1. Value Improvement by Assessing IR Care via Time-Driven Activity-Based Costing
- Author
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Jörg Schlüchtermann, Moritz Wildgruber, Kristian Nikolaus Schneider, Walter Heindel, Michael Köhler, Philipp Schindler, and Max Masthoff
- Subjects
medicine.medical_specialty ,Time Factors ,Vascular Malformations ,Total cost ,Cost-Benefit Analysis ,Workload ,Radiography, Interventional ,Workflow ,030218 nuclear medicine & medical imaging ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,Cost Savings ,medicine ,Health insurance ,Humans ,Radiology, Nuclear Medicine and imaging ,Hospital Costs ,Activity-based costing ,Quality Indicators, Health Care ,Retrospective Studies ,Cost–benefit analysis ,medicine.diagnostic_test ,business.industry ,Treatment process ,Retrospective cohort study ,Interventional radiology ,Quality Improvement ,Cost reduction ,Outcome and Process Assessment, Health Care ,030220 oncology & carcinogenesis ,Emergency medicine ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care - Abstract
Purpose To evaluate time-driven activity-based costing (TDABC) in interventional radiology for image-guided vascular malformation treatment as an example. Materials and Methods Retrospective analysis was performed on consecutive vascular malformation treatment cycles [67 venous malformations (VMs) and 11 arteriovenous malformations (AVMs)] in a university hospital in 2018. All activities were integrated with a process map, and spent resources were assigned accordingly. TDABC uses 2 parameters: (i) practical capacity cost rate, calculated as 80% of theoretical capacity, and (ii) time consumption of each resource determined by interviews (23 items). Thereby, the total costs were calculated. Treatment cycles were modified according to identified resource waste and TDABC-guided negotiations with health insurance. Results Total personnel time required was higher for AVM (1,191 min) than for VM (637 min) treatment. The interventional procedure comprised the major part (46%) of personnel time required in AVM, whereas it comprised 19% in VM treatment. Materials represented the major cost type in AVM (75%) and VM (45%) treatments. TDABC-based treatment process modification led to a decrease in personnel time need of 16% and 30% and a cost reduction of 5.5% and 15.7% for AVM and VM treatments, respectively. TDABC-guided cost reduction and TDABC-informed negotiations improved profit from −56% to +40% and from +41% to +69% for AVM and VM treatments, respectively. Conclusions TDABC facilitated the precise costing of interventional radiologic treatment cycles and optimized internal processes, cost reduction, and revenues. Hence, TDABC is a promising tool to determine the denominator of interventional radiology's value.
- Published
- 2021