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Recently the Department of Pathology, Cooper Medical Center, suffered a sudden reduction in its operating budget. Here the author explains the cause of the crisis and he outlines, for those whose laboratories may experience a similar cut in funds, the steps his department took to meet the reduction without decreasing significantly the laboratory services provided.
For the past few years, The Washington Hospital Center has had a prepaid obstetric clinic program for uninsured patients. Although the program was satisfactory, some deficiencies had developed. For example, research had shown a high correlation between a mother's lack of prenatal care and high healthcare expenditures. By implementing a new program that included financial incentives for various prenatal care programs, the hospital was able to financially break even with the old program, have a more predictable financial performance evaluation, and have healthier mothers and babies.
The 1980 literature on hospital financial management covered wide-ranging territory, from DRGs and reimbursement to capital management and competition. However, strategies for future survival remained unclear.
The effect of hospital reimbursement systems on the financial management of hospitals is briefly discussed, and the organization of hospital financial operations is reviewed. The implementation of Medicare prospective pricing will change the way in which hospital finances are managed. Health-care managers will be concerned with the profitability of product lines, or diagnosis-related groups, in future strategic planning efforts. The hospital's finance department consists of several traditional areas that exist in almost all financial organizations. The functions and interactions of these various areas are discussed in light of previous and current hospital reimbursement strategies. Staffing of the finance department and the duties of the hospital's chief financial officer are also described. The prospective pricing system of hospital reimbursement and increasing pressure from the business community to stem the rising costs of health care will produce changes in the medical and financial operations of the hospital industry over the next decade.
A descriptive case study with multiple sites and a single level of analysis was carried out in four purposefully selected administrative districts of Uganda to investigate the effect of financial management systems under decentralization on malaria control. Data were primarily collected from 36 interviews with district managers, staff at health units and local leaders. A review of records and documents related to decentralization at the central and district level was also used to generate data for the study. We found that a long, tedious, and bureaucratic process combined with lack of knowledge in working with new financial systems by several actors characterized financial flow under decentralization. This affected the timely use of financial resources for malaria control in that there were funds in the system that could not be accessed for use. We were also told that sometimes these funds were returned to the central government because of non-use due to difficulties in accessing them and/or stringent conditions not to divert them to other uses. Our data showed that a cocktail of bureaucratic control systems, corruption and incompetence make the financial management system under decentralization counter-productive for malaria control. The main conclusion is that good governance through appropriate and efficient financial management systems is very important for effective malaria control under decentralization.
One of the nurse executive's most important activities is responding to the new financial pressures in health care. Nurse executives can effectively address this concern through developing nurse managers' financial skills. Financial management seminars can be an effective way to address this development need. This article reports on a seminar in which managers are shown how they can best motivate staff nurses, and provide them with new tools and techniques to perform in a more cost-effective manner.
The authors describe integration of nursing informatics concepts and computer-based instructional strategies in a financial management course for graduate level nursing administration students. Major components include: 1) computer-based instruction for financial management theory; 2) spreadsheet used for decision support; 3) utilization of forecasting software; and 4) evaluation of learning involving computer use.
The changes and expansion in the nurse administrator role indicate a need for a specialized body of financial knowledge and skills for making system focused decisions that integrate the clinical and business aspects of healthcare. A survey of nurse administrators and chief executive officers showed high agreement on the important financial management concepts to the nurse administrator role. A graduate level financial management course that includes concepts for course content and practice applications is proposed.
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BACKGROUND: As funding sources diminish, it is critical for faculty members in primary care residency programs to better utilize available resources. The curriculum presented here, a practice management course for academicians, can provide fellows and new faculty with some of the budgeting and financial management skills necessary to perform in an academic environment. METHODS: The curriculum described is a 6-hour seminar series that relates essential budgeting and financial management concepts with academic practice. RESULTS: Pre- and postassessments displayed a statistically significant increase in the learner's fund of knowledge. One year after instruction, six of seven participants had used an aspect of the curriculum. All seven recommended its continuation. CONCLUSION: This curriculum should be considered for implementation in all fellowship programs that train future faculty.
To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs.
The continuous quality improvement (CQI) process can be a mechanism for balancing a healthcare organization's quests for quality and for profitability. This article explores the role healthcare financial managers can play in the CQI process, discusses how healthcare financial managers can champion a hospital's drive for quality, and presents some basic tools used in the CQI process.
The major purposes in this study were to develop a list of financial management competencies for entry- and advanced-level dietitians, determine hospital foodservice directors'/chief dietitians' (practitioners) perceived importance of these competencies at both levels of practice, and determine educators' perceived importance of these competencies at the entry level. Drawing from the literature and the judgment of eight experts, we developed a list of 50 financial management competencies. Written questionnaires that included importance scales for the competencies were mailed to (a) practitioners in a random sample of 1,500 member hospitals of the American Hospital Association and (b) directors of Plan IV/V, Approved Preprofessional Practice, and Dietetic Internship programs. Response rates were 34% for the practitioners and 47% for the educators. Practitioners rated 8 competencies as important or very important for entry-level dietitians and 26 as important or very important for advanced-level dietitians. Practitioners rated all competencies higher for advanced-level dietitians than for those at the entry level, and educators rated all competencies higher than did practitioners. Content areas, identified by factor analysis, were similar for both levels of practice. Our findings indicate that emphasis in undergraduate and practice programs should be given to the eight competencies identified by practitioners and educators as most important. Our results also may be used for development and evaluation of graduate and continuing education programs and for specialty certification in foodservice management.
PURPOSE: To explore three questions surrounding the financial management of research centers and institutes at U.S. medical schools: How do medical schools allocate institutional funds to centers and institutes? How and by whom are those decisions made? What are the implications of these decision-making models on the future of the academic biomedical research enterprise? METHOD: Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six medical schools, which can produce extrapolations to, but not necessarily generalizable findings to, other institutions and settings. RESULTS: An examination of four dimensions of financial decision-making-funding timing, process, structure, and culture-produces two essential models of how medical schools approach the financial management of research centers. In the first, a "charity" model, center directors make hat-in-hand appeals directly to the dean, the result of which may depend on individual negotiation skills and personal relationships. In the second, a "planned-giving" model, the process for obtaining and renewing funds is institutionalized, agreed upon, and monitored. CONCLUSIONS: The ways in which deans, administrators, department chairs, and center directors attend to, decide upon, and carry out financial decisions can influence how people throughout the medical school think about interdisciplinary and collaborative activities marshalled though centers and institutes.
A case-mix management system relies on the skills of physicians, nurses, and financial managers to devise cost effective treatment plans and product line initiatives. By merging financial and clinical data, one hospital used the approach to identify practice patterns that were inflating expenses. Its case-mix management program--which consists of presenting economic studies of certain cases, profiling physician practice patterns, and budgeting by product lines--is designed to conserve resources while ensuring quality care.
In addition to providing comparable and verifiable evidence regarding outcomes, clinical trials could also serve as sources of accurate and replicable financial information. Trial reports that identify expenses associated with effective diagnostic and therapeutic interventions enable cost controls. Standardized cost calculations could help clinicians and administrators identify more efficient health care technologies. Unfortunately, relatively few published trials include economic analyses and when they do, data are incomplete. Based on analyses of 97 clinical trial reports, this article proposes a standard costing format. Health care financial managers have the costing expertise necessary to implement and interpret standardized cost calculations for clinical trials. With the active involvement of financial managers, a standard costing format for clinical trials can be achieved.