Combining time-driven activity-based costing and lean methodology: an initial study of single-level lumbar fusion surgery to assess value-based healthcare in patients undergoing spine surgery

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  • 1 Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and
  • | 2 Department of Health Systems and Population Health, University of Washington, Seattle, Washington
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OBJECTIVE

Measuring costs across entire episodes of care, time-driven activity-based costing (TDABC) has recently been described as a novel cost accounting arm of value-based care organizations. Lean methodology is a system used to understand pathways of care at a granular level, allowing for standardization. The current work presents an attempt at combining the 2 methodologies to detect meaningful variation in a patient’s care following single-level spine fusion. The objective of this study was to evaluate the combination of TDABC and lean methodologies in detecting meaningful variability in time-based care in patients undergoing single-level spine fusion surgery.

METHODS

This study is a consecutive case series of patients who underwent single-level spine fusion performed by 1 of 5 fellowship-trained spine surgeons. Patients were diagnosed with either lumbar stenosis or spondylolisthesis. Additional inclusion criteria included inpatient stays from 1 to 3 days, discharge to home, and no readmission within 30 days of surgery. Patient demographic data were obtained. Time spent on activities for each personnel role was aggregated in 15-minute increments occurring preoperatively, intraoperatively, and postoperatively. Patients were analyzed in 3 groups based on the duration of their in-hospital stay.

RESULTS

Patients discharged on postoperative day (POD) 3 had statistically significantly more total time spent than those discharged on POD 2. Patients discharged on POD 1 had less total time than those in the former 2 groups. The amount of time spent with patients did not differ for personnel in either preoperative or postanesthesia care unit phases of care. There was a statistically significant difference in time spent in surgery for surgeons, anesthesia attendings, circulators, and scrub technicians.

CONCLUSIONS

In a healthcare setting run by lean methodology, TDABC may detect meaningful variability in an episode of care for single-level spine fusion. Clinicians and administrators can use this combination to allocate costs appropriately, optimize value care streams, and help improve patient care.

ABBREVIATIONS

ASA = American Society of Anesthesiologists; BMI = body mass index; NA-C = nursing assistant–certified; OR = operating room; PA-C = physician assistant–certified; PACU = postanesthesia care unit; POD = postoperative day; RN = registered nurse; TDABC = time-driven activity-based costing.

Supplementary Materials

    • Supplemental Fig. 1 (PDF 636 KB)

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  • 1

    Karhade AV, Bono CM, Makhni MC, et al. Value-based health care in spine: where do we go from here?. Spine J. 2021;21(9):14091413.

  • 2

    Sethi RK, Yanamadala V, Shah SA, et al. Improving complex pediatric and adult spine care while embracing the value equation. Spine Deform. 2019;7(2):228235.

  • 3

    Sethi R, Yanamadala V, Burton DC, Bess RS. Using lean process improvement to enhance safety and value in orthopaedic surgery: the case of spine surgery. J Am Acad Orthop Surg. 2017;25(11):e244e250.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Sethi RK, Pumpian RP, Drolet CE, Louie PK. Utilizing lean methodology and time-driven activity-based costing together: an observational pilot study of hip replacement surgery utilizing a new method to study value-based health care. J Bone Joint Surg Am. 2021;103(23):22292236.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Hwang RW, Golenbock SW, Kim DH. Drivers of cost in primary single-level lumbar fusion surgery. Global Spine J. Published online April 9, 2021.doi: 10.1177/21925682211009182

    • Search Google Scholar
    • Export Citation
  • 6

    Keel G, Savage C, Rafiq M, Mazzocato P. Time-driven activity-based costing in health care: a systematic review of the literature. Health Policy. 2017;121(7):755763.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Kaplan RS. Improving value with TDABC. Healthc Financ Manage. 2014;68(6):7683.

  • 8

    Yanamadala V, Kim Y, Buchlak QD, et al. Multidisciplinary evaluation leads to the decreased utilization of lumbar spine fusion: an observational cohort pilot study. Spine (Phila Pa 1976). 2017;42(17):E1016E1023.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Benton JA, Mowrey WB, De La Garza Ramos R, et al. A multidisciplinary spine surgical indications conference leads to alterations in surgical plans in a significant number of cases. Spine (Phila Pa 1976).2021;46(1):E48E55.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Ostadi B, Mokhtarian Daloie R, Sepehri MM. A combined modelling of fuzzy logic and Time-Driven Activity-based Costing (TDABC) for hospital services costing under uncertainty. J Biomed Inform. 2019;89:1128.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Radhakrishnan NS, Singh H, Southwick FS. Teaching novice clinicians how to reduce diagnostic waste and errors by applying the Toyota Production System. Diagnosis (Berl). 2019;6(2):179185.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Oetgen ME, Martin BD, Gordish-Dressman H, Cronin J, Pestieau SR. Effectiveness and sustainability of a standardized care pathway developed with use of lean process mapping for the treatment of patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2018;100(21):18641870.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Bradywood A, Farrokhi F, Williams B, Kowalczyk M, Blackmore CC. Reduction of inpatient hospital length of stay in lumbar fusion patients with implementation of an evidence-based clinical care pathway. Spine (Phila Pa 1976).2017;42(3):169176.

    • Search Google Scholar
    • Export Citation
  • 14

    Teisberg E, Wallace S, O’Hara S. Defining and implementing value-based health care: a strategic framework. Acad Med. 2020;95(5):682685.

  • 15

    Porter ME, Lee TH. From volume to value in health care: the work begins. JAMA. 2016;316(10):10471048.

  • 16

    Centauri F, Mazzocato P, Villa S, Marsilio M. System-wide lean implementation in health care: a multiple case study. Health Serv Manage Res. 2018;31(2):6073.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Khan RM, Albutt K, Qureshi MA, et al. Time-driven activity-based costing of total knee replacements in Karachi, Pakistan. BMJ Open. 2019;9(5):e025258.

  • 18

    Schroeder GD, Hilibrand AS, Kepler CK, et al. Utilization of time-driven activity-based costing to determine the true cost of a single or 2-level anterior cervical discectomy and fusion. Clin Spine Surg. 2018;31(10):452456.

    • Crossref
    • Search Google Scholar
    • Export Citation

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