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

Format:Electronic

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.