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Investing: reducing risks to enhance returns.

The financial assets of a healthcare organization can present many opportunities for investment. In order to develop a profitable investment program that avoids risky speculation, however, healthcare financial managers must fully understand the nature and risks of their organizations' investments. They must define and monitor their investment objectives, limitations, levels of acceptable risk and policies and conditions through a statement of investment policy and comprehensive investment guidelines.

Financial Audit↗

Corporate integrity agreements: making the best of a tough situation.

Healthcare providers increasingly are entering into corporate integrity agreements as part of settlements with the Federal government in fraud-and-abuse cases. Providers pursue these settlements to avoid the costs of defending themselves against fraud charges. However, the costs relating to the long-term compliance activity mandated in the settlement's corporate integrity agreement also can be substantial. These costs include significant staff resources that must be devoted to compliance efforts demanded by the agreement and the required engagement of consultants to monitor the organization's compliance. Healthcare financial managers should be familiar with the elements of a typical corporate integrity agreement and understand strategies for negotiating such an agreement. Effective negotiations can help minimize the organization's costs of compliance with the agreement and facilitate its ongoing implementation of the agreement.

Financial Audit↗

A guide to taxable debt financing alternatives.

The 1986 Tax Reform Act placed new restrictions on the use of tax-exempt financing for certain healthcare projects, and policymakers are considering further restrictions. In light of these developments, financial managers should become familiar with the available taxable debt financing options. These include commercial paper, taxable variable rate demand notes, floating rate notes, medium-term notes, long-term domestic public offerings, and domestic private placements.

Capital Financing↗

Healthcare finance and economics.

This article is a wide-ranging overview of the field of healthcare financing, health economics and the development of financial management. It vividly demonstrates that all healthcare systems have too many demands and too few resources, and that problems can manifest themselves in different forms depending on the precise funding structure of the health service concerned.

Cost Control↗

New healthcare price indexes aid financial analysis.

Two new price indexes are available for measuring healthcare inflation. One price index focuses on hospital care; the other focuses on physician services. Healthcare financial managers may find the new price indexes helpful when preparing and evaluating budgets, premiums, and capitation rates. Healthcare reform analysts may use the new price indexes to calculate premium caps, payment rates, and global expenditure limits.

Accounts Payable and Receivable↗

Is your hospital's tax-exempt status at risk?

The IRS has proposed changes to Section 501(c)(3) of the Internal Revenue Code that could affect the tax-exempt status of not-for-profit healthcare organizations. Healthcare financial managers should ensure that their organizations maintain compliance with the tax-exempt requirements and remain above reproach, particularly in the areas of: An organization's intent for public service. Implications of Section 4958 on the organization's tax-exempt status. Political activities. Operating an affiliated business.

Financial Management, Hospital↗

Optimize APC revenue with process-oriented assessments.

To maintain or improve revenue streams under the Medicare outpatient prospective payment system (PPS), healthcare financial managers should use a process-oriented approach to assess the effectiveness of revenue capture in departments most affected by the PPS's use of ambulatory patient classifications, which typically include the radiology, cardiology, and emergency departments. Such an assessment should be conducted by a multidisciplinary team with senior management support. The team ideally should include the CFO, COO, and leaders from the departments to be assessed. Such an assessment process should consist of five basic phases: chargemaster/charge-capture analysis, revenue-capture process assessment, claims review, development of implementation strategies, and monitoring.

Ambulatory Care↗

Steps toward an automated scorecard system.

An automated scorecard, a visual representation of process metrics, can help healthcare financial managers immediately identify trends against targets. Collaboration among all areas of the organization is essential in establishing a successful scorecard system. Essential considerations for implementing an automated scorecard system are: Clear metrics. Ownership and accountability for all metrics. Rapid feedback on performance. Collaboration. An open information culture.

Economics, Hospital↗

Family coping with the crisis of heart attack.

Forty families of patients who had suffered from their first heart attack were studied during the hospitalization and after discharge. Areas of family functioning examined were maintenance of the emotional health of family members, financial management, household management, and dealing with children and their needs. Impacts of this family crisis varied among these areas as well as over time. Families employed different sets of coping strategies in different areas of their life. Implications of these findings for social work intervention in such crises are discussed.

