An analysis of convalescent plasma unit cost calculation using time-driven activity-based costing (TDABC) method

Introduction: The viral pneumonia disease covid-19 is currently becoming a pandemic throughout the world due to SARS-CoV-2. With a lack of therapy choices for covid-19, convalescent plasma therapy was considered an emergency intervention in some countries. Convalescent plasma was, by unit cost, the most expensive service at the laboratory of Dolopo Hospital, thus easy, practical, and efficient calculation of unit cost was needed. This research aims to analyze the unit cost of convalescent plasma as calculated using the Time-Driven Activity-Based Costing (TDABC) method and to examine the difference between the unit cost of convalescent plasma calculated using the TDABC with the real cost at Dolopo Hospital. Methods: This qualitative research used a case study approach. The primary data were obtained through observation of convalescent plasma activity, and the secondary data were obtained through interviews related to the data of convalescent plasma cost. Results: The convalescent plasma unit cost calculated based on the TDABC method was IDR2,287,675 and on real cost was IDR2,250,000. The result of the calculation using the TDABC method was higher than the real cost calculation by IDR36.765. Conclusion: The research results showed that cost analysis using the TDABC method resulted in a more detailed and accurate calculation that the calculation was activity and time-based. © 2023, Sanglah General Hospital. All rights reserved.

Hospital at Home: Paying for What It's Worth

Am J Manag Care. 2021;27(9):369-371. https://doi.org/10.37765/ajmc.2021.88739 _____ Takeaway Points A framework centered around cost, quality, and equity is essential to define the value of hospital-at-home programs. * Validated disease-specific tools should be consistently used to measure process metrics, outcome metrics, quality-of-life measures, and caregiver satisfaction measures. * Equity-focused process metrics, care utilization measures, and risk-adjusted outcome metrics should be reported. * Total costs of care for hospital-at-home programs should be consistently measured through a time-driven activity-based costing method. * Personal, societal, technical, and allocative value should be considered when determining the value of hospital-at-home programs. _____ In recent years, home health care has grown to 3% of overall US health care spending.1 Investment in home health care delivery including telemedicine grew considerably during the COVID-19 pandemic.2 One area that has lagged in terms of growth has been the hospital-at-home model. For home health agencies (different from hospital-at-home programs, which provide more acute care services), CMS uses a more comprehensive Home Health Quality Reporting process to assess risk-adjusted process measures, outcomes measures, occurrences of adverse events, utilization of care measures, and cost measures.9 After the COVID-19 pandemic, similar reporting processes should be implemented for measuring the quality and outcomes of hospital-at-home programs. Because hospital-at-home programs share features of both inpatient hospital admissions and home health agencies, they are uniquely positioned to both treat the patient acutely and improve the living conditions and resources that led to the acute illness. The American Heart Association's Get With the Guidelines – Heart Failure, an in-hospital program, describes a comprehensive, robust set of quality measurements including process and outcome measurements for heart failure management.11 Process metrics include assessment of left ventricular ejection fraction, adherence to guideline-recommended medical therapy at discharge, and scheduled follow-up;process metrics correlate well to high-quality heart failure care.12 Outcome metrics include 30-day mortality and 30-day readmission rates.12 Although hospital-at-home programs have been associated with lower costs, these cost reductions are mostly due to reduced length of hospitalization,13 number of consultations,14 and clinical testing.13 It is yet unclear if the reduction in services utilized also leads to a reduction in value for the patient—either through fewer completed process metrics or significantly increased caregiver burden. Of 34 studies included in a meta-analysis comparing the costs of hospital at home with those of hospitalizations, 32 studies found hospital at home to cost less.3 For example, in a recent randomized controlled trial evaluating patients treated in a hospital-at-home program compared with those treated in a traditional hospital, the risk-adjusted cost reduction of home care management was 19%.15 In this trial, costs were calculated by summing the costs of labor, equipment, medications, laboratory tests, imaging tests, and transport during the period of hospitalization.15 In hospital-at-home models, cost savings are thought to be achieved due to reduced length of hospitalization,13 decreased number of consultations,14 reduced nursing labor costs,15 and decreased clinical testing.13 However, no uniform method exists to track and assess costs,16 and there is worry that the costs of hospital-at-home programs are underestimated.17 To fill this gap, these programs should report and analyze the total costs of care—including costs incurred by patients and their caregivers—rather than simply the reimbursement rates for care.

Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital.

BACKGROUND: The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. METHODS: This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. RESULTS: A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p <  0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient. CONCLUSIONS: This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.

