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Medicare changes create accounting, reporting, and auditing problems. Task Force on Federal Health Care Legislation, American Institute of Certified Public Accountants.

Hospital auditors and financial officers must adjust and react to the changing financial healthcare environment brought about by PPS. A close review of accounting systems, reporting methods, auditing procedures, and internal control systems should be made to determine that assets are safe-guarded and financial information is presented in conformity with GAAP. This article identified new problems and suggested solutions. Old tasks may no longer be necessary. For example, retroactive adjustments are not as important as they used to be. Estimates for capital and outpatient costs may continue to be required, but elaborate cost-finding techniques may no longer be necessary to estimate retroactive adjustments for reimbursable items. We recommend that prior to beginning an audit of a hospital's financial statements, each hospital's financial officers and its auditors discuss the possible accounting, reporting, and auditing implications as a result of PPS.

Financial Audit↗

Cost accounting for end-of-life care: recommendations to the field by the Cost Accounting Workgroup.

Accurate measurement of economic costs is prerequisite to progress in improving the care delivered to Americans during the last stage of life. The Robert Wood Johnson Excellence in End-of-Life Care national program assembled a Cost Accounting Workgroup to identify accurate and meaningful methods to measure palliative and end-of-life health care use and costs. Eight key issues were identified: (1) planning the cost analysis; (2) identifying the perspective for cost analysis; (3) describing the end-of-life care program; (4) identifying the appropriate comparison group; (5) defining the period of care to be studied; (6) identifying the units of health care services; (7) assigning monetary values to health care service units; and (8) calculating costs. Economic principles of cost measurement and cost measurement issues encountered by practitioners were reviewed and incorporated into a set of recommendations.

Accounting↗

The Medicare Cost Report and the limits of hospital accountability: improving financial accounting data.

Health policy makers, legislators, providers, payers, and a broad range of other players in the health care market routinely seek information on hospital financial performance. Yet the data at their disposal are limited, especially since hospitals' audited financial statements--the "gold standard" in hospital financial reporting--are not publicly available in many states. As a result, the Medicare Cost Report (MCR), filed annually by most U.S. hospitals in order to receive payment for treating Medicare patients, has become the primary public source of hospital financial information. However, financial accounting elements in the MCR are unreliable, poorly defined, and lacking in critical detail. Comparative analyses of MCRs and matched, audited financial statements reveal long-standing problems with the MCR's data, including major differences in reported profits; variations in the reporting of both revenues and expenses; an absence of relevant details, such as charity care, bad debt, operating versus nonoperating income, and affiliate transactions; an inconsistent classification of changes in net assets; and a failure to provide cash flow statements. Because of these problems, MCR financial data give only a limited and often inaccurate picture of the financial position of hospitals. Audited financial statements provide a more complete perspective, enabling analysts to address important questions left unanswered by the MCR data. Regulatory action is needed to create a national database of financial information based upon audited statements.

Accounting↗