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One area of internal analysis that has attracted increasing attention from healthcare managers is product line management. The coded data produced by the health information management professional is integrated with financial data to provide decision makers with valuable information about service quality and profitability.
The hospital financial manager must play an increasingly larger role in the development of overall hospital policy. Human resources, as well as physical assets and capital must be considered, and the financial manager needs to establish programs that not only create a sound economic base, but that also show management's commitment to people.
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For financial survival, hospitals must use a wide variety of methods, ranging from operational audits and profitability analyses to sharing and improved collection efforts.
As PPS and other fixed-price initiatives replace cost-based reimbursement in the hospital industry, the burden of assuming the risk for business success or failure shifts from the payor to the hospital. As a consequence, theories of risk to the business firm which have found application in other industries now deserve attention by hospital management. Incorporating such risk concepts into hospital strategies and actions requires a view of financial management that goes beyond the generally accepted accounting principles of managing and assigning costs for maximum revenue and profitability. This article examines the financial theory of risk in business firms, illustrates the various components of risk as they apply to a hospital business, and discusses how the hospital management strategies of cost-reduction, marketing, diversification, and multiorganizational affiliation can alter the risk characteristics of a hospital business.
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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.
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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