Contribution of Continuous Virtual Monitoring to Hospital Safety, Quality, and Value of Care for COVID-19 Patients.

Introduction: The rapid onset of the COVID-19 pandemic increased hospital admissions and shortages for personal protective equipment (PPE) used to slow the spread of infections. In addition, nurses treating COVID-19 patients have time-consuming guidelines to properly don and doff PPE to prevent the spread. Methods: To address these issues, the Medical University of South Carolina repurposed continuous virtual monitoring (CVM) systems to reduce the need for staff to enter patient rooms. The objective of this study was to identify the economic implications associated with using the CVM program for COVID-19 patients. We employed a time-driven activity-based costing approach to determine time and costs saved by implementing CVM. Results: Over the first 52 days of the pandemic, the use of the CVM system helped providers attend to patients needs virtually while averting 19,086 unnecessary in-person interactions. The estimated cost savings for the CVM program for COVID-19 patients in 2020 were $419,319, not including potential savings from avoided COVID-19 transmissions to health care workers. A total of 19,086 PPE changes were avoided, with savings of $186,661. After accounting for cost of the CVM system, the net savings provided an outstanding return on investment of 20.6 for the CVM program for COVID-19 patient care. Conclusion: The successful and cost saving repurposing of CVM systems could be expanded to other infectious disease applications, and be applied to high-risk groups, such as bone marrow and organ transplant patients.

Comparison of the Unit Cost of Diagnostic Imaging Services Before and During the COVID-19 Pandemic Using the Activity-Based Costing (ABC) Method

Background: The consequences of coronavirus disease (COVID-19) pandemic, especially the financial burden imposed on the healthcare systems and hospitals, have been unpredictable around the world. Radiology wards have been exposed to the highest burden during this pandemic. Objective(s): This study aimed to calculate the cost of diagnostic imaging services before and during the COVID-19 pandemic, using the activity-based costing (ABC) method in an important diagnostic center of COVID-19 in Khorramabad, Iran. Patients and Methods: In this retrospective study, data were extracted from the hospital accounting sources in the radiology ward over two years (2019-2021). According to the ABC method, four types of cost were defined, including wage, supporting services, Consuming materials, and overhead expenses. Therefore, based on the monthly number of services, the unit cost of each service was calculated. Result(s): The unit cost of all services during the COVID-19 pandemic was higher than before, except for CT scan (before: 6.1 USD;during: 5.6 USD) (P = 0.008). The unit cost of MRI servicewas 5.7 USD before the pandemic and 7.1 USD during the pandemic (P = 0.57);the cost per radiography service was 1.8 USD before the pandemic and 7.1 USD during the pandemic (P = 0.01);and the cost per sonography service was 1.1 USD before the pandemic and 2.8 USD during the pandemic (P = 0.04). Finally, the cost of mammography increased dramatically during the pandemic (before the pandemic: 21.3 USD;during the pandemic: 48.2 USD) (P = 0.004). Conclusion(s): The COVID-19 pandemic has increased the radiology department expenses. The cost of CT scan services decreased due to the large number of services provided compared to the pre-pandemic period. Copyright © 2022, Author(s).

COVID-19 and hospital management costs: the Italian experience.

BACKGROUND: This article investigates the hospital costs related to the management of COVID-19 positive patients, requiring a hospitalization (from the positivity confirmation to discharge, including rehabilitation activities). METHODS: A time-driven activity-based costing analysis, grounding on administrative and accounting flows provided by the management control, was implemented to define costs related to the hospital management of COVID-19 positive patients, according to real-word data, derived from six public Italian Hospitals, in 2020. RESULTS: Results reported that the higher the complexity of care, the higher the hospitalization cost per day (low-complexity = €475.86; medium-complexity = €700.20; high-complexity = €1,401.65). Focusing on the entire clinical pathway, the overall resources absorption, with the inclusion of rehabilitation costs, ranged from 6,198.02€ to 32,141.20€, dependent from the patient's clinical condition. CONCLUSIONS: Data could represent the baseline cost for COVID-19 hospital management, thus being useful for the further development of proper reimbursement tariffs devoted to hospitalized infected patients.

