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1.
Rev Med Suisse ; 18(799): 1928-1933, 2022 Oct 12.
Article in French | MEDLINE | ID: mdl-36226457

ABSTRACT

The work of a self-employed physician being a liberal activity, his practice does not only require the mastery of the medical art but also of the financial management of his practice. This article aims at reminding some basic accounting notions necessary for the adequate financial management of a medical practice.


Le travail du médecin indépendant étant une activité libérale, sa pratique n'impose pas seulement la maîtrise de l'art médical, mais également celle de la gestion financière de son cabinet. Cet article a pour but de rappeler quelques notions de base de comptabilité nécessaires à la gestion financière adéquate d'un cabinet médical.


Subject(s)
Accounting , Financial Management , Physicians , Practice Management, Medical , Humans
2.
Arthroscopy ; 37(5): 1620-1627, 2021 05.
Article in English | MEDLINE | ID: mdl-33232748

ABSTRACT

PURPOSE: To analyze the implementation and benefits of time-driven activity-based costing (TDABC) in the field of orthopaedic surgery. METHODS: We performed a search of PubMed, Google Scholar, and Embase in March 2020, using the following terms: "Time-Driven Activity-Based Costing," "TDABC," "Orthopaedic Surgery," and "Cost." Then we selected the studies that used the TDABC methodology to generate costs for a particular aspect of orthopaedic surgery. The included studies were divided into the following 5 main categories for ease of analysis: joint arthroplasty, trauma, hand, electronic medical record (EMR) implementation, and pediatric. We analyzed the overall ability of TDABC in the field of orthopaedic surgery, compared to the standard costing methods. RESULTS: We included a total of 19 studies that implemented the TDABC methodology to generate a cost, which was compared to traditional accounting methods. The orthopaedic subspecialty with the most amount of TDABC implementation has been the field of joint arthroplasty. In these studies, the authors have noted that TDABC has provided a more granular breakdown of costs and has calculated a lower cost compared with traditional accounting methods. CONCLUSION: TDABC is a powerful cost analysis method that has demonstrated benefit over the activity-based costing (ABC) approach in determining a lower and more accurate cost of orthopaedic procedures. Furthermore, the TDABC method generates an average cost reduction of $10,000 and $12,000 for total hip arthroplasty and total knee arthroplasty, respectively. CLINICAL RELEVANCE: TDABC can allow health care administration to better determine and understand the cost drivers of particular orthopaedic procedures at their institutions. With improved estimates on the true cost of an activity, hospital administrators and department chairs can adjust to ensure cost-effective, patient-centered health care.


Subject(s)
Accounting/economics , Health Care Costs , Orthopedic Procedures/economics , Anterior Cruciate Ligament Reconstruction/economics , Humans , Time Factors
3.
J Arthroplasty ; 36(8): 2674-2679.e3, 2021 08.
Article in English | MEDLINE | ID: mdl-33875286

ABSTRACT

BACKGROUND: Traditional hospital cost accounting (TA) has innate disadvantages that limit the ability to meaningfully measure care pathways and quality improvement. Time-driven activity-based costing (TDABC) allows a meticulous account of costs in primary total joint arthroplasty (TJA). However, differences between TA and TDABC have not been examined in revision hip and knee TJA (rTJA). We aimed to compare total costs of rTJA by the diagnosis-related group (DRG), measured by TDABC vs TA. METHODS: Overall costs were calculated for rTJA care cycles by DRG for 2 years of financial data (2018-2019) at our single-specialty orthopedic institution using TA and TDABC. Costs derived from TDABC, based on time and resources used, were compared with costs derived from TA based on historical costs. Proportions of implant and nonimplant costs were measured to total TA costs. RESULTS: Seven hundred ninety-three rTJAs were included in this study, with TA methodology resulting in higher cost estimates. The total cost per DRG 468, rTJA with no comorbidities or complications (CC), DRG 467, rTJA with CC, and DRG 466, rTJA with major CC, estimated by TDABC was 69%, 67%, and 49% of the estimation by TA, respectively. Implant and nonimplant costs represented different proportions between methodologies. CONCLUSION: Considerable differences exist, as TA estimations were 31%-51% higher than TDABC. The true cost is likely a value between the estimations, but TDABC presents granular and patient-specific cost data. TDABC for rTJA provides valuable bottom-up information on cost centers in the care pathway and, with targeted interventions, may lead to a more optimal delivery of value-based health care.


