Publications

20 Nov 2020

Utilizing time-driven activity-based costing to determine open radical cystectomy and ileal conduit surgical episode cost drivers

by Janet Baack Kukreja, M.D., M.P.H.a,b, Mohamed A. Seif, M.D.a, Marissa W. Mery, M.D.c, James R. Incalcaterra, Ph.D.d, Ashish M. Kamat, M.D.a, Colin P. Dinney, M.D.a, Jay B. Shah, M.D.e, Thomas W. Feeley, M.D.f, Neema Navai, M.D.

                                 
                                          Objectives: Patients undergoing radical cystectomy represent a particularly resource-intensive
                                             patient population. Time-driven activity based costing (TDABC) assigns time to events
                                             and then costs are based on the people involved in providing care for specific events....

June 2021

The CMS New Rule on Ambulatory Surgical Centers Earns Only Partial Credit

by Junaid Nabi and Robert S. Kaplan

                                 
                                          The Centers of Medicare and Medicaid Services (CMS) recently announced that it will
                                             be removing more than 250 musculoskeletal surgeries from its “inpatient-only list”
                                             in January 2022. An additional 1,500 surgeries will be eliminated in the following
                                             year. The change...

01 Feb 2021

Health Care Measurements that Improve Patient Outcomes

by Robert S. Kaplan, PhD, MS, Lara Jehi, MD, MHCDS, Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, Andrea Pusic, MD, MHS, FACS, FRCSC, Mary Witkowski, MD, MBA

                                 
                                          This article describes the challenges and solutions in determining whether a patient’s
                                             treatment has been successful. Such an assessment depends on multiple factors, including
                                             the patient’s pretreatment status; the qualifications of personnel performing the
                                             treatment;...

01 Jan 2021

Integrated Practice Units: A Playbook for Health Care Leaders

by Michael E. Porter, PhD, MBA, Thomas H. Lee, MD, MSc

                                 
                                          The playbook for assembling and integrating a successful Integrated Practice Unit
                                             (IPU) features several key steps, including defining the patient condition or set
                                             of related conditions to be served, as well as defining patient needs across the care
                                             cycle and mapping...

01 Jul 2020

Assessing the Training Costs and Work of Diagnostic Radiology Residents Using Key Performance Indicators – An Observational Study

by Michael E. Porter, PhD, MBA, Thomas H. Lee, MD, MSc

                                 
                                          The playbook for assembling and integrating a successful Integrated Practice Unit
                                             (IPU) features several key steps, including defining the patient condition or set
                                             of related conditions to be served, as well as defining patient needs across the care
                                             cycle and mapping...

17 Jun 2020

Six Tests for Physicians and Their Leaders for the Decade Ahead

by Thomas H. Lee, MD, MSc, Toby Cosgrove, MD

                                 
                                          In the years immediately ahead, physicians and their leaders must move to a new level
                                             of health care in which they reliably deliver the performance that society needs.
                                             To enable and ensure success, significant changes will be required. A set of six tests
                                             for physicians...

June 2020

Are cost advantages from a modern Indian hospital transferable to the United States?

by F. Erhun, PhD, a,b R. S. Kaplan, PhD, c V. G. Narayanan, PhD, c K. Brayton, MD, JD, MS, a M. Kalani, MD, a M. C. Mazza, PhD, a C. Nguyen, MD, MS, a T. Platchek, MD, a B. Mistry, MD, MBA, c R. Mann, BA, a D. Kazi, MD, MS, d C. Pinnock, MD, MPH, a K. A. Schulman, MD, MBA, a J. Xue, MD, MPH, a D. Ballard, MD, MSPH, PhD, FACP, e M. Mack, MD, e B. James, MD, a,f G. Poulsen, MBA, f J. Punnen, MD, g D. Shetty, MD, g and A. Milstein, MD, MPH

                                 
                                          Rationale and Objectives: To quantify the costs and work of diagnostic radiology (DR)
                                             residents using the radiology key performance indicator turn-around time (TAT) as
                                             the outcome measure. Materials and Methods: In an Institutional Review Board-approved
                                             study, the...

