Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery
Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery
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DOI：
10.1007/s11999-015-4214-0
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发表时间：
2016-01-01
影响因子：
4.2
通讯作者：
Bozic, Kevin J.
中科院分区：
文献类型：
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作者：
Akhavan, Sina;Ward, Lorrayne;Bozic, Kevin J.
传统医院成本核算系统的成本估算存在固有的局限性，限制了其对测量过程和质量改进的有用性。时间驱动作业成本法（TDABC）等较新的方法可能提供更精确的真实成本估算，但据我们所知，在关节置换手术中，这种TDABC与更传统的方法之间的差异尚未得到系统的探讨。（2）初次全膝关节置换术（TKA）;（3）采用TDABC与传统医院会计（TA）对三名外科医生进行全关节置换术（TJA）的评估（术前、术中和术后）由三级医疗中心的三名外科医生之一进行初次TJA的患者。每个护理阶段的人员成本使用TDABC基于满载劳动力率进行测量，包括医生补偿。与消耗品（包括植入物）相关的成本根据直接购买价格计算。在17个月（2012年1月至2013年5月）内汇总了677例初次TJA的总成本，并将其分为成本类别（食宿、植入、手术室服务、药物、用品、其他服务）。根据实际时间和资源使用强度，使用TDABC得出的成本与基于作业成本法的TA技术得出的成本进行了比较，间接成本计算为医院决策支持系统的直接成本的百分比。（12，982美元TDABC与23，915美元TA），初次TKA（13，661美元TDABC与24，796美元TA），以及所有三位外科医生单独进行的两种手术（THA：TDABC = TA总成本的49%-55%; TKA：TDABC = TA总成本的53%-55%）。成本类别与TA和TDABC估计之间的最大的变化是手术室服务和房间和board.Conclusions传统的医院成本核算系统高估了许多外科手术，包括主要TJA相关的成本。TDABC提供了与TJA相关的真实资源使用的更准确的度量，可用于识别可作为过程/质量改进目标的高成本/高可变性过程。证据等级III，治疗性研究。
Background Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery.Questions/purposes The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA).Methods Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system.Results Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost categories with the most variability between TA and TDABC estimates were operating room services and room and board.Conclusions Traditional hospital cost accounting systems overestimate the costs associated with many surgical procedures, including primary TJA. TDABC provides a more accurate measure of true resource use associated with TJAs and can be used to identify high-cost/high-variability processes that can be targeted for process/quality improvement.Level of Evidence Level III, therapeutic study.