Provide a clear recommendation(s) with action plan(s) for BCH. Provide a quantitative analysis to substitute your answer.

The Way Forward Meara, Waters and Shah met to review the ndings of their respective TDABC pilot projects. The studies had shown considerable differences between the costs and margins calculated by the TDABC approach and those produced by the Foundation's and hospital's existing cost systems. Dr. Meara and his team wondered about the causes of the discrepancies. As the discussion continued, Meara suddenly realized that one of his patients had failed to show for an appointment. He wondered whether he could measure the costs associated with these frequent \"no-shows.\" Shah and Waters confirmed that Orthopaedics also experienced scheduling and communication problems, especially when they received incomplete clinical information about a patient. For example, when the Emergency Department transferred a patient with a wrist fracture but with incomplete information on necessary X-rays or casting orders, patient service representatives, nurses and physicians in Orthopaedics had to make multiple phone calls to resolve the confusion. This was more likely to occur for complex patients or patients coming from distant locations. While the costs of incomplete information were not currently tracked, Shah noted that a preliminary TDABC analysis had showed about $100 of costs incurred to clarify the miscommunication whenever an X-ray was ordered with incomplete information. In addition, the patient experienced delays in trea'anent for the fracture. As the meeting closed, Meara re-stated his belief that innovative payment models could not be implemented with poor costing information: With reimbursement models, such as bundled payments, you will be burned if you don't know your costs. How can you offer a bundled all-in price if you don't know what your procedures truly cost and what drives those costs? Waters and Kasser contemplated how they could use bundled payments for fracture care: We would like to get to the point where we could negotiate with payors for a fair and competitive price for treating fractures in all our centers. Our goal would be to deliver high quality care, over the patient' 5 entire care cycle, with few complications, better outcomes for patients and overall lower cost for Massachusetts payors. As they prepared for an upcoming meeting of the Enterprise Costing Workgroup, a multidisciplinary team representing multiple hospital and clinical departments, Meara and Waters considered what to recommend. 11