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The FASB explores accounting for future cash flows.

The FASB's Statement of Financial Accounting Concepts No. 7, Using Cash Flow Information and Present Value in Accounting Measurements (Statement No. 7), presents the board's views regarding how cash-flow information and present values should be used in accounting for future cash flows when information on fair values is not available. Statement No. 7 presents new concepts regarding how an asset's present value should be calculated and when the interest method of allocation should be used. The FASB proposes a present-value method that takes into account the degree of uncertainty associated with future cash flows among different assets and liabilities. The FASB also suggests that rather than use estimated cash flows (in which a single set of cash flows and a single interest rate is used to reflect the risk associated with an asset or liability), accountants should use expected cash flows (in which all expectations about possible cash flows are used) in calculating present values.

Accounts Payable and Receivable↗

Criminal probe.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

Employing the clinical service unit model.

Duke University Hospital has instituted a decision tool that enables administrators and medical directors to manage from both the operational (departmental) perspective as well as from the patient population perspective. The tool automates routine reporting, aligns business information with a new, cross-functional management structure, and provides a focus for improvement opportunities.

Financial Audit↗

Making the best of corporate integrity agreements.

Corporate integrity agreements (CIAs) imposed by the Office of Inspector General (OIG) of HHS have increased dramatically in the past five years. Healthcare organizations that enter into a CIA face burdensome monitoring and reporting requirements. However, it may be possible to lessen these burdens by negotiating modifications to the CIA's requirements. Organizations that have compliance programs in place can negotiate with the OIG to integrate elements of their existing compliance programs into the CIA. The organization also should attempt to negotiate limiting the scope of the monitoring to include only the area that was originally investigated. In addition, it may be valuable to negotiate insertion of a clause in the CIA allowing the organization to request renegotiation of the terms and duration of certain elements of the agreement after the first year, if conditions are met. An organized CIA negotiation process may be valuable in obtaining a reduced scope of the procedures required by the CIA and preparing the organization to meet its obligations.

Annual Reports as Topic↗

Improving IDS performance through group practice expense management.

IDSs can turn around an owned group practice's poor financial performance by taking steps to more effectively manage the practice's expenses. The primary areas on which an IDS should focus its expense-management efforts are physician compensation, nonprovider staffing, and facility planning. The physician compensation system, for example, should include incentives for physicians to improve performance and increase productivity, and the size of the nonprovider staff should be adjusted according to patient volumes. Other areas in which changes in strategy may be required include information system investments; budgeting, accounts-payable, and purchasing processes; and corporate allocations of practice revenues to recover practice acquisition costs.

Costs and Cost Analysis↗

Calculating five types of typical underpayments.

Underpayments to providers under their payer agreements are a cause of many thousands of dollars in lost revenue. Providers should devise a plan to make certain that payments made to them are accurate, on time, and adhere to other contractual obligations. The importance of developing and implementing such a plan is substantiated by the fact that nearly 100 percent of a provider's commercial business is under contract. As a starting point, providers may wish to focus on five common types of underpayments: underfunding due to late payments; fee-schedule changes that are contractually disallowed; miscalculation of performance-based bonuses and errors in risk-payment reconciliations; inappropriate denials or inappropriate downcoding of claims; and non-payments. The successful execution of a plan to identify and resolve problems and recover payments owed relies on the provider's ability to document and prove that payment is due.

Accounts Payable and Receivable↗

Preemptive financial strategies help IPAs avoid insolvency.

The 1999 collapse in California of practice management giants FPA Medical Management, Inc. and MedPartners, Inc. has caused healthcare provider organizations, particularly independent practice associations (IPAs), to examine critical issues related to financial solvency. Problems such as declining membership, ineffective management, weak contracting, and lack of strategic vision frequently are encountered by troubled provider organizations. The common thread that runs through IPA failures is a combination of unreliable accounting data and inadequate reporting systems. This lack of satisfactory financial and reporting information impairs the ability of the provider group to maintain sufficient funds to cover expenses and pay physicians. Successful, financially stable provider networks use well-defined reporting procedures based on fundamental accounting and financial concepts, as well as a sound methodology for measuring and calculating claims liability estimates. In California, new regulations aimed at encouraging provider organizations to assume preemptive financial strategies are in the process of being adopted. IPAs in every state should consider reviewing these regulations as benchmarks by which to assess their financial procedures.

Accounting↗

How to break even on an acquired primary care network.

Challenged by declining revenues, hospitals are taking steps to improve the financial performance of hospital-owned primary care group practices. Although some hospitals are divesting themselves of their group practices, others are attempting turn-around strategies to help them break even on their investment. Ensuring that expenses do not exceed revenues in a primary care network can be achieved by implementing initiatives on network-wide and practice site levels and may require draconian measures. By setting a financial target of break-even, primary care practices can experience dramatic improvements.

Decision Making, Organizational↗

Preparing for the inpatient rehabilitation PPS.

To assess the financial impact of the inpatient rehabilitation prospective payment system (PPS) on its future revenues, the MetroHealth Center for Rehabilitation (MHCR), Cleveland, Ohio, undertook a three-phase process using data from calendar year 2000 to estimate its potential profit or loss for each case-mix group (CMG) identified in the final rule. This process entailed developing a database to facilitate the combination and comparison of patient-charge and clinical data by CMG, using the combined data to estimate costs by cost center, and using payment information included in the final rule to estimate revenues by CMG. Following the assessment, the MHCR decided to expand the database to assist clinicians in making informed decisions in their patient-assessment and care-delivery processes that would account for cost and revenue considerations under the PPS.

Aged↗

AICPA allows low-cost options for compiled financial statements.

The AICPA Accounting and Review Services Committee's (ARSC) SSARS No. 8, Amendment to Statement on Standards for Accounting and Review Services No. 1, Compilation and Review of Financial Statements, issued in October 2000, allows financial managers to provide plain-paper, compiled financial statements for the exclusive use of management. Such financial statements were disallowed in 1979 when the AICPA issued SSARS No. 1, Compilation and Review of Financial Statements. With the issuance of SSARS No. 8, financial managers can prepare plain-paper, compiled financial statements when third parties are not expected to rely on the financial statements, management acknowledges such restrictions in writing, and management acknowledges its primary responsibility for the adequacy of the financial statements.

Accounting↗

"Must-know" legal issues for healthcare CFOS.

Healthcare financial managers are finding that regulatory agencies' customary focus on Medicare and tax-exemption concerns is shifting to other issues directly related to financial management. Regulatory agencies, such as the Securities and Exchange Commission, are scrutinizing not-for-profit and charitable trust law matters. Because of this renewed attention to existing regulations, healthcare financial managers need to increase their diligence in ensuring their organizations' compliance with those laws governing areas for which they traditionally have been accountable, including auditor relationships, restricted gifts, consulting arrangements, investment management, and financial reporting.

Charities↗