Evidence-Based Experiences of Using Time-Driven Activity-Based Costing in Telemedicine-Based Health Care Delivery Protocols.

Background: In the era of value-based health care, maximizing health outcomes and minimizing costs require different value optimization strategies. To maximize value and ensure control of expenditure, time-driven activity-based costing (TDABC) is widely used in health care organizations. In our study, we examined the impact of telehealth technologies on value creation by using the TDABC approach. Methods: We mapped four pairs of (traditional and telemedicine supported) health care delivery processes in terms of time, resource use, and information flow. Data were collected from four sources: approved protocol descriptions, in-depth interviews with senior clinicians, a financial controlling database of unit costs, and additional comments from controlling experts. Results: We found that technological improvements do not necessarily increase the value of protocols. Of the protocols studied, two telemedicine protocols proved to be more cost-effective (80.37% and 45.29% compared with the originals). However, significant cost overruns were detected in two other telemedicine protocols (902.90% and 161.01%, respectively). An increased value could be detected only when the use of telemedicine technology resulted in greater savings in net human capacity compared with the additional expenditure related to telemedicine technology. Conclusions: We concluded that the use of telemedicine technology leads to modifications in protocols at numerous points, which have a significant impact on cost levels. It is not sufficient to examine only the costs of modified steps, as proposed in the TDABC methodology. Our study also suggests that a refined TDABC method is a potential tool for assessing the complex effects of technological change.