Research management. U.S. rules on accounting for grants amount to more than a hill of beans.
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This is the third in a series of articles examining governance in Canadian hospitals. These articles draw upon experiences gained from operational reviews of hospitals across Canada to suggest approaches to building more effective hospital governance.
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Measures of reported self-confidence in performing financial analysis by 59 professional male analysts, 31 born between 1946 and 1964 and 28 born between 1965 and 1976, were investigated and reported. Self-confidence in one's ability is important in the securities industry because it affects recommendations and decisions to buy, sell, and hold securities. The respondents analyzed a set of multiyear corporate financial statements and reported their self-confidence in six separate financial areas. Data from the 59 male financial analysts were tallied and analyzed using both univariate and multivariate statistical tests. Rated self-confidence was not significantly different for the younger and the older men. These results are not consistent with a similar prior study of female analysts in which younger women showed significantly higher self-confidence than older women.
In this paper, we report results from the first study to systematically examine trends in the financial experience of hospitals with health maintenance organization (HMO) contracts. The longitudinal analysis (1990 through 1997) focused on hospitals in Florida. Hospital operating margins for HMO contracts grew tighter toward the end of the study period when the median margin was less than 1%. Teaching hospitals had operating margins that on average were below that of their nonteaching counterparts. The continued growth of HMOs and other managed care entities may have important implications for the future financial viability of U.S. hospitals.
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As capital sources dry up, hospitals should consider restructuring their finances to maximize the value of current assets, to achieve greater cost efficiency, and to fund new businesses and services that will generate new revenues. Strategic asset redeployment consists of analyzing assets; plans for new business development, equipment, and real estate acquisitions; and the impact on the budget. Hospitals are leasing more frequently to finance new equipment and property, but they are also looking at existing equipment and property to determine whether refinancing through a sale/leaseback makes sense. Also, before a hospital decides to offer a costly new service, such as magnetic resonance imaging, an impartial analysis should first determine the market for and the financial feasibility of the service. Once a service is determined to be viable, the term of the financing should match the life span of the project.
Previous studies of financial distress have utilized operating margins to measure this outcome. This study examines financial distress from the standpoint of cash flow, which is defined as net income plus depreciation adjusted for accruals. Defining financially distressed hospitals as ones with negative cash flows, the findings of the study show that these hospitals possess a lower occupancy rate, exhibit a slower collection of receivables, and have higher amounts of debt. However, the findings show that it is harder to predict financial distress defined in terms of cash flow than in profitability.
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Total financial management is a program designed by author Robert Katz, M.S., C.P.A., which says that by managing from the top down, the physician/administrator team can regain control of the practice and its major financial centers. His article describes the two-phased approach to total financial management.
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To comply with new accounting rules issued by the American Institute of Certified Public Accountants (AICPA), hospitals will have to change the way they report charity care in the financial statements they prepare for fiscal years ending mid-July 1991 and later. In the past, those hospitals which did report charity care information usually lumped it with bad debts under a caption such as "uncompensated services" or disclosed a specific amount of charity care to comply with Hill-Burton or other governmental programs. From now on, however, providers' financial statements must distinguish bad debt from charity care, not report gross patient revenues in the income statement, not imply that charity services generate revenue or receivables, make specific disclosures about the level of charity care provided, and report bad debts as an expense, rather than as a deduction from revenue. Distinguishing bad debts from charity care will be difficult. The AICPA defines bad debts as actual or expected uncollectibles resulting from an extension of credit, and charity care as services for which the provider does not expect payment. The AICPA believes that facilities which establish a definitive management policy on charity care should be able to distinguish between the two. To collect the data necessary to meet the AICPA requirements, hospitals need to establish a method to catalog the charity services they provide. Facilities should also ensure that patients and staff are familiar with their charity care policies.
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While the group that represents tax-exempt bond authorities would like to see that investors receive more financial information from hospitals, some of its members are fighting proposed disclosure guidelines because they're fearful the rules would swamp their staffs with added paperwork and other administrative burdens and, in some cases, even threaten their very existence.
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