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PubMed1986

NPV vs. IRR: with capital budgeting, which do you choose?

The standard that defines quality health care rises as new technologies and procedures become available. To the health care financial manager, maintaining quality health care becomes a twofold problem--how to keep up with the latest developments while staying within budget guidelines. Two methods of analyzing capital expenditures are available to the financial manager, IRR and NPV. The latter is the safest and most reliable. NPV takes into account present market conditions and neither penalizes nor overly rewards either the buyer or seller of a particular project. This article is the first of a two-part series on capital budgeting in health care and takes the financial manager beyond the pure arithmetic of NPV and IRR to show the depth and meaning behind the arithmetic.

Accounts Payable and Receivable↗
PubMed1988

Living with the budget.

One of the traditional problems faced by radiology administrators is reconciliation of department expenditures with the department budget. While every department administrator had had experience in preparing budgets a few key points are worthy of review.

Budgets↗
PubMed1984

The missing links between planning and budgeting. Keys to survival in an era of entrepreneurialism.

For hospitals to survive the challenges of their turbulent environment, they must build stronger links between their planning and budgeting processes. Hospitals have traditionally experienced a gap between their long-range plans and short-range budgets. This article examines the scope, nature, and causes of this gap; clarifies the need to bridge this gap; and then discusses three major initiatives (missing links) to bridge the gap. Implications of these missing links for the hospital's board, physicians, managers, and systems are also described.

Budgets↗
PubMedDate not supplied

Coping with 1989's unfavorable capital-budgeting climate.

Lower inpatient revenues, higher costs, and dramatic changes in the health care environment are, combined, creating an unfavorable climate for new capital acquisitions. Yet techniques exist to aid CEOs in prioritizing their capital budgets; hospital associations could help, in other ways, to minimize costly technology-acquisition mistakes. Managing the 1989 capital budgeting process wisely will prepare hospitals for stiff competition in the 1990s.

Budgets↗
PubMed1977

Zero-based budgeting: implications for social services?

It is now fact that there is a commitment to the implementation of Zero-Based Budgeting (ZBB) at the federal level. In all likelihood, the adoption of the zero-based approach will have unique implications for the administration and administrators of social service agencies. The following article explores the impetus behind budgetary reform, with a primary focus on the current appeal of ZBB. The author strongly suggests that there are similarities between the now passé Planning, Programming, and Budgeting System and ZBB that permit inferences about any implementation difficulties that ZBB may experience. It is further suggested that ZBB will present social workers with situations and opportunities that will severely challenge many on their current approaches to social service administration.

Budgets↗
PubMedDate not supplied

Budget variance analysis using RVUs.

This article details the use of the variance analysis as management tool to evaluate the financial health of the practice. A common financial tool for administrators has been a simple calculation measuring the difference between actual financials vs. budget financials. Standard cost accounting provides a methodology known as variance analysis to better understand the actual vs. budgeted financial streams. The standard variance analysis has been modified by applying relative value units (RVUs) as standards for the practice.

Accounting↗
PubMed1999

How to develop a unit personnel budget.

To handle fluctuating patient census and acuity, it's imperative that nurse managers develop a fiscally responsible and workable personnel budget per assigned unit. This month, we take you back to the basics of how to develop a personnel budget.

Bed Occupancy↗
PubMed1999

The financial burdens of the Balanced Budget Act of 1997.

The Balanced Budget Act of 1997 (BBA) was signed into law on August 5, 1997 as Public Law No. 105-33. This single act introduced a revolutionary phase for the health care industry in the United States. It marked the beginning of momentous change to the overall health care coverage provided through the Medicare program. These changes, contained in the Balanced Budget Act, were intended to reduce substantially Medicare reimbursement, primarily to postacute care providers, including Certified Home Health Agencies. As a matter of fact, the Federal Register of August 5, 1999 states that "the intent of Section 4602 of the BBA is to control the soaring expenditures of the Medicare home health benefit that have been driven largely by increased utilization rather than price per visit."

Budgets↗
PubMed2000

Use of business planning methods to monitor global health budgets in Turkmenistan.

