Activity-Based-Medical-Cost Accounting and Management

A Non-Traditional Accounting System

[By Dr. David Marcinko MBA MEd CMP]CPA

Sooner or later you will want to ascertain and then demonstrate the cost effectiveness of your medical care. By using the process of Activity Based Cost (ABC) management, you will be able to do so.  But, if you’re using a traditional accounting system, you won’t know a thing about your activity costs. Here’s how. 

Traditional Cost Accounting Methods 

In a traditional medical practice cost accounting system, costs are assigned to different procedures and services based on volume.  In others words, office costs are spread over the entire office’s product line and you may not know the true profitability of any single medical activity. So, if the office is doing more “procedures” than general medicine, for example, more indirect office overhead costs will be allocated to the procedural portion of the practice. 

ABC management, on the other hand, determines the actual costs of the resources that each service consumes. Because general medicine requires more human resources than “technical procedures,” ABC management will assign more costs to the general medical portion of the practice. 

Accordingly, most physicians, office managers, and their accountants are surprised that a prior notion of office profitability is different than previously thought. ABC management is just more accurate in measuring medical service profitability than traditional accounting methods. 

Medical Activity Cost Drivers 

Examples of medical activities that are office cost drivers include such items as monitoring vital signs, taking radiographic images, removing dressings or casts, performing laboratory tests or veni-punctures, surgical set-ups or operative procedures; etc.  

However, in the office setting, the most economically important activities are listed as specific CPT codes for each medical specialty.  The most important end result of ABC management is the shift of general overhead costs to low volume services from high volume services. These effects are not symmetrical as there is a bigger dollar effect on the per-unit costs of the low volume service.  

ABC Managerial Accounting Improvements 

ABC management improves office managerial cost accounting systems in three ways: 

  1. It increases the number of cost pools used to accumulate general overhead office costs. Rather than accumulate overhead costs in a single office-wide pool, costs are accumulated by activity, service or procedure.
  2. It changes the base used to assign general overhead costs to services or patients. Rather than assigning costs on the basis of a measure of volume (employee or doctor hours), costs are assigned on the basis of medical services or activities that generated those costs.
  3. It changes the nature of many overhead costs in that those formerly considered indirect, are now traced to specific activities or services. The office service mix may then be adjusted accordingly, for additional profit.   

Methodology 

In order to perform an ABC analysis for your medical office, calculate the cost of delivering a single unit of medical or surgical activity using only the work component of the resource based relative value scale (RBRVS).

Do this by adding up your office’s average variable expenses for the prior 1-3 years.  Now, count the number of work resource based relative value units (RBRVUs) delivered for each CPT code for the same time period, using the latest edition of the Federal Register to obtain the latest list of RVUs by CPT code. Then divide total variable expenses by the total number of work RVUs in order to arrive at the marginal cost of a single unit of service for the time period being evaluated.

For example, if your office had variable expenses of $480,000, and produced 80,000 work RVUs last year, it cost $6, on top of the office’s fixed expenses, to deliver one unit of work product. So, if an HMO plan offers to reimburse you at a rate of $11 per member, per month, and you can expect to reasonably deliver on average of one RVU pm/pm, you’ll earn enough on the contract to cover your marginal costs and some of your fixed and direct expenses. 

CASE MODELs: CVPA 4 and CVPA 3

dhimc-bookAssessment

Remember, this method assumes that you have the excess operating capacity and time slots, available and unused, to see the additional patients of the new plan without adding extra overhead expenses to service the contract.

If not, or if you plan for capitation to become a major portion of your practice, you might want the capitated contract(s) to cover all your office expenses, so be sure to include both the fixed and other direct costs to your variable cost calculations. ABC determines the actual costs of resources rendered for each activity and represents a real measure of practice profitability. Office service mix can then be changed to either maximize revenues or better suit your practice personality.

A Caveat

Suppose however, that a medical service is competitively priced but still shows that the CPT code is unprofitable. For example, the costs of special requests can adversely affect office profits. Yet, special patient requests are one of the biggest reasons that a CPT code or procedure isn’t profitable.

In this case, look closely at activity costs and determine which ones are being performed inefficiently. Improving the efficiency of those kinds of medical services, or referring them out or abandoning them all together, will increase office profitability.

MORE: ABCM

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PODCAST: Hospital Owned Health Plans

COST-CONTROL THRU MANAGED CARE

BY ERIC BRICKER MD

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Access Management in the Hospital Check-In and Admissions Setting

The Role of Operational Activity Based Cost Management

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

www.HealthcareFinancials.com

In order to be paid and maintain cash flow, hospitals and clinics set up levels of specialization. The result is usually more handoffs, delays, eroding financial positions, and a frustrated set of patients and physicians. Much seems out of control. When you factor in the maze of Health Insurance Portability and Accountability Act (HIPAA) technologies, it becomes overwhelming. Now, consider these operational inefficiencies in light of Obama Care?

Access Management

At the hub of the patient hospital or clinic experience is admitting or registration. This department collects information for clinicians treating the patient, meets Joint Commission standards and other requirements, facilitates medical record documentation, patient flow, revenue capture, billing and collections, and ultimately begins to settle accounts. The access management area has numerous customers in addition to the doctor, patient, or family member sitting across from them.

Increasing HR Complexity

Without the benefit of relevant information, managers attempt to staff access management departments based on past history — namely, if patient and physician complaints are not too high, there is probably enough staff. However, staffing in access management has not kept up with the increased demands and complexity of the process, and other hospital areas often suffer. Clinicians and medical records personnel must often deal with incomplete or incorrect information, and take up the slack.

Beware Un-Happy Stakeholders

All of these deficits make for an unhappy set of customers (physicians and patients) as they continually live with the repercussions of inaccurate and incomplete information. This does not go unnoticed by patients and physicians, as these situations erode confidence in the hospital’s ability to get things done correctly.

Emotional Touch Points

Access Management is the clinic or hospital’s first chance to create an “emotional contract” with the customer. It is here that the tone is set for the patient on the issues with respect to his or her hospitalization. And it is here that the provider has the chance to begin working on the patient’s behalf so that clinical outcomes are appropriate. All of this must happen in an environment that minimizes the likelihood of an unfavorable occurrence, and outside the realm of the complex legal requirements established by state and federal officials.

Tips from the Manufacturing Sector

So why are there unresolved issues in the access management area? In a manufacturing environment, if there are problems on the front-end design, huge problems ripple downstream in terms of recalls, warranty-related expenses, lawsuits, and customers that abandon the company’s products. world -class manufacturers dealt with these issues with their ISO-9000, Total Quality Management (TQM), and Six Sigma programs during the ’80s and ’90s. Hospitals, however, have allowed issues in their access management process to fester and create huge and costly problems in the downstream process. 

Assessment

In an effort to help solve access management issues, every provider must take a proactive role in dealing with the trend. The first step in this journey is healthcare administrator and physician-executive assessment.

This assessment is not a management engineering set of time studies aimed at micro-costing every second of work. The critical path information needed for this plan is reasonable and collected in a few days by talking to the people performing the work. Estimates are gathered based on workers’ views about how they spend their time. This information is combined with available workload measures and general ledger cost information, and activity-based reports are produced.

Conclusion

Going forward, ABCM it is an exercise in operational planning. Activity-based information is used to look at areas where work can be restructured so errors and rework can be eliminated. New technologies that target problematic activities are selected and implemented. Outside companies that can perform complex activities more economically can be used (e.g., www.ICMS.net).

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