Effect of a Job Demand-Control-Social Support Model on Accounting Professionals' Health Perception.

The Job Demand-Control and Job Demand-Control-Support (JDCS) models constitute the theoretical approaches used to analyze the relationship between the characteristics of labor and occupational health. Few studies have investigated the main effects and multiplicative model in relation to the perceived occupational health of professional accountants. Accountants are subject to various types of pressure in performing their work; this pressure influences their health and, ultimately, their ability to perform a job well. The objective of this study is to investigate the effects of job demands on the occupational health of 739 accountants, as well as the role of the moderator that internal resources (locus of control) and external resources (social support) have in occupational health. The proposed hypotheses are tested by applying different models of neural networks using the algorithm of the Extreme Learning Machine. The results confirm the relationship between certain stress factors that affect the health of the accountants, as well as the direct effect that the recognition of superiors in occupational health has. Additionally, the results highlight the moderating effect of professional development and the support of superiors on the job's demands.

Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals.

STUDY OBJECTIVE: Recently, there has been interest in activity-based cost accounting for inpatient surgical procedures to facilitate "value based" analyses. Research 10-20years ago, performed using data from 3 large teaching hospitals, found that activity-based cost accounting was practical and useful for modeling surgeons and subspecialties, but inaccurate for individual procedures. We hypothesized that these older results would apply to hundreds of hospitals, currently evaluable using administrative databases. DESIGN: Observational study. SETTING: State of Texas hospital discharge abstract data for 1st quarter of 2016, 4th quarter of 2015, 1st quarter of 2015, and 4th quarter of 2014. PATIENTS: Discharged from an acute care hospital in Texas with at least 1 major therapeutic ("operative") procedure. MEASUREMENTS: Counts of discharges for each procedure or combination of procedures, classified by ICD-10-PCS or ICD-9-CM. MAIN RESULTS: At the average hospital, most surgical discharges were for procedures performed at most once a month at the hospital (54%, 95% confidence interval [CI] 51% to 55%). At the average hospital, approximately 90% of procedures were performed at most once a month at the hospital (93%, CI 93% to 94%). The percentages were insensitive to the quarter of the year. The percentages were 3% to 6% greater with ICD-10-PCS than for the superseded ICD 9 CM. CONCLUSIONS: There are many different procedure codes, and many different combinations of codes, relative to the number of different hospital discharges. Since most procedures at most hospitals are performed no more than once a month, activity-based cost accounting with a sample size sufficient to be useful is impractical for the vast majority of procedures, in contrast to analysis by surgeon and/or subspecialty.

Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery.

STUDY OBJECTIVE: Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital. DESIGN: Observational study. SETTING: State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. PATIENTS: Inpatients discharged with a major therapeutic ("operative") procedure. MEASUREMENTS: For each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month. MAIN RESULTS: Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (P<0.00001). Average percentage differences were insensitive to the endpoint, with similar results for the percentage of patient days and percentage of DRG case-mix weights. CONCLUSIONS: Approximately 2/3rd (mean 68%) of inpatient costs among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them.

Using Medical Informatics to Improve Clinical Trial Operations.

The continued escalation of clinical trial costs is becoming a public health concern. During the past decade, medical research funding peaked and there is growing concern that there may be insufficient resources to test many promising medical products. Recent changes in the regulatory environment create opportunities for the use of medical informatics to improve clinical trial operations and reduce costs. We report on a Medical Informatics Europe 2016 workshop conducted during the Health - Exploring Complexity (HEC) 2016 conference. We review presentation given on Secondary Data Use, eSource, and Data Quality in Clinical Trials and report on the workshop's discussions.

User's Satisfaction of Multiple Accounting Record System.

UNLABELLED: The study hospital had developed a multiple account recording system that generates the accounting information of the consumed materials based on daily nursing records. A questionnaire survey was delivered to further investigate the impact of the system. METHODS: Four concepts of the system were investigated. (1) Supportive and time saving; (2) impact on workflows and job satisfactions; (3) ease of use; and (4) overall satisfactions. RESULTS: The system scored 4.03 out of 5 as the highest for helpfulness for daily practices, 3.98 for decrease the time for recording material consumptions, 3.98 for actually changed the way they work. DISCUSSION: Users mostly expressed positive attitude towards the system.

