Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol

F.  Erhun; B.  Mistry; T.  Platcheck; A.  Milstein; V.G.   Narayanan; R. S. Kaplan

Article | BMJ Open

Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol

by F. Erhun, B. Mistry, T. Platcheck, A. Milstein, V.G. Narayanan and R. S. Kaplan

Abstract

Coronary artery bypass graft (CABG) surgery is a common treatment for coronary artery disease—a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32,000. The same operation reportedly costs less than $2000 to produce in India. The proposed study will (1) identify the difference in the costs incurred to perform CABG surgery at three Joint Commission accredited hospitals, two in U.S. and one in India, and (2) characterize the opportunity to reduce the cost of performing CABG surgery. We use time-driven activity-based costing (TDABC) to quantify the hospitals' costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labor and non-labor resources utilized to perform each activity) with the unit cost of each resource used to provide the care. We will conduct a variance analysis of labor costs to separate out price and quantity effects across the three hospitals to reveal opportunities to bend the cost curve for CABG production in the USA.

Keywords: Activity Based Costing and Management; Health Disorders; Health Care and Treatment; United States; India;

Format: Electronic

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Citation:

Erhun, F., B. Mistry, T. Platcheck, A. Milstein, V.G. Narayanan, and R. S. Kaplan. "Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol." BMJ Open 5, no. 8 (2015).

By mid-2016, five years of aggressive growth had transformed Fetchr from a small logistics startup to a 1,000-employee, full-fledged last-mile delivery company operating across four countries in the Middle East and North Africa (MENA). Already beneficiaries of the largest Series A round to the Middle East from an American firm, CEO Idriss Al Rifai and the Fetchr team had ambitions of raising another $40 million in Series B and deliberated continuing international expansion. But first, Al Rifai and his team needed to address the operational efficiency and profitability issues that led their investors to threaten the discontinuation of funding and put the company’s future at stake. The case provides background information on the logistics sphere in the Middle East and the challenges companies face in the region. The case then takes the reader through Al Rifai’s journey of founding and growing Fetchr, backed with innovations like their patented GPS-based delivery technology. Finally, the case zooms in on Fetchr’s management team as they race against time to perform evaluations of their operational efficiency, weigh cost-cutting options, and explore strategies to improve profitability.

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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Mahindra Finance is a non-banking lender operating mainly in the rural and semi-urban areas of India. Set up in 1991, the company had grown to become a market leader with assets of $8.5 billion and a presence in 3,30,000 villages across India. Since most of Mahindra's customers are occupied in farming or allied activities, they are reliant on India's erratic monsoons for their source of livelihood. In order to manage the credit risks associated with lending to such a group, Mahindra Finance has developed ways of diversifying its risks and dealing with bad debt. The case discusses Mahindra Finance's practices of how to manage credit risk, measure this risk, make appropriate provisions for this risk, and finally communicate the risk and its management to the capital markets.

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Time-driven Activity-based Costing of Multivessel Coronary Artery Bypass Grafting across National Boundaries to Identify Improvement Opportunities: Study Protocol

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