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A new perspective on hospital financial ratio analysis.

Using audit financial data in a study of 2,189 not-for-profit hospitals for the period 1989-1992, six financial characteristics of performance were defined. These characteristics are profitability factor, fixed-asset efficiency, capital structure, fixed-asset age, working capital efficiency, and liquidity. The statistical output also shows the specific sets of financial ratios that can be used to measure the six characteristics of hospital performance. The results of this study can be beneficial to healthcare financial managers, hospital boards, policy groups, and other relevant entities because it affords them a clear understanding of an institution's financial performance.

Capital Financing↗

Developing reports.

The development and uses of reports for hospital pharmacy financial management are described. The source of the data and the availability, characteristics, and primary uses of each financial report are discussed. The reports deal with weekly, monthly, and fiscal-year-to-date drug expenses, monthly drug expenses by hospital cost center, monthly personnel expenses, and monthly revenue. Other reports that examine drug expenses, workload, and revenue in terms of patient days and number of hospital admissions are presented. A proposed drug use by diagnosis-related group (DRG) report is included. The development and use of hospital pharmacy financial reports will enhance the manager's ability to improve or maintain services.

Costs and Cost Analysis↗

Activity-based costing management in a private practice setting.

Activity-based costing is a method of calculating cost of a service, focusing on operations. It gives quick and tangible cost information to operations and financial managers. While this method has be used more in the manufacturing area, it is gaining acceptance in the medical practice. This article describes activity-based costing and illustrates how to start utilizing it in a practice.

Cost Allocation↗

Selling accounts receivable to fund working capital.

The sale of accounts receivable by hospitals and other healthcare providers--and the securing of those receivables--has been the subject of considerable recent discussion. New developments and revised analyses of the financial and legal aspects of the sale of receivables make a continuing review of this financial management tool advisable.

Accounts Payable and Receivable↗

H. Richard Nesson, MD.

When the Massachusetts General Hospital and the Brigham and Women's Hospital announced their plans to merge in 1994, the idea of two prestigious academic centers joining together was novel. Now, almost three years later the merged entity, Partners Health Care System, Inc., has become a model for many academic health centers seeking strength in a time of fiscal uncertainty. Richard Nesson, MD, began his relationship with Harvard in 1954 as an undergraduate and now as president of Partners he has the task of directing Harvard's two largest hospitals. Through solid strategic planning and financial management, Nesson has been able to effectively position Partners to respond to increasing managed care pressures. Interviewed at Partners' headquarters in the Prudential Building in downtown Boston, Nesson discussed the growing penetration of managed care in New England and the challenges of maintaining the multiple missions of academic medical centers in an increasingly financially-oriented market.

Academic Medical Centers↗

A review of 'The Health Security Act of 1993'.

The Health Security Act of 1993, which is now before Congress, holds the potential to effect major changes in the way health care is delivered in this country and in how that delivery is financed. This article reviews the principal provisions proposed to be contained in the act (as presented in the preliminary summary released in September 1993) and offers suggestions regarding the issues that hospital financial managers should begin addressing now.

Accounting↗

Master's degree-level community health nursing educational needs: a national survey of leaders in service and education.

This study identified the core components of the curriculum for master's degree-level community health nurses (CHNs) and assessed whether existing educational programs provide this knowledge base. According to 588 leaders in community health nursing (CHN) service and education, all master's degree-prepared CHNs require skills in the administrative role. Interdisciplinary core content areas needed to fulfill role responsibilities include a practicum experience; epidemiology; community health assessment and diagnosis; administration and management, including program planning and evaluation, financial management, budgeting, and quality assurance; research methods and biostatistics; health promotion and disease prevention; interventions at the aggregate level; and leadership theory. There were notable discrepancies between what was considered essential and what actually was included in CHN education. This article provides suggestions and possible alternatives for initiating change to ensure adequate educational preparation for graduate-level CHN practice.

Clinical Competence↗

Core curriculum for master's-level community health nursing education: a comparison of the views of leaders in service and education.

This study identified core components of the curriculum for master's-level community health nurses (CHNs) and assessed whether leaders in service agreed with leaders in education on the importance of these components. Through a mailed survey, 588 leaders in CHN service and education identified the following as the most important to include in the core CHN curriculum: a practicum experience; epidemiology; community health assessment and diagnosis; administration and management, including public health administration, management theory, program planning and evaluation, financial management and budgeting, and quality assurance; research methods and biostatistics; health promotion and disease prevention; intervention at the aggregate level; and leadership theory. These leaders also indicated that skills in both administration and direct care are essential for CHN practice. While there was remarkable agreement between service and education leaders in many areas, notable disagreements were seen in the importance accorded administrative skills. Service leaders rated these skills much more highly than did leaders in education.

Community Health Nursing↗

Physician relations programs can increase referrals.