Introdução à gestão de custos em saúde / Introduction to costs management in Health / Introducción a la gestión de costes en Salud

O exercício da gestão de custos no Sistema Único de Saúde (SUS) tornou-seimperativo em virtude da necessidade de garantir maior eficiência na aplicação dosrecursos e sustentabilidade do sistema.Recentemente, o Ministério da Saúde, o Conselho Nacional de Secretários deSaúde (Conass) e o Conselho Nacional de Secretarias Municipais de Saúde (Conasems)definiram que o desenvolvimento de metodologias, instrumentos e sistemas de informaçãopara a apuração de custos, que possibilitem estimar os recursos financeiros parao custeio global do SUS, é essencial ao aprimoramento da gestão interfederativa.Este reconhecimento revela o quanto a gestão de custos está sendo consideradaestratégica para os gestores do SUS, assim como a essencialidade da elaboração deferramentas, da formação de pessoas e do desenvolvimento de cultura organizacionalque favoreça a sua implantação.Nesse contexto, insere-se o Programa Nacional de Gestão de Custos (PNGC),um conjunto de ações que visam promover a gestão de custos, no âmbito do SUS, pormeio da produção, difusão e aperfeiçoamento de informações relevantes e pertinentesa custos, utilizadas como subsídio para a otimização do desempenho de serviços, unidades,regiões e redes de atenção em saúde do SUS...

Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals.

BACKGROUND: Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. METHODS: During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics--that is second- and third-generation cephalosporins, carbapenems, and quinolones--in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. RESULTS: Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval. CONCLUSIONS: There is a need for caution in interpreting pharmacy sales data aggregated over short registration intervals, especially so for oral formulations. Even a one-month registration period may be too short.

Comparison of incidence of hospital utilization for poisoning and other injury types.

OBJECTIVES: We investigated the incidence of hospital utilization for injuries and compared poisoning with other forms of injury. Previous studies have suggested poison control centers reduce health-care costs by decreasing hospital utilization. METHODS: We conducted a one-year retrospective study involving patients treated for injuries at acute-care hospitals in Kentucky in 2008. We also compared inpatient discharges with discharges directly from the emergency department (ED) to determine hospitalization rates. The primary data sources were the Kentucky Hospital Billing database and the Kentucky Regional Poison Control Center (KRPCC) database. RESULTS: In 2008, there were 377,642 hospital encounters for injuries in Kentucky. The most common mechanisms of injury were falls, struck by/against, motor vehicle traffic crashes, and overexertion. Three causes of injury were greater than one standard deviation above the mean in percentage of inpatient admissions: poisoning (41.3%), firearms (38.4%), and drowning (22.4%). During this same year, KRPCC reported 46,258 poisonings, with 76.5% of patients managed outside of a health-care facility, 11.4% of patients treated and released from the ED, 7.1% of patients admitted to inpatient care, 2.3% of patients admitted to psychiatric care, and 2.7% lost to follow-up. CONCLUSIONS: Three causes of injury had the greatest percentage of patients admitted for inpatient medical care--poisoning, firearms, and drowning--suggesting a high level of severity in these injuries presenting to the ED. We believe availability and use of a poison control center reduced hospital utilization for poisoning primarily by managing a large number of low-severity patients outside of the hospital system.

[Instruments of management accounting in german hospitals - potentials for competitive advantage and status quo]. / Der Einsatz von Controllinginstrumenten in Krankenhäusern - Erfolgspotenziale und Status quo.

AIM: The aim of this study is to provide an analysis of the status quo for the usage of instruments of management accounting in German hospitals. METHODS: 600 managing directors of German hospitals were asked to answer a questionnaire about the usage of management accounting instruments in their hospitals. We obtained 121 usable datasets, which are evaluated in this study. RESULTS: A significant increase in the usage of management accounting instruments can be observed over time. The respondents have an overall positive perception of the usage of these instruments. Cost accounting and information systems are among the most widely used instruments, while widely discussed concepts like the balanced scorecard or clinical pathways show surprisingly low usage rates.

Public accountants' field dependence: Canadian evidence.

The cognitive styles of 113 practicing, professional accountants from Nova Scotia, Canada were examined using the Group Embedded Figures Test. They completed a demographic survey for descriptive information as well as their rank in the firm and preferred area of professional practice. Analysis suggested professional accountants tend to be more analytical than intuitive in cognitive style and, consistent with recent findings in other fields, men and women in accounting do not appear to be different in cognitive style. No statistically significant differences were found on the embedded figures scores across ranks of trainee, manager, and partner or across select, preferred areas of professional practice.

A modified method of activity-based costing for objectively reducing cost drivers in hospitals.