Subject(s)
Accounting , Arthroplasty, Replacement, Knee , Diagnosis-Related Groups , Hospital Costs , Humans , Time Factors
4.
Clin Orthop Relat Res ; 477(9): 2071-2081, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31107316

ABSTRACT

BACKGROUND: With increasing emphasis on value-based payment models for primary total joint arthroplasty (TJA), there is greater need for orthopaedic surgeons and hospitals to better understand the actual costs and resource use of TJA. Time-driven activity-based costing (TDABC) is a methodology for accurate cost estimation, but its application in the TJA care pathway across institutions/regions has not yet been analyzed. QUESTIONS/PURPOSES: In this systematic review of studies applying TDABC to primary TJA, we investigated the following: (1) Is there variation in TDABC methodology and cost estimates across institutions? (2) Is a standard set of direct and indirect costs included across studies? (3) Is there a difference in cost estimates derived from TDABC and traditional hospital cost-accounting approaches? and (4) How are institutions using TDABC (process and outputs) with respect to the TJA care pathway? METHODS: A comprehensive search strategy was developed that included the keywords "TDABC," "time-driven activity-based cost," "THA," "TKA," "THR," "TKR," and "TJR" in the PubMed/MEDLINE, EMBASE, Web of Science, Ovid SP, Scopus, and ScienceDirect databases for articles published between 2004 and 2018 as well as extensive hand searching and citation mining. Relevant studies (n = 15) were screened to include THA or TKA as the focus of the TDABC model, full-text articles, TDABC-based cost estimates for TJA, and studies written in English (n = 8). Due to the heterogeneity of outcomes/methodology in TDABC studies involving TJA, quality assessment was based on each study's adherence to the seven steps delineated by Kaplan et al. in their original publication introducing TDABC in health care. RESULTS: There was substantial variation in TDABC methodology (especially in scope), adherence to the seven steps of TDABC, and data collection. Only five of eight studies incorporated indirect costs into their TDABC calculation, with notable differences in which direct and indirect expenses were included. TDABC-based cost estimates for TJA ranged from USD 7081 to USD 29,557, with variation driven by the TJA timeframe and whether implant costs were included in the costing calculation. TDABC was most frequently used to compare against traditional hospital accounting methods (n = 4), to increase operational efficiency (n = 4), to reduce wasted resources (n = 3), and to mitigate risk (n = 3). CONCLUSIONS: TDABC-based cost estimates are more granular and useful in practice than those calculated via traditional hospital accounting; however, there is a lack of standardized principles to guide TDABC implementation (especially for indirect costs) due to institutional and regional differences in TDABC application. Although TDABC methodology will likely continue to vary somewhat between studies, standardized principles are needed to guide the definition, estimation, and reporting of costs to enable detailed examination of study methodology and inputs by readers. LEVEL OF EVIDENCE: Level III, economic and decision analysis.


Subject(s)
Accounting/methods , Arthroplasty, Replacement/economics , Health Expenditures , Health Resources/economics , Hospital Costs , Humans , Time Factors
5.
Rev Epidemiol Sante Publique ; 66 Suppl 2: S73-S91, 2018 Mar.
Article in French | MEDLINE | ID: mdl-29530439

ABSTRACT

The hospital costing process implies access to various sources of data. Whether a micro-costing or a gross-costing approach is used, the choice of the methodology is based on a compromise between the cost of data collection, data accuracy, and data transferability. This work describes the data sources available in France and the access modalities that are used, as well as the main advantages and shortcomings of: (1) the local unit costs, (2) the hospital analytical accounting, (3) the Angers database, (4) the National Health Cost Studies, (5) the INTER CHR/U databases, (6) the Program for Medicalizing Information Systems, and (7) the public health insurance databases.