Harmonizing ABC System with ERP System for Operational Effectiveness Improvement during Covid-19 Pandemic

Relying on modern technological systems has always been one of the most important means used to mitigate the negative effects of crises facing the economies of countries, especially if these systems are harmonized and integrated to achieve a competitive advantage for the company and improve operational effectiveness. The aim of this study is to measure the impact of harmonizing activity-based-costing system with enterprise resource planning in improving the operational effectiveness of manufacturing companies listed on the Amman Stock Exchange by implementing industry type as a mediating variable. In order to achieve the study objectives, a designed questionnaire was developed and distributed to specialists in the accounting department, enterprise resource planning system managers, and costing managers within the study population. The study revealed that industry type as a mediating variable has modified the role of enterprise resource planning system integration with the activity-based-costing system in improving operations effectiveness, especially in the food, supplies, and agricultural sectors, and it is recommended for managers to develop and improve their current systems by attracting software specialists to build the integration between information systems. © 2022 IEEE.

The French healthcare system and the health crisis: From disorganization to reorganization

This article describes the state of affairs in the French healthcare system before the SARS-CoV-2 pandemic and explains the logic behind the “reforms” of the last twenty years. We explain activity-based costing (T2A) and outline its origins, its advantages, and its limits within the context of spending restrictions called for by the National Health Insurance Expenditure Target (ONDAM). We then turn to the situation in psychiatry. The economic weight of psychiatry makes it necessary to regulate expenditure. However, the types of patient care involved in psychiatry conflict with the very logic of activity-based costing, since it is a medical activity that is inseparable from outpatient care as part of a patient care pathway. Our article then demonstrates the implications of the shift toward outpatient care and ambulatory healthcare pathways in the social, medico-social, and care sectors. What has taken place in psychiatry is used as an example to depict the complexities involved in this shift. This article then discusses the burden that this shift places upon carers, as we move from hospital care to care pathways, and from hospitals as producers of care to hospitals as a factor in the health of a population. Then, with emphasis on the great upheaval that the French healthcare system is currently undergoing, the article describes the adaptations that actors within the system are making in order to deal with the pandemic. It thus seeks to draw some lessons and perspectives from the health crisis. The article concludes on the importance of structuring care along a continuum, from general practitioner to hospital and back again, so as to provide continuity of care for the patient. © 2021 John Libbey Eurotext. All rights reserved. Cet article décrit la situation du système de santé avant l’épidémie de Sars-Cov-2. Il expose la logique qui sous-tend les « réformes» depuis 20 ans. La tarification à l’activité (T2A) est présentée en y retraçant sa genèse, ses avantages et ses limites dans un contexte d’un objectif national de dépenses d’Assurance maladie (Ondam) resserré. La situation en psychiatrie est alors décrite. Son poids économique oblige à en réguler les dépenses. Toutefois, les modalités de prise en charge des patients en psychiatrie entrent en conflit avec la logique même de la T2A car cette activité médicale ne peut pas se penser sans impliquer l’ambulatoire à travers un parcours de soins du patient. Cet article montre ensuite les implications du virage ambulatoire vers l’extrahospitalier et les parcours de santé en lien avec le social, le médicosocial et les aidants. L’expérience de la psychiatrie est prise en exemple pour en dépeindre les complexités. Cet article aborde alors la charge que ce virage engendre pour les aidants dans le système de soin, passage du soin hospitalier au parcours, passage de l’hôpital producteur de soins à l’hôpital élément de la santé d’une population. Puis, mettant en évidence un système de santé en pleine mutation, il relève les adaptations que les acteurs du système ont été capables d’entreprendre pour faire face à la pandémie. Il en dégage ainsi des enseignements et des perspectives de cette crise sanitaire. Cet article conclut sur l’importance d’une offre structurée suivant un continuum de soins du médecin généraliste à l’hôpital et inversement pour une continuité des soins pour le patient. © 2021 John Libbey Eurotext. All rights reserved.

A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical wards in Québec.

BACKGROUND: Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions (e.g., isolation, and donning and removing personal protective equipment) are keystones of infection prevention and control (IPC). There is a lack of rigorous IPC economic evaluations demonstrating the cost-benefit of IPC programs in general, and a lack of assessment of the value of investing in CBPs more specifically. OBJECTIVE: This study aims to assess overall costs associated with each of the four CBPs. METHODS: Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials (e.g. masks, cloths, disinfectants) required for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars ($). Sensitivity analyses were performed. RESULTS: A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 20 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21 cents per action, while cleaning of small equipment (N = 85) was 25 cents per action. Additional precautions median cost was $4.1 per action. The donning or removing or personal protective equipment (N = 720) cost was 76 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27 cents per action. CONCLUSIONS: The costs of clinical best practices were low, from 20 cents to $4.1 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.