دانلود رایگان ترجمه مقاله کاربرد TDABC (هزینه های مبتنی بر زمان – فعالیت) – الزویر ۲۰۱۶
دانلود رایگان مقاله انگلیسی هزینه های تقسیم مطالعه سی تی: کاربرد TDABC (هزینه های مبتنی بر فعالیت زمان – متغیر) در یک مرکز علمی ثالثیه به همراه ترجمه فارسی
عنوان فارسی مقاله: | هزینه های تقسیم مطالعه سی تی: کاربرد TDABC (هزینه های مبتنی بر فعالیت زمان – متغیر) در یک مرکز علمی ثالثیه |
عنوان انگلیسی مقاله: | Dissecting Costs of CT Study: Application of TDABC (Time-driven Activity-based Costing) in a Tertiary Academic Center |
رشته های مرتبط: | حسابداری، حسابداری عمومی و حسابداری مالی |
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نشریه | الزویر – Elsevier |
کد محصول | F477 |
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بخشی از ترجمه فارسی مقاله: مقدمه مواد و روش ها |
بخشی از مقاله انگلیسی: INTRODUCTION 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. MATERIALS AND METHODS The study was exempt from an institutional review board approval at our institution. None of the authors had direct or indirect financial conflicts related to this study. Setting The setting is an urban level I trauma academic medical center. In the main general hospital, two state-of-the-art CT scanners are open and fully staffed 24 hours a day 7 days a week to accommodate outpatients (OP), inpatients (IP), and emergency department (ED) patients. Time-driven Activity-based Costing (TDABC) Detailed elsewhere (11,15), TDABC uses two proven management tools—process mapping from industrial engineering and activity-based costing from accounting (16). The process map outlines every step of the care process. For each step, the time to carry out each activity is estimated. Next, the costs of resources required for each step (15) are calculated by determining the cost per unit of capacity. By multiplying the cost per unit of capacity by the required task time for each step of the process and summing each component cost, the total cost of the process is estimated. The TDABC method uses a bottoms-up approach to measure the human and capital costs expended throughout an entire episode of care (11,17). Within healthcare, TDABC has been applied to several medical care pathways (18,19), including endoscopic sinus surgery (20), tonsillectomy (21), arthroplasty (22), head and neck surgery (23), heart valve surgery (13), anesthesiology care (14), and complex neurosurgery procedures (24). The team performing the TDABC for AP CT consisted of a business manager for the department of radiology, value (industrial) engineers, financial analysts, physicians, technologists, and the CT manager. A research team from Harvard Business School (D.H., R.K.) provided the process map template and guided the project. |