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Abstract：
A shift in healthcare payment models from volume toward value-based incentives will require deliberate input into systems development from both perioperative clinicians and administrators to ensure appropriate recognition of the value of all services provided-particularly ones that are not reimbursable in current fee-for-service payment models. Time-driven activity-based costing (TDABC) methodology identifies cost drivers and reduces inaccurate costing based on siloed budgets. Inaccurate costing also results from the fact that current costing methods use charges and there has been tremendous cost shifting throughout health care. High cost, high variability processes can be identified for process improvement. As payment models inevitably evolve towards value-based metrics, it will be critical to knowledgably participate in the coordination of these changes. This document provides 8 practical Recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI) aimed at outlining the principles of TDABC, creating process maps for patient workflows, understanding payment structures, establishing physician alignment across service lines to create integrated practice units to facilitate development of evidence-based pathways for specific patient risk groups, establishing consistent care delivery, minimizing variability between physicians and departments, utilizing data analytics and information technology tools to track progress and obtain actionable data, and using TDABC to create costing transparency.
摘要：
医疗保健支付模式从数量向基于价值的激励的转变将需要围手术期临床医生和管理人员在系统开发中的深思熟虑的投入，以确保适当识别所提供的所有服务的价值，特别是在当前的收费服务支付模式中无法偿还的服务。时间驱动的基于活动的成本计算（TDABC）方法根据孤立的预算确定成本动因并减少不准确的成本计算。不准确的成本计算还由于以下事实：当前的成本计算方法使用收费，并且在整个医疗保健中都发生了巨大的成本转移。成本高,可以识别高可变性过程以进行过程改进。随着支付模式不可避免地朝着基于价值的指标发展，知识渊博地参与这些变化的协调将是至关重要的。本文件提供了围手术期评估和质量改进协会（SPAQI）的8项实用建议，旨在概述TDABC的原则，为患者工作流程创建流程图，了解支付结构，建立跨服务线的医生联盟，以创建综合实践单元，以促进针对特定患者风险群体的循证路径的开发，建立一致的护理交付，尽量减少医生和科室之间的差异，利用数据分析和信息技术工具跟踪进度并获取可操作的数据，并使用TDABC创建成本计算透明度。
