title: Increasing value in plagiocephaly care: a time-driven activity-based costing pilot study.
abstract: BACKGROUND
  Process management within a health care setting is poorly understood and often leads to an incomplete understanding of the true costs of patient care. Using time-driven activity-based costing methods, we evaluated the high-volume, low-complexity diagnosis of plagiocephaly to increase value within our clinic.
  
  
  METHODS
  A total of 59 plagiocephaly patients were evaluated in phase 1 (n = 31) and phase 2 (n = 28) of this study. During phase 1, a process map was created, encompassing each of the 5 clinicians and administrative personnel delivering 23 unique activities. After analysis of the phase 1 process maps, average times as well as costs of these activities were evaluated for potential modifications in workflow. These modifications were implemented in phase 2 to determine overall impact on visit-time and costs of care.
  
  
  RESULTS
  Improvements in patient education, workflow coordination, and examination room allocation were implemented during phase 2, resulting in a reduced patient visit-time of 13:25 (19.9% improvement) and an increased cost of $8.22 per patient (7.7% increase) due to changes in physician process times. However, this increased cost was directly offset by the availability of 2 additional appointments per day, potentially generating $7904 of additional annual revenue. Quantifying the impact of a 19.9% reduction in patient visit-time at an increased cost of 7.7% resulted in an increased value ratio of 1.113.
  
  
  CONCLUSIONS
  This pilot study effectively demonstrates the novel use of time-driven activity-based costing in combination with the value equation as a metric for continuous process improvement programs within the health care setting.
authors: From the *Department of Plastic and Oral Surgery, Boston Children's Hospital; †Harvard School of Dental Medicine; and ‡Harvard Medical School; and §Harvard School of Public Health, Boston, MA.
authors: Gino
authors: G
authors: Inverso
authors: Michael D
authors: MD
authors: Lappi
authors: Susan J
authors: SJ
authors: Flath-Sporn
authors: Ronald
authors: R
authors: Heald
authors: David C
authors: DC
authors: Kim
authors: John G
authors: JG
authors: Meara
mesh_terms: D001900:Boston; D017046:Cost Savings / Q000379:methods* / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010865:Pilot Projects; D059041:Plagiocephaly / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D017064:Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D013997:Time Factors