Time driven activity-based costing methods used in radiation oncology clinics.

Abstract

79 Background: Since 2010 The University of Texas MD Anderson Cancer Center (UTMDACC) has been using Time Driven Activity Based Costing (TDABC) to assist in tracking and quantifying changes made to clinical processes to improve efficiency of patient care delivery. Radiation Oncology (RO) providers have recently utilized this method to assist in the growing clinical patient volumes and increasing enrollment in clinical trials. UTMDACC contains disease specific multi-disciplinary centers with separate clinics for different disciplines. Resources are limited which can affect clinical providers’ ability to meet the needs of increasing patient volumes. Implementing efficient clinic work flow models will allow clinicians to provide excellent quality of clinical care even with limited resources. Methods: Standard disease-site specific note templates were created and implemented throughout the entire RO department. Additionally, standardized roles for medical assistants, residents, physician assistants (PAs), attending physicians and nurses were implemented to minimize duplication of responsibilities. Using TDABC methodology, process maps for pre and post implementation pathways were created to illustrate areas of change and possible benefit. Results: Process maps were compared for new consult and follow up and on treatment patient visits. Process times for these patient care visits were compared pre- and post-implementation of templates and clinical roles. Time savings of 110, 18 and 34 minutes were observed for consult visits, follow up visits and on-treatment visits when comparing current to baseline process maps. Conclusions: Standardization of note templates and roles for all members of the care team has led to improvements in process flow and efficiency in the RO clinic setting. Our findings suggest that further implementation of TDABC methodology by having all providers work at the top of their license could can improve clinical efficiency and patient care. Further metrics with a larger sample size is recommended to validate our results. [Table: see text]

Examining the Financial Impact of Altered Fractionation in Breast Cancer: An Analysis Using Time-Driven Activity-Based Costing

“…Since 2010, the University of Texas MD Anderson Cancer Center has used TDABC to enact changes in clinical processes and has been able to achieve time savings of 110 minutes for consultation visits, 18 minutes for follow-up visits, and 35 minutes for on-treatment visits. 22 One of the most significant limitations of TDABC is the temptation to compare estimated cost to real reimbursement. The total cost value calculated with TDABC is highly dependent on inputs to the model, including estimations of capacity and costs (eg, personnel, equipment) Differences in these inputs have led to significant variation in reported TDABC figures in the literature.…”