هزینه های تقسیم مطالعه سی تی: کاربرد TDABC (هزینه های مبتنی بر فعالیت زمان – متغیر) در یک مرکز علمی ثالثیه Dissecting Costs of CT Study: Application of TDABC (Time-driven Activity-based Costing) in a Tertiary Academic Center

The growing pressure to reduce the overall healthcare expenditure and to improve coordination of care has led to transformation of the Medicare payment model. The US Department of Health and Human Services announced the goal that 30% of Medicare payments are tied to alternative payment models by the end of 2016 and 50% by the end of 2018 (1). This value-based payment models reward quality and value of care over quantity of services, clearly shifting from the traditional fee-for-service model (1). Bundled payment, one approach of alternative payment models, facilitates improved coordination and integration of care and holds the provider team accountable for the full cycle of care to achieve better outcomes (2). The healthcare expense of medical imaging has dramatically increased over the past several decades (3,4). Most of the growth in imaging expenditures has been driven by increased utilization of advanced imaging, including computed tomography (CT), magnetic resonance imaging, and positron emission tomography (PET). Efforts to reduce healthcare costs have had impact on the reduction of imaging-related expense. For example, from 2009 to 2010, the imaging volume among Medicare beneficiaries declined by 3.5% (5). Nevertheless, as of June 2012, medical imaging remains 11.9% of the total Medicare charges (MedPAC Report on March 2014; www.medpac.gov). To contain potential overutilization and reduce healthcare expenditures (6), recent reimbursement models have shifted from the traditional fee-for-service toward bundled payments or capitation models, incentivizing physicians and hospitals to deliver more effective care and reduce wasteful practice. In shifting the financial risk from insurers or other payers to the hospitals and providers, imaging has a risk of transforming from a profit center to a cost center for the organization. Although decreased utilization is one approach to reducing imaging expenses, improving the efficacy of delivery to reduce costs of service is an alternative and complementary strategy (7). Under the healthcare payment transformation, accurate costing will be a critical competency to survive and thrive in the value-based payment models. Implementation of Value Driven Outcomes, a homegrown data analytic tool, was recently reported to reduce cost of care and improve quality by informing physicians’ actual costs of care, variations of costs among the care team, and quality measures (8). Abdomen and pelvis CT (AP CT) is one of the most frequently performed radiological examinations. For example, one study from integrated multispecialty group practice showed that AP CT represents 50% of all CT examinations (9). Utilization of AP CT is unlikely to decrease significantly as AP CT plays a central role in clinical diagnosis across a range of conditions, such as trauma, cancer, and acute abdomen. To reduce the costs of delivering this service, the specific components or cost drivers need to be understood (10). A cost accounting method known as time-driven activity-based costing (TDABC) provides an actionable process and costing data to redesign delivery of care effectively (10–۱۴). The following are the objectives of this study: (1) map the process for performing an AP CT study in an academic institution using the TDABC, (2) identify the component costs to conduct an AP CT, and (3) consider, in light of costing and process data, opportunities to reduce the costs of AP CT.