Subject(s)
Data Collection , Databases, Factual , Information Storage and Retrieval , Accounting/methods , Accounting/standards , Data Collection/methods , Data Collection/standards , Databases, Factual/standards , Databases, Factual/statistics & numerical data , France/epidemiology , Health Care Costs/statistics & numerical data , Hospital Costs/standards , Hospital Costs/statistics & numerical data , Humans , Information Storage and Retrieval/standards , Information Storage and Retrieval/statistics & numerical data
7.
Am J Epidemiol ; 185(3): 238-246, 2017 02 01.
Article in English | MEDLINE | ID: mdl-28073765

ABSTRACT

Large-scale environmental epidemiologic studies often rely on exposure estimates based on linkage to residential addresses. This approach, however, is limited by the lack of residential histories typically available for study participants. Our objective was to evaluate the feasibility of using address data from LexisNexis (a division of RELX, Inc., Dayton, Ohio), a commercially available credit reporting company, to construct residential histories for participants in the California Teachers Study (CTS), a prospective cohort study initiated in 1995-1996 to study breast cancer (n = 133,479). We evaluated the degree to which LexisNexis could provide retrospective addresses prior to study enrollment, as well as the concordance with existing prospective CTS addresses ascertained at the time of the completion of 4 self-administered questionnaires. For approximately 80% of CTS participants, LexisNexis provided at least 1 retrospective address, including nearly 25,000 addresses completely encompassed by time periods prior to enrollment. This approach more than doubled the proportion of the study population for whom we had an address of residence during the childbearing years-an important window of susceptibility for breast cancer risk. While overall concordance between the prospective addresses contained in these 2 data sources was good (85%), it was diminished among black women and women under the age of 40 years.


Subject(s)
Accounting , Databases, Factual , Environmental Exposure/statistics & numerical data , Epidemiologic Methods , Adult , Aged , Aged, 80 and over , Breast Neoplasms/epidemiology , California , Cohort Studies , Demography , Female , Humans , Middle Aged , Young Adult
8.
Jt Comm J Qual Patient Saf ; 43(4): 166-175, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28325204

ABSTRACT

BACKGROUND: As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety. FOUR KEY COMPONENTS OF A FINANCIAL REPORTING STRUCTURE: The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting. CONCLUSION: If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality.


Subject(s)
Delivery of Health Care/organization & administration , Economics, Hospital , Financial Management , Quality of Health Care , Accounting/standards , Clinical Audit , Delivery of Health Care/economics , Delivery of Health Care/standards , Health Care Sector/economics , Health Care Sector/organization & administration , Health Services Research , Hospitals/standards , Humans , Maryland , Patient Safety , United States
9.
Aust Health Rev ; 41(2): 201-206, 2017 May.
Article in English | MEDLINE | ID: mdl-27248134

ABSTRACT

Objective The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting. Methods A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA. Results The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA. Conclusion Unlike TDABC, RCA calculates lower costs for unused capacities but higher costs for products or services in a healthcare setting in which fixed costs make up a high proportion of total costs. What is known about the topic? TDABC is a revision of the activity-based costing (ABC) system. RCA is also a new costing system that includes both the theoretical advantages of ABC and the practical advantages of German costing. However, little is known about the differences arising from application of TDABC and RCA. What does this paper add? There is no study comparing both TDABC and RCA in a single case study based on a real-world healthcare setting. Thus, the present study fills this gap in the literature and it is unique in the sense that it is the first case study comparing TDABC and RCA for open and laparoscopic gall bladder surgeries in a healthcare setting. What are the implications for practitioners? This study provides several interesting results for managers and cost accounting researchers. Thus, it will contribute to the spread of RCA studies in healthcare settings. It will also help the implementers of TDABC to revise data concerning the cost of unused capacity. In addition, by separating costs into fixed and variable, the paper will help managers to create a blended (combined) system that can improve both short- and long-term decisions.


