 (September 2016): 173–180.
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More from the Authors

    • November 2021
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    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
    • June 2021
    • Journal of Surgical Research

    Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative

    By: Casey J. Allen, Jarrod S. Eska, Nikhil G. Thaker, Thomas W. Feeley, Robert S. Kaplan, Ryan W. Huey, Ching-Wei D. Tzeng, Jeffrey E. Lee, Steven J. Frank, Thomas A. Aloia, Vijaya Gottumukkala and Matthew H.G. Katz
    • May 2021
    • European Urology

    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
More from the Authors
  • 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
  • Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative By: Casey J. Allen, Jarrod S. Eska, Nikhil G. Thaker, Thomas W. Feeley, Robert S. Kaplan, Ryan W. Huey, Ching-Wei D. Tzeng, Jeffrey E. Lee, Steven J. Frank, Thomas A. Aloia, Vijaya Gottumukkala and Matthew H.G. Katz
  • 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
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