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This article discusses techniques that healthcare financial managers can use to interpret and evaluate information from the statement of cash flows for more effective financial decision-making. The use of these techniques as a basis for systematically planning and controlling cash flows has the potential to benefit all healthcare organizations.
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This article discusses four major areas where healthcare financial managers can reconcile the conflicting goals their healthcare organizations face: keeping up with the latest in technology while at the same time constantly striving to reduce healthcare information systems costs.
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The Financial Accounting Standards Board (FASB) recently issued a new statement that requires all companies to change their methods of accounting for debt and equity securities. Rather than allowing organizations to use a historical cost approach in accounting for such financial instruments, FASB Statement No. 115 requires organizations to adopt a market value approach. The provisions of this statement will affect significantly organizations in the healthcare industry that have large investment portfolios.
A successful medical practice acquisition requires both the buyer and the seller to understand the complex legal and business issues that arise throughout the negotiation of the transaction. This article surveys the key issues involved in setting the purchase price, determining how that price will be paid, deciding whether to acquire assets or stock, establishing a physician employment agreement, and addressing the concerns of nonphysician staff.
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Operating margins for hospitals continue to shrink, making it increasingly difficult for hospitals to realize returns high enough to replace capital. Thus, accumulating capital through hospital earnings will continue to be difficult. Credit ratings will continue to drop as not-for-profit hospital operations remain marginal, making access to capital through debt markets more expensive. As a result, not-for-profit hospitals will need to develop creative ways of accessing capital through gifting programs. One such creative way is through the use of charitable remainder trusts--planned gifts that can take three to seven years to mature but can provide long-term-thinking hospital executives with an innovative source of capital.
Various models have been used to carry out medical practice acquisitions. Each model results in a different degree of integration between physicians and purchasing organizations, and all involve potentially detrimental legal and business issues to be resolved. This article describes six models of medical practice acquisition and the most common legal and business problems associated with valuing medical practices.
Subacute care programs serve patients who require less intensive care than traditional acute care, but more intensive care than traditional nursing home care. For hospitals, skilled nursing facilities, and other facilities, subacute care programs may be a means to better serve patients along the continuum of care while cutting costs and enhancing payment. Before launching a subacute care program, healthcare executives must determine potential benefits; payment mechanisms; equipment, space, and staffing requirements; and financial risks. With this knowledge, executives can make an informed decision about whether to develop a subacute care program.
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This study identifies a group of financially distressed hospitals and tracks them over time to identify the consequences of their financial distress and the factors that may precipitate different events. Of 2,547 that supplied complete financial data to the American Hospital Association for the period 1983-1985, a total of 340 community hospitals met our definition for distress. The most striking finding is that 91.2 percent of hospitals that were distressed in 1983-1985 survived through the end of 1990. Distressed hospitals also had significantly higher rates of system acquisition and merger, as well as higher rates of system divesture. Growing competition in a market appeared to be a major factor in the closure of a distressed hospital. The results of this study suggest that financially distressed hospitals have a remarkable resiliency that allows them to continue operation without dramatic change. This may be good news to local community officials concerned about maintaining financially weakened hospitals. Alternatively, it may be bad news if poor financial performance is a signal of unneeded capacity.
When a hospital's top executives engage in fraud, theft, and embezzlement, it can be one of the most unobtrusive and damaging crimes a health care institution can face. While, in the past, even incidents involving millions of dollars were covered up and often went unprosecuted, today the U.S. Attorney General is pursuing such crimes more vigorously because of the federal funds that can be involved. In this report, those involved in investigating and prosecuting executive-level fraud cases offer advice on what to watch for and how to protect your facility against these financially damaging crimes.
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To obtain cost data needed to improve managed care decisions and negotiate profitable capitation contracts, most healthcare provider organizations use one of three costing methods: the ratio-of-costs-to-charges method, the relative value unit method, or the activity-based costing method. Although the ratio-of-costs to charges is used by a majority of provider organizations, a case study that applied these three methods in a renal dialysis clinic found that the activity-based costing method provided the most accurate cost data. By using this costing method, healthcare financial managers can obtain the data needed to make optimal decisions regarding resource allocation and cost containment, thus assuring the longterm financial viability of their organizations.
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