Subject(s)
Accounting/methods , Gallbladder Diseases/economics , Gallbladder Diseases/surgery , Health Care Costs , Health Facility Administration/economics , Laparoscopy/economics , Costs and Cost Analysis , Humans , Time Factors
10.
Radiol Manage ; 39(2): 11-16, 2017 Mar.
Article in English | MEDLINE | ID: mdl-30726644

ABSTRACT

MaKing and justitying capital expenditures can be a difficult part of a supervi- sory or managerial position. Understanding more advanced accounting tools for justifying these expenditures, like Internal Rate of Return (IRR) and Net Present Value (NPV), can improve the chances of receiving necessary funding. NPV avoids the weaknesses of the IRR method by allowing decision makers to specify when cash flows will occur instead of assuming that net cash flows will be equal each year ofa project. Taking the time to learn basic account- ing definitions and tools can improve your ability to manage and provide greater opportunities to help patients, staff, and the community.


Subject(s)
Accounting , Capital Expenditures/statistics & numerical data , Financial Management, Hospital/methods , Radiology Department, Hospital/economics , Decision Making, Organizational , Humans
11.
Ann Occup Hyg ; 60(5): 567-80, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27026660

ABSTRACT

OBJECTIVES: Changes in the modern economy have affected the financial sector. Time pressures, excessive work demands, and job stress are frequent concerns among bank employees, which might predispose them to burnout symptoms. The objective of the present study was to investigate the association between burnout symptoms and exposure to psychosocial work conditions in bank employees. METHODS: A cross-sectional study of 1046 bank employees was carried out in Pará and Amapá, northern Brazil. We applied a self-administered questionnaire evaluating socio-demographic characteristics, burnout (Maslach Burnout Inventory), and two job stress models (Demand-Control-Support and Effort-Reward Imbalance). Two levels of burnout symptoms were analysed: moderate level of burnout (MLB) and high level of burnout (HLB). Logistic regression models were used to estimate associations between the two levels of burnout and the two stress models, controlling for relevant covariates. RESULTS: The overall prevalence of burnout was 71.8% (31.1% for HLB; 40.7% for MLB), regardless of gender. Exposure to adverse psychosocial conditions in the workplace, such as high strain, low social support at work, high effort/low reward, and over commitment showed strong association with HLB and MLB, and these associations were independent of age, gender, and other occupational characteristics. CONCLUSIONS: We found that psychosocial conditions in the financial sector involving high strain, low social support at work, high effort/low reward, and over commitment represent possible risk factors for moderate and HLB symptoms in bank employees.


Subject(s)
Accounting , Burnout, Professional/epidemiology , Workplace , Adult , Aged , Brazil , Burnout, Professional/psychology , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Middle Aged , Social Support , Surveys and Questionnaires , Young Adult
12.
Int J Health Care Qual Assur ; 29(6): 646-63, 2016 Jul 11.
Article in English | MEDLINE | ID: mdl-27298062

ABSTRACT

Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest service price. Originality/value - Since the literature review found no study comparing RCA with TCS in a real-life health care setting, little is known about differences arising from applying these systems in this context. Thus, the current study fills this gap in the literature by comparing RCA with TCS for both open and laparoscopic gallbladder surgeries.


Subject(s)
Accounting/methods , Health Care Costs , Health Facility Administration/economics , Costs and Cost Analysis , Gallbladder/surgery , Humans , Laparoscopy/economics
13.
Radiol Manage ; 38(6): 12-16, 2016 Nov.
Article in English | MEDLINE | ID: mdl-30645784

ABSTRACT

Making and justifying capital expenditures can be a difficult part of a supervisory or managerial position. Understanding some basic tools for making estimates and calculating values can help simplify this process. Breaking down some of the most common accounting methods into a six-step, intuitive process allows everyone, even those with little or no accounting background, to use and understand the results of these tools. Accounting tools can seem complex when they are first used, but after walking through them step-by-step and practicing them, they can become an essential tool in working with executives and other administrators.