After undergoing many changes, the financing of health care in countries of the former Soviet Union is now showing signs of maturing. Soon after the political transition in these countries, the development of insurance systems and fee-for-service payment systems dominated the discussions on health reform. At present there is increasing emphasis on case mix adjusted payments in larger hospitals and on global budgets in smaller district hospitals. The problem is that such systems are often mistrusted for not providing sufficient financial control. At the same time, unless further planned restructuring is introduced, payment systems cannot on their own induce the fundamental change required in the health care system. As described in this article, in Tejen etrap (district), Turkmenistan, prospective business plans, which link planned objectives and activities with financial allocations, provide a framework for setting and monitoring budget expenditure. Plans can be linked to the overall objectives of the restructuring system and can be used to ensure sound financial management. The process of business planning, which calls for a major change in the way health facilities examine their activities, can be used as a vehicle to increase awareness of management issues. It also provides a way of satisfying the requirement for a rigorous, bottom-up planning of financial resources.

Budgets↗
PubMed1979

Programming, budgeting, and control in health care organization: the state of the art.

The planning, budgeting, and controlling processes (PBCP) largely subsume all of the planning and controlling activities of an organization. This paper discusses these activities within the context of a single management control system, focusing on three topics. First, a brief historical perspective of management concerns which relate to PBCP is presented and several important external pressures currently imposed on the health care industry are discussed. Second, normative models of the processes--programming, budgeting, and controlling--are presented. The discussion focuses on the elements and relationships of these processes, and numerous references to the literature are provided. Third, several issues related to the gap between the state of the art in PBCP for hospitals and the current state of practice are discussed.

Budgets↗
PubMed2002

Projecting the budget impacts of HIPAA.

Although the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was meant to simplify and reduce the cost of delivering health care, the initial steps to comply with all areas of the law are projected to be very costly. Healthcare organizations should take the time to figure the cost of HIPAA compliance into their budgets to avoid costly surprises as compliance measures are implemented. There are several steps a healthcare finance manager can take to manage budget expectations for HIPAA compliance.

Budgets↗
PubMed2001

Compatibility of household budget and individual nutrition surveys: results of the preliminary analysis.

The EU-supported project entitled: "Compatibility of household budget and individual nutrition surveys and disparities in food habits" aimed at comparing individualised household budget survey (HBS) data with food consumption values derived from individual nutrition surveys (INS). The present paper provides a brief description of the methodology applied for rendering the datasets at a comparable level. Results of the preliminary evaluation of their compatibility are also presented. A non parametric modelling approach was used for the individualisation (age and gender-specific) of the food data collected at household level, in the context of the national HBSs and the bootstrap technique was used for the derivation of 95% confidence intervals. For each food group, INS and HBS-derived mean values were calculated for twenty-four research units, jointly defined by country (four countries involved), gender (male, female) and age (younger, middle-aged and older). Pearson correlation coefficients were calculated. The results of this preliminary analysis show that there is considerable scope in the nutritional information derived from HBSs. Additional and more sophisticated work is however required, putting particular emphasis on addressing limitations present in both surveys and on deriving reliable individual consumption point and interval estimates, on the basis of HBS data.

Adolescent↗
PubMed2001

Methodological issues using household budget survey expenditure data for individual food availability estimation: Irish experience in the DAFNE pan-European project. DAta Food NEtworking.

OBJECTIVE: Irish participation in the EU-supported DAta Food NEtworking (DAFNE) project required compliance with the overall aims and objectives. The Irish Household Budget Survey (HBS) expenditure data had to be transformed into a format compatible with the collaborative effort, by converting them into quantities of foodstuffs available per person per day. SETTING: The Irish 1987 HBS expenditure data on all commodities for 7705 households in the Republic of Ireland, collected using a 14-day diary kept by all members of the household aged 15 years and over. DESIGN: Following identification of 188 food items in the HBS dataset, retail prices per unit weight were sought for each food. Adjustment of prices, collected from a number of different sources, was made to those of 1987 using the Consumer Price Index. Simple models were used to estimate household food availability through application of the adjusted retail prices per unit weight to the expenditure data. The household level data were converted to food availability per person per day. An internal validation of quantities estimated using the retail prices was made using the 12 foodstuffs for which the Irish HBS collects expenses and quantities. RESULTS: The comparison of quantities published by the Irish Central Statistics Office for 12 foodstuffs in the Irish 1987 Household Budget Survey with the quantities estimated using equivalent expenditure data and corresponding retail prices showed agreement, with less than a 10% margin of error for 10 of the foods. CONCLUSION: In spite some difficulty in converting HBS food expenditure data into food availability per person per day, the DAFNE approach is potentially useful for Irish nutrition surveillance purposes and for facilitating comparisons of the Irish HBS food data with those of other European countries.

