Advances in Value-Based Healthcare by the Application of Time-Driven Activity-Based Costing for Inpatient Management: A Systematic Review

Ana Paula Beck da Silva Etges; Karen Brasil Ruschel; Carisi Anne Polanczyk; Richard D Urman

doi:10.1016/j.jval.2020.02.004

Advances in Value-Based Healthcare by the Application of Time-Driven Activity-Based Costing for Inpatient Management: A Systematic Review

Value Health. 2020 Jun;23(6):812-823. doi: 10.1016/j.jval.2020.02.004. Epub 2020 May 26.

Authors

Ana Paula Beck da Silva Etges¹, Karen Brasil Ruschel¹, Carisi Anne Polanczyk², Richard D Urman³

Affiliations

¹ National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil.
² National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
³ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. Electronic address: rurman@bwh.harvard.edu.

PMID: 32540239
DOI: 10.1016/j.jval.2020.02.004

Abstract

Objectives: Implementation of value-based initiatives depends on cost-assessment methods that can provide high-quality cost information. Time-driven activity-based costing (TDABC) is increasingly being used to solve the cost-information gap. This study aimed to review the use of the TDABC methodology in real-world settings and to estimate its impact on the value-based healthcare concept for inpatient management.

Methods: This systematic review was conducted by screening PubMed/MEDLINE and Scopus databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all studies up to August 2019. The use of TDABC for inpatient management was the main eligibility criterion. A qualitative approach was used to analyze the different methodological aspects of TDABC and its effective contribution to the implementation of value-based initiatives.

Results: A total of 1066 studies were retrieved, and 26 full-text articles were selected for review. Only studies focused on surgical inpatient conditions were identified. Most of the studies reported the types of activities on a macrolevel. Professional and structural cost variables were usually assessed. Eighteen studies reported that TDABC contributed to value-based initiatives, especially cost-saving findings. TDABC was satisfactorily applied to achieve value-based contributions in all the studies that used the method for this purpose.

Conclusions: TDABC could be a strategy for increasing cost accuracy in real-world settings, and the method could help in the transition from fee-for-service to value-based systems. The results could provide a clearer idea of the costs, help with resource allocation and waste reduction, and might support clinicians and managers in increasing value in a more accurate and transparent way.

Keywords: TDABC; healthcare costs; microcosting; time-driven activity-based costing; value-based healthcare.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cost Savings
Costs and Cost Analysis / methods*
Delivery of Health Care / economics*
Fee-for-Service Plans / economics
Health Care Costs*
Humans
Inpatients
Resource Allocation / economics
Time Factors