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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 | Journal of Medical Economics | Forthcoming

  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 (forthcoming). (Pre-published online March 4, 2019.)  View Details

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• Working Paper | HBS Working Paper Series | 2019

  Are ISS Recommendations Informative? Evidence from Assessments of Compensation Practices

  Ana Albuquerque, Mary Ellen Carter and Susanna Gallani

  Using detailed information on Institutional Shareholder Services (ISS) assessments of firms’ compensation practices, we examine whether these assessments identify poor compensation practices as measured by subsequent performance. While prior research provides consistent evidence of an association between shareholder voting outcomes and ISS recommendations, the evidence is mixed over whether their recommendations convey information about poor compensation policies. We find that ISS “Against” recommendations are associated with worse future accounting performance, consistent with ISS being able to detect suboptimal compensation packages. However, workload compression has an effect, as we find that the relation between assessments and future performance is stronger during off-season (for firms with non-December fiscal year end).

  Keywords: Proxy Advisors; CEO compensation; Say-on-Pay; Institutional Shareholder voting; Executive Compensation; Performance;

  Citation:

  Albuquerque, Ana, Mary Ellen Carter, and Susanna Gallani. "Are ISS Recommendations Informative? Evidence from Assessments of Compensation Practices." Harvard Business School Working Paper, No. 19-085, February 2019. (Please contact the authors to request paper file.)  View Details

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