April 2020
New England Journal of Medicine Catalyst

The Agenda for the Next Generation of Health Care Information Technology

by Thomas W. Feeley, Zachary Landman and Michael E. Porter

                                 
                                          As the diffusion of value-based health care efforts accelerates globally, the need
                                             for interoperable information technology systems that support value-based care is
                                             essential. A value-enabling IT platform must organize data around conditions.

February 2020

2020 TDABC Starter Kit

by Professor Robert Kaplan and Dr. Syed Shehab

                                 
                                          This article is designed for new partners to help initiate TDABC projects. It reviews
                                             the basic concepts of value-based health care and how a motivated team can undertake
                                             a cost measurement project in their own institution.

January 2020
Academic Medicine

Value Based Health Care in Undergraduate Medical Education

by Jessica Holtzman, Bhushan Deshpande, Jessica Stuart, Thomas W. Feeley, Mary Witkowski, Edward Hundert, and Jennifer Kasper

                                 
                                          The authors present a novel, VBHC curriculum integrated into a required course for
                                             post-core clerkship students—launched in 2018 at Harvard Medical School and taught
                                             in conjunction with Harvard Business School faculty—that highlights key principles
                                             of VBHC.

December 2019
Journal of Medical Systems

Using Time-Driven Activity-Based Costing to Demonstrate Value in Perioperative Care: Recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI)

by Olivia Allin, Richard D Urman, Angela F Edwards ,Jeanna D Blitz ,Kurt J Pfeifer, Thomas W Feeley, and Angela M Bader

                                 
                                          A shift in healthcare payment models from volume toward value-based will require deliberate
                                             input into systems development from both perioperative clinicians and administrators
                                             to ensure appropriate recognition of the value of all provided services.

November 2019
The Leapfrog to Value Initiative

Value-Based Care in Low and Middle Income Nations

                                 
                                          As the concept of value-based health care is rapidly diffusing world wide, this working
                                             paper demonstrates how low and middle income nations can embrace value-based care
                                             and accelerate universal health coverage.

November 2019
The Journal of Bone and Joint Surgery Reviews

A Review of Bundled Payments in Total Joint Replacement

by Olivia Manickas-Hill, Thomas W. Feeley, and Kevin J. Bozic

                                 
                                          Multiple pilot studies evaluating cost and quality using a bundled-payment model in
                                             joint replacement have demonstrated reductions in Medicare payments, primarily from
                                             decreased hospital LOS and post-acute care utilization.

October 2019
New England Journal of Medicine Catalyst

Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support

by Michael Nurok, Jonathan Warsh, Jeffrey Lopez, Mayumi Kharabi, and Robert S. Kaplan

                                 
                                          In this study the authors sought to apply a value (outcomes and cost) analysis to
                                             extracorporeal life support (ECLS), a relatively rare but very expensive ICU therapy
                                             with highly variable outcomes.

August 2019
Health Affairs

Navy Medicine Introduces Value Based Health Care

by Alee Hernandez, Robert S. Kaplan, Mary L. Witkowski, C. Forrest Faison and Michael E. Porter

                                 
                                          In 2016, the Surgeon General of the Navy launched a value-based health care project
                                             at Naval Hospital Jacksonville. The project’s goals were to demonstrate how a value
                                             approach could improve naval readiness and lower cost.

June 2019
JAMA Internal Medicine

Evaluation of Economic and Clinical Outcomes Under the CMS Mandatory Bundled Payments for Joint Replacements

by Derek A. Haas; Xiaoran Zhang; Robert S. Kaplan and Zirui Song

                                 
                                          A study of the initial results of the pilot of mandatory bundled payment for joint
                                             replacement in patients on Medicare.