Financial management issues. The DRG.
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Economical constraints within the health care system advocate the introduction of tighter control of costs in clinical laboratories. Detailed cost information forms the basis for cost control and financial management. Based on the cost information, proper decisions regarding priorities, procedure choices, personnel policies and investments can be made. This presentation outlines some principles of cost analysis, describes common limitations of cost analysis, and exemplifies use of software to achieve optimized cost control. One commercially available cost analysis software, LabCost, is described in some detail. In addition to provision of cost information, LabCost also serves as a general management tool for resource handling, accounting, inventory management and billing. The application of LabCost in the selection process of a new high throughput analyzer for a large clinical chemistry service is taken as an example for decisions that can be assisted by cost evaluation. It is concluded that laboratory management that wisely utilizes cost analysis to support the decision-making process will undoubtedly have a clear advantage over those laboratories that fail to employ cost considerations to guide their actions.
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Principles and Practices Board (P&P Board) Statement No. 2, issued in 1978, provided a basis for differentiating between charity service and bad debts. The statement acknowledged that, while the differentiation was helpful, the financial accounting and reporting of charity service and bad debts were the same. In 1990, the American Institute of Certified Public Accountants (AICPA) published (after review and approval by the Financial Accounting Standards Board and the Governmental Accounting Standards Board) an extensive revision of the guide titled "Audits of Providers of Health Care Services." The revised guide substantially changed the reporting of bad debts and eliminated charity service from revenue. Disclosure of the entity's policy for providing charity service and the level of charity service provided is required by the revised guide. The P&P Board decided that a substantive revision of its Statement No. 2 was required to bring it into conformity with the revised guide and to provide direction on implementation of the revised guide's requirements. This statement supersedes Statement No. 2 and deals with the same issues, including bad debts.
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Surveys of capital investment decisions have often neglected issues related to replacement of existing plant and equipment. As acute care hospitals experience declining inpatient utilization, appropriate hospital capital replacement becomes critical to efficiency and survival. Financial managers of 116 large, acute care hospitals were asked to rank factors that typically affect decisions to replace plant and equipment in their facilities. Factors influencing plant were expected to differ from those affecting equipment. The study found that replacements, particularly of equipment, are largely dictated by physicians, accreditors, and regulators. Rising operating costs and utilization were ranked as less important in replacement decisions. In light of impending health reform, these findings suggest that hospital executives need to reorder their replacement priorities to emphasize cost and efficiency.
Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to universities and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research.
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Hospital diversification and its impact on the operating ratio are studied for 62 New York hospitals during the period 1974-1979. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependent. Institutional diversification is found to yield better financial position, and the better operating ratio allows the institution the wherewithal to diversify. The impact of external government planning and hospital competition are also measured. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. These results should not be generalized beyond the New York State context. Restructuring of the organization, unrelated business ventures, and transactions with related organizations were not a problem in this sample. However, in 1983, many a new corporation is set up whose revenues do not become part of the hospital's and whose complex transactions conceal unallowable costs and maximize reimbursement. A number of hypotheses are advanced concerning hospital administrator's attitude toward risk.
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