Accounting for the costs of quality.

Total quality management (TQM) represents a paradigm shift in the organizational values that shape every aspect of a healthcare provider's activities. The TQM approach to quality management subscribes to the theory that it is not the work of employees of an organization that leads to poor quality; rather, it is the poor design of systems and procedures. In a book recently published by HFMA, Management Accounting for Healthcare Organizations, third edition, authors Suver, Neumann and Boles point out that the changes in behavioral focus and organizational climate brought about by TQM will have a major impact on management accounting function in healthcare organizations. TQM will require new methods of accounting that will enable the effects of declining quality to be recognized and evaluated. It also will require new types of management accounting reports that will identify opportunities for quality improvement and will monitor the effectiveness of quality management endeavors. The following article has been adapted from the book cited above.

Professionals earn Master's and maintain careers at same time.

To accommodate professionals who wish to further their education while meeting their career and family responsibilities, the University of Colorado at Denver and the Western Network for Education in Health Administration designed the Executive Program in Health Administration. A major portion of the program instruction is done through computer conferencing and both residential and nonresidential course work, with students attending on-campus classes for 11 weeks over a 25-month period. On completion of the Executive Program, students earn the master's of science and health administration degree. The students are assigned course work and tested by computer, which they use to talk with professors and form study groups with one another.

Resource measurement by health care providers.

The need to use health care resources effectively and efficiently has led to increased interest in developing a "should cost" approach to performance measurement. The development of appropriate standards and the separation of fixed costs into surrogate variable and capacity components can provide a useful tool for managers to measure performance. This article develops a framework for evaluating the utilization of fixed costs in providing output.

Data base management systems extend computer use.

A data base management system (DBMS) is a tool that can help the healthcare industry manage more information efficiently. This tool has the capability to store and retrieve data without the need for several programs or files. The DBMS is a sophisticated yet "user friendly" program that does not require any extensive computer training. In the age of microcomputers, the DBMS provides more power, eliminates seemingly unnecessary and repetitive work with data input, and falls within the budget range of most healthcare institutions.

Use of cost prediction simulation models for CON affordability review.

The relationship between capital costs and operating costs is being viewed as one of the driving forces behind the rampant inflation in health care costs. A cost prediction simulation model has been developed that can set affordability criteria readily implemented by CON review agencies.

A statistically based method for identifying hospital classification criteria.

The development of valid classification criteria for U.S. hospitals. A number of bills recently introduced in the U.S. Congress call for the linkage of classification criteria to cost limits for hospitals. Such proposals have not indicated how the classification criteria should be validated or tested.A research project was therefore undertaken to determine whether 87 large community hospitals could be classified into interpretable and reproducible homogenous groups. By means of an automatic interaction detector (AID), a set of unique classification criteria were identified. These included residency and internship education programs, medical school affiliation, renal dialysis, and organ bank facilities. Application of the criteria to 1970 and 1971 data for the 87 hospitals resulted in five reproducible and stable groups of hospitals. The criteria were validated by several tests involving different types of cost comparisons and ratios.The research results indicate that an AID-based classification structure is a feasible model for grouping or classifying large hospitals for comparative purposes. Only a small number of variables are necessary to classify large hospitals, and the criteria do not need to be overly complex. Many of the variables traditionally used may be omitted.

A computer simulation model of hospital mergers.

The results of a study and a computer model designed to predict the costs of a potential merger of three hospitals rely on a statistically based cost-prediction model. This model was adapted to reflect several different merger options, and the future costs of the three unmerged hospitals were simulated using a stochastic simulation model.

Should financial statements disclose the cost of replacing hospital assets?

The health care industry must do more than point fingers to convince outsiders that health care costs are not seriously out of line. Reporting replacement-cost information can help the industry identify the effects of inflation on hospital costs.

Consolidation of community hospitals.

The largest component of U.S. health care expenditures is the cost of hospital care. Evidence seems to indicate that community hospital costs can be reduced through the consolidation of some, or even all, hospital services. Although no discernible set of relevant minimal costs for the hospital industry has been established as yet, significant economies of scale can be attributed to the consolidation process. In addition to potential economic benefits, medical benefits can also accure to the community as well when inefficient, low-volume services are combined to provide more attractive resources to highly qualified specialists. Many independent community hospitals operate autonomously, often to the detriment of community health needs and economy. Those hospitals that fail to take advantage of the opportunities offered by consolidation may not be keeping faith with the population they claim to serve.