Subject(s)
Accounting/economics , Capital Expenditures , Radiology Department, Hospital/economics , Radiology/economics , Accounting/methods , Humans , United States
14.
Radiol Manage ; 38(5): 23-26, 2016 Sep.
Article in English | MEDLINE | ID: mdl-30726596

ABSTRACT

Accounting terminology and methods are essential parts of management and can be used to improve the efficacy of communication with other managers and executives. While learning these terms and methods can seem daunting, the rewards are well worth the effort. Accounting terminology can seem almost as complex as medical terminology: revenues, expenses, iRR, net pres- ent value, and profit. However, manag- ers and supervisors don't need to understand all of those terms, just those most commonly used. Once those basics have been mastered, they will provide sufficient background to understand the many forms, information requests, and questions accounting and finance lead- ers will provide and request. Imaging supervisors and directors can use these terms and methods to success- fully communicate with management about resources needed and their impact on the community and the bottom line of the organization. The reward for the time spent is well worth the effort.


Subject(s)
Accounting , Financial Management, Hospital/methods , Interdisciplinary Communication , Practice Management, Medical/organization & administration , Terminology as Topic , Humans
15.
Healthc Financ Manage ; 70(3): 34-7, 2016 Mar.
Article in English | MEDLINE | ID: mdl-27183756

ABSTRACT

A new version of the FASB accounting standard covering not-for-profit healthcare organizations contains potentially significant changes to the statement of operations and changes in net assets, statement of cash flows, and notes to the financial statements. Healthcare organizations already have tremendous flexibility with disclosures around all aspects of their business. Although auditors prefer to see only information that can be effectively audited, this preference does not prevent organizations from expanding on certain activities or transactions covered by GAAP in their footnotes.


Subject(s)
Accounting/standards , Documentation/methods , Financial Management, Hospital , Hospitals, Voluntary , United States
16.
Healthc Financ Manage ; 70(4): 48-51, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27244975

ABSTRACT

Seeing a need to refresh the current guidelines, the Financial Accounting Standards Board (FASB) proposed an update to the financial accounting and reporting model for not-for-profit entities. In a response to solicited feedback, the board is now revisiting its proposed update and has set forth a plan to finalize its new guidelines. The FASB continues to solicit and respond to feedback as the process progresses.


Subject(s)
Accounting/standards , Hospitals, Voluntary/economics , Mandatory Reporting , United States
17.
Healthc Financ Manage ; 70(5): 78-83, 2016 May.
Article in English | MEDLINE | ID: mdl-27382712

ABSTRACT

Recently released lease accounting standards from the Financial Accounting Standards Board (FASB) present three significant challenges for healthcare organizations: All leases must be reported on a company's balance sheet, increasing liabilities on the balance sheets of healthcare organizations considerably. Contractual agreements not previously considered leases will now be treated as leases. Classification of some equipment leases could change.


Subject(s)
Accounting , Delivery of Health Care/economics , United States
19.
J Public Health Manag Pract ; 21(5): 509-13, 2015.
Article in English | MEDLINE | ID: mdl-26214536

ABSTRACT

In its 2012 report on the current and future states of public health finance, the Institute of Medicine noted, with concern, the relative lack of capacity for practitioners and researchers alike to make comparisons between health department expenditures across the country. This is due in part to different accounting systems, service portfolios, and state- or agency-specific reporting requirements. The Institute of Medicine called for a uniform chart of accounts, perhaps building on existing efforts such as the Public Health Uniform National Data Systems (PHUND$). Shortly thereafter, a group was convened to work with public health practitioners and researchers to develop a uniform chart of accounts crosswalk. A year-long process was undertaken to create the crosswalk. This commentary discusses that process, challenges encountered along the way and provides a draft crosswalk in line with the Foundational Public Health Services model that, if used by health departments, could allow for meaningful comparisons between agencies.


Subject(s)
Health Expenditures/trends , Public Health/economics , Accounting , Data Collection , Humans , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Program Development , Program Evaluation , United States
20.
JAAPA ; 28(4): 45-8, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25802940

ABSTRACT

This article describes the basics of cost accounting for healthcare providers and how these concepts relate to decision making in medical practice. By understanding cost accounting and cost analysis, providers can be better prepared to compete and survive in a changing healthcare environment.


Subject(s)
Accounting , Costs and Cost Analysis , Economics, Medical , Humans
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