Economic Impact of Refinements in ERAS Pathways in DIEP Flap Breast Reconstruction

Introduction Enhanced recovery after surgery (ERAS) protocols at our institution have led to an expected decrease in hospital length of stay and opioid consumption for patients treated with deep inferior epigastric perforator (DIEP) flaps for breast reconstruction. We look to examine the economic patterns across these years to see the impact of costs for the patient and institution. Methods This study retrospectively evaluated consecutive patients treated with bilateral DIEP flaps for breast reconstruction between October 2015 and August 2020. We categorized the cases into three categories: pre-ERAS, ERAS, ERAS + bupivacaine. Primary outcomes observed included the contribution margin per operating suite case minute and total cost to the patient. An analysis of variance determined whether there was a difference between the three groups and a Tukey post-hoc analysis made pairwise comparisons. A p-value < 0.05 was significant. Results A total of 268 cases of bilateral DIEPs performed by the two senior authors were analyzed in this study. Seventy-four cases were pre-ERAS, 72 were ERAS, and 122 were ERAS + bupivacaine. There was a statistical difference between the contribution margin per operating minute. A Tukey post hoc test revealed that the average contribution margin per operating suite case minute was significantly higher for the ERAS and ERAS + bupivacaine compared with the pre-ERAS groups.There was a statistically significant difference between the total cost to the patients. A Tukey post hoc test revealed that the average total cost to the patient was statistically significantly lower for the ERAS and ERAS + bupivacaine compared with the pre-ERAS group. Conclusion Implementation of ERAS and continued improvements in ERAS resulted in significantly decreased costs for the patient and increased profitability for the hospital. Investing in improvements to ERAS protocols can improve profitability for the institution while simultaneously improving costs and access to care for patients in need of breast reconstruction.

Penerapan Sistem Menu Engineering Dalam Upaya Peningkatan Kualitas Menu di Restoran Bintan Inti Executive Village Clubhouse

This research is a form of analysis and evaluation of the menu at the Bintan Inti Executive Village (BIEV) Clubhouse through a menu engineering system with the aim of improving the quality and effectiveness of the menu served. The formulation of the problem which is the basis of this research is how to improve the quality of the food and beverage menu through the menu engineering system and what recommendation actions should be taken based on the resulting data from the analysis that appears. This study uses variables, which are menu analysis in improving the quality of the menu at BIEV Clubhouse with sub variables, such as food cost, menu mix, and contribution margin. The results of this study that there were 8 menus or 30.77% menus with star categories, 5 menus or 19.23% menus with the plowhorse category, 4 menus or 15.38% menus with the puzzle category, and 9 menus or 34.62%. menu with dog category. The recommended follow-up actions to BIEV Clubhouse management is reducing the menu with the dog category, evaluating product prices and production costs for menus with the plowhorse category, taking suggestive selling steps for menus with the puzzle category, and maintaining the quality and performance of menus with the star category.

A Generalized Stochastic Cost–Volume–Profit Model

Cost–volume–profit (CVP) analysis is a widely used decision tool across many business disciplines. The current literature on stochastic applications of the CVP model is limited in that the model is studied under the restrictive forms of the Gaussian and Lognormal distributions. In this paper we introduce the Mellin Transform as a methodology to generalize stochastic modeling of the CVP problem. We demonstrate the versatility of using the Mellin transform to model the CVP problem, and present a generalization of the CVP model when the contribution margin and sales volume are both defined by continuous random distributions.

ANALISIS FINANSIAL DENGAN PENDEKATAN COST VOLUME PROFIT PADA USAHA KOPI BUBUK BUKIT BARISAN DI KABUPATEN BENGKULU TENGAH

The purpose of this study is to estimate the amount of Bukit Barisan Coffee's operating profit that is reflected in the contribution margin, breakeven point, margin of safety (MOS), degree of operating laverage (DOL) and calculate profit target in next period. The research method used is a case study. The analysis used is cost-volume-profit analysis (CVP). The data used are primary and secondary data. Based on the results of the analysis, it was found that the profit was IDR 18,323,806 / month with a production of 896 kg / month, a contribution margin of IDR 21,028,250, a break even point of IDR 6,630,105 and 115 kg of ground coffee, a MOS value of IDR 44,921,895 and a DOL value of IDR 1.15. The planned profit target of IDR 20,156,186 can be achieved if sell 974 kg of coffee or get sales of IDR 55,757,635. To achieve the profit target, an alternative scenario is used to increase sales volume by 10% and a fixed selling price.

