title: Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives.
abstract: OBJECTIVE
  To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors describe the implementation experiment, share lessons learned across the care continuum, and report how TDABC has actively engaged health care providers in costing activities and care redesign.
  
  
  METHODS
  After the selection of pilots in neurosurgery and urology and the creation of the TDABC team, multidisciplinary process mapping sessions, capacity-cost calculations, and model integration were coordinated and offered to engage care providers at each phase.
  
  
  RESULTS
  Reviewing the maps for the entire episode of care, varying types of personnel involved in the delivery of care were noted: 63 for the neurosurgery pilot and 61 for the urology pilot. The average cost capacities for care coordinators, nurses, residents, and faculty were $0.70 (range $0.63-$0.75), $1.55 (range $1.28-$2.04), $0.58 (range $0.56-$0.62), and $3.54 (range $2.29-$4.52), across both pilots. After calculating the costs for material, equipment, and space, the TDABC model enabled the linking of a specific step of the care cycle (who performed the step and its duration) and its associated costs. Both pilots identified important opportunities to redesign care delivery in a costconscious fashion.
  
  
  CONCLUSIONS
  The experimentation and implementation phases of the TDABC model have succeeded in engaging health care providers in process assessment and costing activities. The TDABC model proved to be a catalyzing agent for cost-conscious care redesign.
authors.affiliation: Departments of Neurosurgery.
authors.forename: Nancy
authors.initials: N
authors.lastname: McLaughlin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Burke
authors.forename: Nisheeta P
authors.initials: NP
authors.lastname: Setlur
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Niedzwiecki
authors.forename: Alan L
authors.initials: AL
authors.lastname: Kaplan
authors.forename: Christopher
authors.initials: C
authors.lastname: Saigal
authors.forename: Aman
authors.initials: A
authors.lastname: Mahajan
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kaplan
mesh_terms: D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D017050:Episode of Care; D006801:Humans; D019635:Neurosurgical Procedures / Q000191:economics*; D010559:Personnel Management / Q000191:economics; D010865:Pilot Projects; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D013997:Time Factors; D016526:Workload / Q000191:economics
keywords: BPH = benign prostatic hyperplasia; FTE = full-time equivalent; MVD = microvascular decompression; OR =operating room; TDABC = time-driven activity-based costing; cost; health care; process improvement; quality; redesign; time; value