Crisis Intervention↗

Manufacturers, hospitals cooperate on imaging equipment acquisition.

In the past, some diagnostic imaging equipment manufacturers offered "boiler plate" financing strategies to healthcare organizations. Today, however, many employ representatives with backgrounds in finance and train them to work with hospitals to develop financing strategies appropriate for the organization. This consultive relationship allows equipment manufacturers to create customized financing plans to fit a hospital's individual needs. For example, radiologists and financial managers can now work with manufacturers' representatives to determine which imaging equipment would be the most appropriate and cost-effective for a particular hospital. Manufacturers' representatives also may consult with the hospitals' strategic planners to determine the most appropriate piece of equipment to buy and to arrange financing.

Capital Expenditures↗

Capitalizing strategic planning costs to recognize future value.

As healthcare organizations devote more resources to strategic planning, financial managers should consider capitalizing, rather than expensing, planning costs. Traditionally, healthcare organizations have absorbed these costs in the year a plan is developed. However, a strategic plan may be viewed as an intangible asset that provides the organization with future benefits. Therefore, its costs can be amortized over the plan's life.

Accounting↗

Watch for pitfalls of discounted cash flow techniques.

Discounted cash flow (DCF) techniques can enhance the effectiveness of a healthcare organization's capital budgeting decisions. But a financial manager unaware of common misapplications of DCF techniques may make capital decisions with a hidden bias against long-term projects, an inaccurate evaluation of options, or inappropriate estimations of expected inflation and risk. Social and psychological factors also can impede effective decisions on projects already introduced.

Accounts Payable and Receivable↗

Selecting an information system: a vendor talks back. Before you pick your partner, apply the right criteria.

Historically, the responsibility for selecting a healthcare information system was delegated to data processing or financial managers. In today's environment, however, the CEO's direct involvement in the selection process, rather than just review or approval, is imperative. How can you establish a partnership with your information system vendor? What are the steps for picking a Healthcare Information System (HIS) partner and laying the groundwork for successful system selection?

Commerce↗

Financing hospitals and clinical pharmacy services.

This article describes the existing health care operating environment and specifically details the reimbursement pressures within the hospital milieu. The paper outlines several financial management subjects that have special relevance to financing clinical pharmacy services. The process of developing new clinical pharmacy services which were subsequently approved for third-party payment is highlighted. The article optimistically concludes that new and extremely relevant clinically oriented pharmacy programs that offer valuable service to the patient population can be developed and implemented with approval for reimbursement.

Cost Control↗

Data collection and utilization: bringing physicians on board.

Healthcare financial managers can encourage the physicians in their organizations to help collect and utilize clinical and performance data in four ways. The data should be used to develop individual physicians' practice preferences by emphasizing patient outcomes. Modified treatment recommendations or protocols that rely on the performance data should be introduced as improvements to be adopted just as the physicians would alter practice behavior based on data published in medical journals. Physician advice and direction should be solicited about how to collect data and how best to use those data within the organization. Finally, physicians should be included in any financial benefits that result from successful data utilization.

Benchmarking↗

Calculating the economic impact of healthcare facilities on communities.

A methodology has been developed to calculate the direct, indirect, and induced spending effects of a healthcare facility on the community it serves. This methodology may be used by financial managers to produce data that demonstrate the effect of facilities on local economies. The data may be used by administrators to increase awareness of the pivotal economic role healthcare facilities play in communities among business and government leaders, economic development organizations, medical staff members, facility employees, trustees, and patients.

Accounting↗

Career path to CFO: selection, training, and placement.

Not long ago, chief financial officers (CFOs) in hospitals could focus almost exclusively on financial accounting. Today, however, financial managers must tend diverse tasks of coordination, education, and professional specialization. The authors suggest that those who desire the position of CFO would do well to couple accounting expertise with a capacity to understand ethics and mores, economics, descriptive and predictive statistics, people from diverse socioeconomic and cultural backgrounds, as well as features of disease, its prevention, and course of treatment.

Career Mobility↗