THE FACTORS THAT AFFECT ZIS FUNDRAISING ON ZAKAT MANAGEMENT ORGANIZATION IN 2016-2019

ABSTRAKStudi ini bertujuan untuk menganalisis pengaruh penerapan PSAK 109 pada laporan keuangan, penyaluran dana ZIS, rasio penggunaan dana amil, dan rasio margin kontribusi dana amil terhadap penghimpunan dana ZIS oleh OPZ pada tahun 2016-2019. Studi ini menggunakan pendekatan kuantitatif dengan teknik regresi data panel dengan pengambilan sampel menggunakan purposive sampling. Penelitian ini menemukan bahwa secara parsial, pengaruh penerapan PSAK 109 pada laporan keuangan terhadap penghimpunan dana ZIS oleh OPZ berpengaruh positif tidak signifikan. Pengaruh penyaluran dana ZIS terhadap penghimpunan dana ZIS oleh OPZ berpengaruh positif signifikan. Pengaruh rasio penggunaan dana amil dan rasio margin kontribusi dana amil terhadap penghimpunan dana ZIS ole OPZ berpengaruh negatif tidak signifikan. Sedangkan secara simultan, penerapan PSAK 109 pada laporan keuangan, penyaluran dana ZIS, rasio penggunaan dana amil, dan rasio margin kontribusi dana amil berpengaruh secara signifikan terhadap penghimpunan dana ZIS oleh OPZ tahun 2016-2019. Penelitian ini diharapkan bisa meningkatkan kinerja amil dan bisa lebih menerapkan standar akuntansi dalam pencatatan keuangannya. Bagi regulator bisa digunakan sebagai acuan dalam menetapkan besaran bagian dana amil.Kata Kunci: PSAK 109, Penghimpunan Dana ZIS, Penyaluran Dana ZIS, Rasio Dana Amil ABSTRACTThe purpose of this study is to analyze the effect of the application of PSAK 109 on financial statements, the distribution of ZIS funds, the ratio of the use of amil funds, and the ratio of the contribution margin of amil funds to the ZIS fundraising by OPZ in 2016-2019. This study uses a quantitative approach with panel data regression with purposive sampling. This study found that partially the effect of the application of PSAK 109 on the financial statements on the ZIS fundraising by OPZ has positive effect but insignificant. The effect of the distribution of ZIS funds on the ZIS fundraising by OPZ has a significant positive effect. The effect of the ratio of the use of amil funds and the ratio of the contribution margin of amil funds to the ZIS fundraising by OPZ has a negative effect and insignificant. Yet, simultaneously, the application of PSAK 109 in financial statements, distribution of ZIS funds, ratio of use of amil funds, and ratio of contribution margin of amil funds significantly affects the ZIS fundraising by OPZ in 2016-2019. This research is expected to improve the performance of amil and the amil is able to better apply accounting standards in their financial records. For regulators, this can be used as a reference in determining the portion of fund for the amil.Keywords: PSAK 109, ZIS Fundraising, Distribution of ZIS Funds, Amil Fund Ratio

Lack of Surgeon Standardization on Implant Selection in Ankle Fracture Fixation May Increase Costs and Decrease Contribution Margin

Background Surgical standardization has been shown to decrease costs without impacting quality; however, there is limited literature on this subject regarding ankle fracture fixation. Methods. Between October 5, 2015 and September 27, 2017, a total of 168 patients with isolated ankle fractures who underwent open reduction, internal fixation (ORIF) were analyzed. Financial data were analyzed across ankle fracture classification type, implant characteristics, and surgeons. Bivariate analyses were conducted. One-way analysis of variance was used to compare hardware costs across all 5 surgeons. Linear regression analysis was used to determine if hardware cost differed by surgeon when accounting for fracture type. Results The mean contribution margin was $4853 (SD $6446). There was a significant difference in implant costs by surgeon (range, lowest-cost surgeon: $471 [SD $283] to $1609 [SD $819]; P < .001). There was no difference in the use of a suture button or locking plate by fracture type (P = .13); however, the cost of the implant was significantly higher if a suture button or locking plate was used ($1014 [SD $666] vs $338 [SD $176]; P < .001). There was an association between surgeon 3 (β = 200.32 [95% CI 6.18-394.47]; P = .043) and surgeon 4 (β = 1131.07 [95% CI 906.84-1355.30]; P < .001) and higher hardware costs. Conclusions Even for the same ankle fracture type, a wide variation in implant costs exists. The lack of standardization among surgeons accounted for a nearly 3.5-fold difference, on average, between the lowest- and highest-cost surgeons, negatively affecting contribution margin. Levels of Evidence Level IV