A physician relations program can enhance an IDS's relationship with both staff and community physicians, leading to an increased referral base and improved physician satisfaction and productivity. A tactical plan is essential for developing such a program. In formulating its plan, the IDS should examine its goals and market opportunities with respect to physicians, as well as its current approach to physician relations and the current status of its relationship with physicians. The IDS then should create a new position for physician representatives to implement the tactical plan. Representatives may be charged with tasks such as increasing referrals to specific clinical services areas and developing relationships with physicians. The IDS's financial management should establish a baseline for financial returns to provide representatives with clear targets for increasing case volume and revenue.

Benchmarking↗

2000--the year of the "super CFO".

Just as the financial manager of today bears little resemblance to the hospital bookkeeper of 20 years ago, the CFO in the year 2000 will differ from today's CFO. In 2000 the CFO will have to be a combined expert in finance, economics, accounting, business law, health law and risk management, as well as people motivation. The evolutionary process will take the CFO through the hospital maze as we know it today, and on into the world of insurance, medical transportation and hotel management--possibly even shopping centers and spaghetti factories.

Administrative Personnel↗

Healthcare cost of risk initiative: preliminary findings.

The Cost of Risk Initiative, jointly sponsored by HFMA and MMI Companies, Inc., is designed to identify the cost of risk in health care organizations and to gather case study examples of best practices in the management of the cost of risk. The first phase of the ongoing initiative, a pilot study, was completed in 1995. Although response to the pilot study was low, and the findings therefore are not statistically significant, the study provides initial insight into the cost of risk and the extent to which the cost of each component of risk contributes to the total cost of risk in various types of healthcare organizations. The total cost of risk ranged from 1 percent to 12.5 percent of net patient revenues among study participants. The organizations with the greatest average cost of risk were medical group practices. Costs for employee benefits, professional and general liability, workers' compensation, and risk management administration contributed the most to the total cost of risk. Baseline studies that will be conducted later this year and longitudinal data to be collected over the next five years will provide more reliable data that healthcare financial managers can use to assess and improve risk management in their organizations.

Cost Allocation↗

Using FTE and RVU performance measures to assess financial viability of academic nurse-managed centers.

Financial performance measures are essential to improve the fiscal management of academic nurse-managed centers (ANMCs). Measures are compared among six ANMCs in a consortium and against an external, self-sustainable, profitable ANMC and national data for family practice physicians. Performance measures help identify a center's strengths and weaknesses facilitating the development of strategies aimed at a variety of targets (business practices related to revenue and costs) to improve financial viability. Using a variety of financial performance measures to inform decision making will aid ANMCs in keeping their doors open for business.

Academic Medical Centers↗

Creative leasing strategies for medical office buildings.

The financing and ownership of medical office buildings have changed along with their design and function. Once merely a convenience for the medical staff, medical office buildings are becoming an increasingly important part of a hospital's marketing and financial strategies. Understanding the economic evolution of these buildings will help hospital financial managers approach their development in a manner that will meet the needs of the future.

Financial Management, Hospital↗

Integrating clinical, financial information: improving patient management.

The need for integrated financial and clinical information is becoming increasingly important to financial managers and clinicians alike. Typical billing systems collect only a small amount of clinical information. But by using billing systems more creatively--superimposing a clinical classification system on a billing system--hospital managers could retrieve clinical information from the billing system without undergoing chart review. The hospital's largest database, its billing information, could be used to more efficiently manager patient care.

Abstracting and Indexing↗

Information technology needs for integrated delivery systems.

Financial managers of integrated delivery systems are becoming increasingly aware of the need to upgrade and improve their information technology strategies. Such improvements include moving toward a core-process focus that will enhance a system's ability to secure covered lives, manage risk and health status, and deliver high-quality care.

Delivery of Health Care, Integrated↗

Evolution of a cardiovascular information system.

The competitive nature of our evolving health care system mandates a concomitant increase in the level of sophistication of the cardiovascular information system. The new paradigms in health care also mandate a re-engineering of the process of data collection and analysis. This paper deals with a variety of hardware, software, and human issues encountered at our institution. Topics covered include implementation of service line management, utilization of an interdisciplinary medical informatics model, database conversion, and application development. Special attention will be paid to the development of a system which is a comprehensive information system for clinical and financial management of the cardiovascular patient, not just a quality-of-care database.

Cardiology Service, Hospital↗

Identifying and validating managed care data.

In a managed care organization, data can be the key to facilitating high-quality care and to managing patient care delivery systems effectively, in addition to monitoring costs. Reviewing electronic data requests before contacting data producers, asking the right questions about data, and knowing how to identify good data can help financial managers use data effectively to provide information. In the managed care environment, information is only as good as the steps taken to obtain and validate the data.

Accounting↗