Hospital budget review: is there a better way?
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OBJECTIVE: This study explores the relationship between quality of care and investment in property, plant, and equipment (PPE) in hospitals. DATA SOURCES: Hospitals' investment in PPE was derived from audited financial statements for the fiscal years 1984-1989. Peer Review Organization (PRO) Generic Quality Screen (GQS) reviews and confirmed failures between April 1989 and September 1990 were obtained from the Massachusetts PRO. STUDY DESIGN: Weighted least squares regression models used PRO GQS confirmed failure rates as the dependent variable, and investment in PPE as the key explanatory variable. DATA EXTRACTION: Investment in PPE was standardized, summed by the hospital over the six years, and divided by the hospital's average number of beds in that period. The number of PRO reviewed cases with one or more GQS confirmed failures was divided by the total number of cases reviewed to create confirmed failure rates. PRINCIPAL FINDINGS: Investment in PPE in Massachusetts hospitals is correlated with GQS confirmed failure rates. CONCLUSIONS: A financial variable, investment in PPE, predicts certain dimensions of quality of care in hospitals.
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Despite its proliferation, we know relatively little about the impact of hospital restructuring to offer new services. This exploratory study examines the relationship between types of services offered and financial performance among separately incorporated subsidiaries of acute care hospitals. We draw data from the subsidiaries of all hospital firms operating in one state (Virginia) that requires reporting by all such firms. Results from multiple regression analyses of 1987 data indicate that units that existed longer, produced health care or related products, or were nonprofit subsidiaries of nonprofit firms tended to be more profitable than the other subsidiaries.
This article describes the rationale for accessing variable rate debt and the appropriate amount. It explores historical interest rate relationships and explains the motivation for incurring variable rate debt during certain interest rate environments. The article also explores the risks of variable rate debt and the liquid resources needed for prudent asset-liability management. Finally, the article outlines the financial statement impact of using variable rate debt.
As managed care pushes hospitals to redesign themselves into "integrated health care delivery systems," hospital executives are faced with "make or buy" decisions for a variety of alternate site care businesses. This article dissects the nuances of the buy option, which involves some rather subtle issues often new to most hospital-based executives.
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This review of the literature on environmental auditing and the potential role of accountants distinguishes between compliance audits and audits of the environmental management system. After an extensive introduction to the concept, this review focuses on the similarities and differences between an environmental audit and a financial statement audit. The general approach to both types of audits is similar, except that environmental audits are largely unregulated. Both audits place an emphasis on the evaluation of control systems, which is an argument in favor of external auditors playing a role in environmental audits. Another argument for including external accountants is their code of ethics. However, these professionals seem to be reluctant to enter the field of environmental auditing. It is argued that this reluctance is because of a lack of generally accepted principles for conducting environmental audits. If external accountants are engaged in environmental auditing, they should be part of multidisciplinary teams that also include scientists and engineers to avoid a too strong focus on procedures. Rather than treating these audits as totally different, it is proposed that there be a move towards integrated, or even universal, audits.