A multifactorial approach to understanding anesthesia selection.

A full hospital cost accounting model to track the total costs of surgery and anesthesia for inpatients, from the perspective of a hospital CFO, utilizing time-allocation methodology is presented. This model was tested in a prospective multicenter economic clinical trial in three settings.

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.

Variance analysis refines overhead cost control.

Many healthcare organizations may not fully realize the benefits of standard cost accounting techniques because they fail to routinely report volume variances in their internal reports. If overhead allocation is routinely reported on internal reports, managers can determine whether billing remains current or lost charges occur. Healthcare organizations' use of standard costing techniques can lead to more realistic performance measurements and information system improvements that alert management to losses from unrecovered overhead in time for corrective action.

Product line cost estimation: a standard cost approach.

Product line managers often must make decisions based on inaccurate cost information. A method is needed to determine costs more accurately. By using a standard costing model, product line managers can better estimate the cost of intermediate and end products, and hence better estimate the costs of the product line.

Principles and methods of managerial cost-accounting systems.

An introduction to cost-accounting systems for pharmacy managers is provided; terms are defined and examples of specific applications are given. Cost-accounting systems determine, record, and report the resources consumed in providing services. An effective cost-accounting system must provide the information needed for both internal and external reports. In accounting terms, cost is the value given up to secure an asset. In determining how volumes of activity affect costs, fixed costs and variable costs are calculated; applications include pricing strategies, cost determinations, and break-even analysis. Also discussed are the concepts of direct and indirect costs, opportunity costs, and incremental and sunk costs. For most pharmacy department services, process costing, an accounting of intermediate outputs and homogeneous units, is used; in determining the full cost of providing a product or service (e.g., patient stay), job-order costing is used. Development of work-performance standards is necessary for monitoring productivity and determining product costs. In allocating pharmacy department costs, a ratio of costs to charges can be used; this method is convenient, but microcosting (specific identification of the costs of products) is more accurate. Pharmacy managers can use cost-accounting systems to evaluate the pharmacy's strategies, policies, and services and to improve budgets and reports.

Pictures of performance: the key to improved nursing productivity.

A useful way to measure, track, and control nursing productivity is available, in addition to techniques for establishing productivity objectives and visualizing and displaying daily productivity performance. Many incentives for productivity improvement are available as well.

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.

Financial management and DRGs.

Healthcare providers face increasing financial risk as the federal government continues to refine the DRG-based prospective payment system. Healthcare providers that survive must establish systems that provide information in resource need, consumption and cost. The process illustrated in this article will help healthcare providers identify and establish the necessary systems.

Goal programming as a capital investment tool for teaching hospitals.

In order to be effective in today's complex environment, hospital management needs an orderly and rational method for balancing conflicting requirements.

Variance analysis. Using standards to predict nurse staffing patterns.

The use of standards to predict required nurse staffing patterns has received attention in recent years because of pressures for cost containment, revenue limitations and the increased availability of data. The establishment of a standard hour system can lead to a comparison of actual hours to the standard hours predicted and adjusted for case mix and changes in volume. The authors previously developed nurse staffing prediction models based on information from a 220-bed short-term hospital. Further study in terms of variance analysis (standard hours to actual hours) is explored in this article.

Managing rate adjustments by health care providers.

Health care managers must be prepared to assess the impact of changes in the environment that differ from the planning scenario used in developing the budget. Even though rate adjustments cannot now be made at frequent intervals for a variety of reasons like administrative actions, board policies and legal prohibitions, the effective administrator will be aware of the impact of infrequent adjustments. What we imply in this paper is that administrators must be able to assess the impact of cost and volume changes on the rate structure more frequently than once a year if timely decisions on rate adjustments are to be made. The model developed here offers a tool to aid decision makers in this task.