Adolescent↗
PubMed2001

A preliminary assessment of the use of household budget survey data for the prediction of individual food consumption.

OBJECTIVE: To compare individualised household budget survey (HBS) data with food consumption values derived from individual nutrition surveys (INSs). SETTING: Four European countries: Belgium, 1980-85 and 1987-88; Greece, 1993-94; Norway, 1992-94; and the United Kingdom, 1985-88. DESIGN: Household budget survey data were individualised with non-parametric models. Individual nutrition survey data were converted into 'HBS-like' estimates, with the application of recipe-based calculations and yield factors for weight changes during food preparation. To correct for over- and underreporting or recording in both surveys, quantities (in g day(-1)) of 14 principal food groups were expressed as fractions of total food quantity (in g day(-1)). For each food group, INS and HBS-derived mean values were calculated for 24 research units, jointly defined by country (four countries involved), gender (male, female) and age (younger, middle-aged and older). Pearson correlation coefficients were calculated and correlation diagrams were drawn. CONCLUSION: The results of this preliminary analysis show that there is value in the nutritional information derived from HBSs. However, additional and more sophisticated work is required, in order to derive reliable point and interval estimates of individual food consumption based on HBS data.

Adult↗
PubMed2003

Priority setting in a Canadian surgical department: a case study using program budgeting and marginal analysis.

INTRODUCTION: A key mandate of Canadian regional health authorities is to set priorities and allocate resources within a limited finding envelope. The objective in this study was to determine how resources within a surgical program in a Canadian rural hospital might be reallocated to better meet the needs of the local community. METHODS: Early in 2001, at the Canmore General Hospital, Canmore, Alta., an expert-panel working group, consisting of a community health service leader, operating-room nurse clinician, acute care head nurse and a general surgeon, assisted by a research assistant and 2 health economists carried out a program budgeting and marginal analysis project to assess multiple data inputs into the decision-making process and to develop recommendations for service expansion and resource release. They considered the cost and benefits of altering the mix of resources used, based on Headwaters Health Authority activity and financial data, and local expert opinion. RESULTS: The primary recommendation was to implement an additional surgery day per week (38 days of major surgery and 12 days of minor surgery over a 50-week year). However, the total dollars to fund such an expansion could not be released from within the Canmore budget, and additional dollars were not forthcoming from the health region. A secondary objective of implementing an additional minor surgery day every 3 weeks was pursued and the required resources were obtained. CONCLUSIONS: Due to resource constraints in health care, efforts by both clinicians and administrators should be made to better spend available resources. The marginal analysis process used in this study served as a useful framework for priority setting, which is generalizable to other surgical and nonsurgical programs in Canada.

Alberta↗
PubMed2004

Dental school vacant budgeted faculty positions, academic year 2002-03.

The number of vacant budgeted full-time faculty positions has changed little over the last three years, standing in 2002-03 at 280. The number of part-time vacancies, though, has continued to decline to twenty-seven. The average number of vacancies per school was 5.7, down from 6.4 of the past several years. The average number of vacancies reported to be usual and normal at any one time was 3.6. Forty-three percent of the schools reported four or fewer vacant budgeted faculty positions in 2002-03. Overall, the order of primary disciplines by their number of vacancies varies from year to year; however, with no particular trend by discipline. Also there does not appear to be any significant correlation between discipline and the length of time a position has been vacant. Fifty-five percent of the vacant positions had been vacant less than seven months. Salary/budget limitations and lack of response to position announcements were the most frequently reported factors influencing the ability to fill a position. There were 921 reported faculty separations in 2002-03. Forty-six percent were a result of faculty leaving for private practice. The number of new faculty reported in 2002-03 was 1,231. Fifty-one percent of the new faculty came from private practice. The total number of faculty reported in 2002-03 was 357 more than reported in 2001-02. Rather than a perceived pending shortage of faculty, it may be more of an endemic number of vacancies due to the amount of time needed to fill a position. While there is no indication expressed in the survey that current vacancies are adversely affecting the quality of dental education, foresight, planning, and necessary steps need to continue to ensure the preparation and continuity of a dental workforce sufficient in size and expertise to meet the teaching, research, patient care, and administrative needs of the dental education community.

Budgets↗