OBJECTIVES: Activity-based costing (ABC) is widely used to precisely allocate indirect costs to medical services. In the ABC method, the indirect cost is divided among the medical services in proportion to the volume of "cost drivers", for example, labor hours and the number of hours of surgery. However, the workload of data collection of cost drivers can be time-consuming and a considerable burden if there are many cost drivers. The authors aim to develop a method for objectively reducing the cost drivers used in the ABC method. METHODS: In the ABC method, the cost driver is assigned for each activity. We assume that these activities and cost drivers are the best combination. Our method, that is cost driver reduction (CDR), can objectively select surrogates of the cost drivers for each activity in ABC from candidate cost drivers. Concretely, the total indirect cost of an activity is temporarily allocated to the medical services using each candidate of cost drivers. The difference between the costs calculated by each candidate and the proper cost driver used in ABC is calculated to evaluate the similarity by the evaluation function. RESULTS: We estimated the cost of laboratory tests using our method and revealed that the number of cost drivers could be reduced from seven in the ABC to four. Similarly, the results of cost estimation obtained by our method were as accurate as those calculated using the ABC. CONCLUSIONS: Our method provides two advantages compared to the ABC method: 1) it provides results that are as accurate as those of the ABC method, and 2) it is simpler to perform complicated estimation of hospital costs.

The relative value of growth.

Most executives would say that adding a point of growth and gaining a point of operating-profit margin contribute about equally to shareholder value. Margin improvements hit the bottom line immediately, while growth compounds value over time. But the reality is that the two are rarely equivalent. Growth often is far more valuable than managers think. For some companies, convincing the market that they can grow by just one additional percentage point can be worth six, seven, or even ten points of margin improvement. This article presents a new strategic metric, called the relative value of growth (RVG), which gives managers a clear picture of how growth projects and margin improvement initiatives affect shareholder value. Using basic balance sheet and income sheet data, managers can determine their companies' RVGs, as well as those of their competitors. Calculating RVGs gives managers insights into which corporate strategies are working to deliver value and whether their companies are pulling the most powerful value-creation levers. The author examines a number of well-known companies and explains what their RVG numbers say about their strategies. He reviews the unspoken assumption that growth and profits are incompatible over the long term and shows that a fair number of companies are effective at delivering both. Finally, he explains how managers can use the RVG framework to help them define strategies that balance growth and profitability at both the corporate and business unit levels.

[Health insurance in the contributive and subsidized regimes and its impact on the service providers]. / Aseguramiento en los regímenes contributivo y subsidiado, e impacto en los prestadores de servicios.

The performance of 18 private Health-promoting (EPS) and Family Compensation (CCF) entities, as well as their general balances for 1997, 1998 and 1999, were studied to determine the profit margins achieved by EPS's in their work of administering health insurance. The average behavior of each EPS balance sheet was analyzed to reduce the effect produced by extreme cases; each EPS's value was thus weighted by the number of its affiliated people. The expected behavior of the costs and expenses of companies whose main business is providing health insurance could thus become determined. The main source of operational income for a private EPS is the contributive regime's per capita unit of payment (UPC). Subsidized regime participation and that of other sources of income has decreased year by year. By contrast, public EPS's have shown decreasing participation in income obtained from UPC (contributive and subsidized) and growing dependence on other sources of income; this can be interpreted as being a symptom of weak commercial management. According to the balance sheets provided by the SNS, the EPS (public, private and Family Compensation entities), including the Social Security Institute (ISS), together obtained a total of 4.18 billion pesos operational income in 1999, an increase of 21.7% as compared to 1998. Income received from the ISS amounted to 1.93 billion dollars in 1999 (46% of the total). At 2000 prices, the total amount of operational income was 4.54 billion pesos in 1999 (15.6% real increase). Taking the behavior of 4 EPS's as our reference point (Sanitas, Humana Vivir, Coomeva and Famisanar), it can be concluded that an EPS whose main business is health insurance needs a 17.2% gross margin to cover its operational and non-operational costs and a 1.1% margin before tax.

Aseguramiento en los regímenes contributivo y subsidiado, e impacto en los prestadores de servicios / Health insurance in the contributive and subsidized regimes and its impact on the service providers

Con el fin de establecer el margen que logran las Entidades Promotoras de Salud- EPS en su labor de administración del seguro de salud, se utilizó información de los estados de resultados y balances generales para 1997, 1998 y 1999 entregados a la Superintendencia Nacional de Salud-SNS por 18 EPS privadas y Cajas de Compensación Familiar-CCF. Para disminuir el efecto de los casos extremos, el análisis se hizo sobre el comportamiento promedio de cada partida de resultados o de balance, para lo cual el valor de cada EPS se ponderó por el número de afiliados. Así es posible establecer el comportamiento esperado de los costos y gastos de una entidad cuyo negocio central sea el aseguramiento en salud. Las EPS privadas tienen como fuente principal de ingresos operacionales la Unidad de Pago por Capitación-UPC del régimen contributivo. La participación del régimen subsidiado y de las otras fuentes de ingresos es cada año menor. Por el contrario, las EPS públicas denotan una participación cada vez menor de los ingresos por UPC (contributiva y subsidiada) y una creciente dependencia de los otros ingresos, lo cual puede tomarse como síntoma de una gestión comercial débilDe acuerdo con los estados de resultados suministrados por la SNS, incluido el ISS, las EPS (públicas, privadas y CCF) lograron un total de ingresos operacionales de $ 4,18 billones en 1999, lo cual significó un incremento de 21,7 por ciento con respecto a 1998. Los ingresos del Instituto de Seguros Sociales-ISS fueron de $ 1,93 billones en 1999 (46 por cientodeltotal) A precios del año 2000, el total de ingresos operacionales ascendió a $ 4,54 billones en 1999 (15,6 por ciento de incremento real). A partir del comportamiento de las 4 EPS tomadas como referencia (Sanitas, Humana Vivir, Coomeva y Famisanar), se concluye que una EPS cuyo negocio básico sea el aseguramiento en salud necesita un margen bruto de 17,2 por ciento para cubrir los gastos de operación y los no operacionales, y lograr un margen antes de impuestos de 1,1 por ciento.

The contribution of gender-role orientation, work factors and home stressors to psychological well-being and sickness absence in male- and female-dominated occupational groups.

The associations of work stress, types of work and gender-role orientation with psychological well-being and sickness absence were investigated in a questionnaire survey of 588 male and female nurses and 387 male and female accountants. We hypothesised that health might be impaired among women working in the male-dominated occupation (accountancy), and men in the female-dominated occupation (nursing), but that effects might be moderated by job strain (perceptions of high demand and low control), work and home hassles, and traditional male (instrumentality) and female (expressivity) psychological characteristics. Responses were analysed from 172 female and 61 male nurses, and from 53 female and 81 male commercial accountants. Female accountants were more likely than other groups to have high anxiety scores on the Hospital Anxiety and Depression Scales, while male nurses had the highest rates of sickness absence. Male nurses and female accountants also reported more work-related hassles than did female nurses and male accountants. Men and women in the same occupation did not differ in job strain or job social support, but nurses reported greater job strain than accountants, due to higher ratings of demands and lower skill utilisation. After adjusting for age, sex, occupation, paid work hours and a measure of social desirability bias, risk of elevated anxiety was independently associated with higher job strain, lower job social support, more work hassles, more domestic responsibility, lower instrumentality and higher expressivity. The association between sex and anxiety was no longer significant after instrumentality had been entered into the regression model. Sickness absence of more than three days over the past 12 months was independently associated with higher job strain, more work hassles, lower instrumentality and higher expressivity. The results suggest that when men and women occupy jobs in which they are in the cultural and numerical minority, there may be adverse health effects that are gender-specific. Psychological traits related to socially constructed gender roles may also be relevant, and mediate in part the differences in psychological well-being between men and women.

What if pediatric residents could bill for their outpatient services?

OBJECTIVE: We prospectively studied the potential of billing and coding practices of pediatric residents in outpatient clinics and extrapolated our results to assess the financial implications of billing inaccuracies. Using Medicare as a common measure of "currency," we also used the relative value unit (RVU) and ambulatory payment class methodologies as means of assessing the productivity and financial value of resident-staffed pediatric clinics. METHODS: Residents were asked to submit voluntarily shadow billing forms and documentation of outpatient clinic visits. Documentation of work was assessed by a blinded reviewer, and current procedure terminology evaluation and management codes were assigned. Comparisons between resident codes and calculated codes were made. Financial implications of physician productivity were calculated in terms of dollar amounts and RVUs. Resource intensity was measured using the ambulatory payment class methodology. RESULTS: A total of 344 charts were reviewed. Coding agreement for health maintenance visits was 86%, whereas agreement for acute care visits was 38%. Eighty-three percent of coding disagreement in the latter group was resulting from undercoding by residents. Errors accounted for a 4.79% difference in potential reimbursement for all visit types and a 19.10% difference for acute care visits. No significant differences in shadow billing discrepancies were found between different levels of training. Residents were predicted to generate $67 230, $87 593, and $96 072 in Medicare revenue in the outpatient clinic setting during each successive year of training. On average, residents generated 1.17 +/- 0.01 and 0.81 +/- 0.02 work RVUs for each health maintenance visit and office visit, respectively. Annual productivity from outpatient clinic settings was estimated at 548, 735, and 893 work RVUs in the postgraduate levels 1, 2, and 3, respectively. CONCLUSION: When pediatric residents are not trained adequately in proper coding practices, the potential for billing discrepancies is high and potential reimbursement differences may be substantial. Discussion of financial issues should be considered in curriculum development.