Cost Objects: The ED Dilemma. How is your ED performing?

Background: The aim of this study is to a propose a standardized methodology to identify a list of cost objects that can be used by any ED to compute costs considering that the resulting data must facilitate unit management by improving the information available for decision-making. Methods: This study considers two stages, first, we analyzed the case-mix of two hospitals collecting their data to define and diagram their processes, activities and to obtain their cost objects, second, we used four additional hospitals to validate our initial findings. Results: We recognized 59 cost objects. Hospitals may have all these cost objects or just a subset of them depending on the services they provide. Conclusions: Among the main benefits of our cost objects definition are: the possibility of tracing the processes generated by the services delivered by EDs, the economic sense in its grouping, the chance of using any costing methodology, the flexibility with other classification systems such as DRGs and ICDs, and the opportunity of costing for both diseases and treatments. Furthermore, cost comparison among hospitals using our final 59 cost objects list is more accurate and based on comparable units. In different EDs, each cost object will be the result of a similar combination of activities performed. We also present the results of applying this cost objects list to a particular ED. A total of 53 out of 59 cost objects were identified for that particular unit within a calendar year.

Cost Objects: The ED Dilemma. How is your ED performing?

Background The aim of this study is to propose a list of cost objects that can be used by any ED to compute costs considering that the resulting data must facilitate unit management by improving the information available for decision-making. Methods This study considers two stages, first, We analyzed the case-mix of two hospitals collecting their data to define and diagram their processes, activities and to obtain their cost objects, second, we used four additional hospitals to validate our initial findings. Results We recognized 59 cost objects. Hospitals may have all these cost objects or just a subset of them depending on the services they provide. Conclusions Among the main benefits of our cost objects definition are: the possibility of tracing the processes generated by the services delivered by EDs, the economic sense in its grouping, the chance of using any costing methodology, the flexibility with other classification systems such as DRGs and ICDs, and the opportunity of costing for both diseases and treatments. Furthermore, cost comparison among hospitals using our final 59 cost objects list is more accurate and based on comparable units. In different EDs, each cost object will be the result of a similar combination of activities performed. We also present the results of applying this cost objects list to a particular ED. A total of 54 out of 59 cost objects were identified for that particular unit within a calendar year.

Penghitungan Biaya Satuan pada Instalasi Rawat Jalan di Rumah Sakit X Jambi menggunakan Metode Step Down

Abstrak Tanggung jawab Rumah sakit adalah memberikan pelayanan yang berkualitas dan terjangkau bagi masyarakat, sehingga penentuan tarif dengan perhitungan biaya aktual sangat diperlukan sebagai dasar pengambilan keputusan yang lebih presisi. Penelitian ini bertujuan untuk menghitung biaya satuan dan analisis perbandingan biaya antar unit di instalasi rawat jalan menggunakan metode step down. Penelitian ini merupakan bagian dari partial economic evalution yaitu hanya memotret deskripsi biaya dari suatu objek (cost object) tanpa membandingkan luaran layanan dari unit yang di analisis. Tahapan analisis data meliputi identifikasi sumber dari pusat biaya dengan menentukan final cost, intermediate cost dan indirect cost, tahap kedua yaitu mengidentifikasi dan menghitung biaya investasi, biaya operasional dan biaya pemeliharaan. Hasil penelitian menujukkan biaya satuan tertinggi terdapat di poli gigi dan mulut sebesar Rp 621.100,99 /kunjungan sedangkan biaya satuan terendah di poli penyakit dalam yaitu sebesar Rp 214.307,51/kunjungan. Diharapkan hasil penelitian ini dapat menjadi pertimbangan dalam perubahan ataupun penyesuaian tarif layanan dan menjadikan bahan evaluasi pada poli rawat jalan agar lebih efisien dalam pengelolaanya. Abstract Hospital has a responsibility to provide quality and affordable health care to the community. Therefore, determining tariffs by calcu­lating the actual cost is very important, especially for internal stakeholders in undergoing cost analysis, performance evaluation and decision making, including tariff negotiation with external stakeholders. This research objective is to calculate unit costs and compar­atively analyzing costs between units in an outpatient installation using the step-down method. This research used a partial economic evaluation which only portrays the description of cost object without comparing the output from the analyzed unit. The stages of data analysis include identifying the resource of cost center by firstly determining the final cost, intermediate cost and indirect cost, the second stage is identifying and calculating investment cost, operational cost, and maintenance costs, the third stage is determining the allocation basis, and the fourth stage is calculating the total cost. The highest unit cost occurs in dental poly at Rp.621.100,99/visit, while the lowest unit cost is in internal medicine which is Rp.241.307,51/visit. It is hoped that the results of this study can be taken into consideration in the changes made by service rates and making evaluation materials on outpatient care so that they are more efficient in their management.

Cost Objects: The ED Dilemma. How is your ED performing?

Background The aim of this study is to propose a list of cost objects that can be used by any ED to compute costs considering that the resulting data must facilitate unit management by improving the information available for decision-making. Methods This study considers two stages, first, We analyzed the case-mix of two hospitals collecting their data to define and diagram their processes, activities and to obtain their cost objects, second, we used four additional hospitals to validate our initial findings. Results We recognized 59 cost objects. Hospitals may have all these cost objects or just a subset of them depending on the services they provide. Conclusions Among the main benefits of our cost objects definition are: the possibility of tracing the processes generated by the services delivered by EDs, the economic sense in its grouping, the chance of using any costing methodology, the flexibility with other classification systems such as DRGs and ICDs, and the opportunity of costing for both diseases and treatments. Furthermore, cost comparison among hospitals using our final 59 cost objects list is more accurate and based on comparable units. In different EDs, each cost object will be the result of a similar combination of activities performed. We also present the results of applying this cost objects list to a particular ED. A total of 54 out of 59 cost objects were identified for that particular unit within a calendar year.

IMPLEMENTASI SISTEM ACTIVITY BASED COSTING TERHADAP PERHITUNGAN HARGA POKOK PRODUK (Studi Kasus pada The Redwood City Plan of Crimson Components Company)

With the Activity Based Costing (ABC) system, it will improve the existing deficiencies in the conventional system in terms of as a basis for managers in decision making. Many companies can improve planning, product costing, operational controls and management controls by using activity analysis to develop a detailed picture of the activity providing the basis for Activity Based Costing. Activity Based Costing is used to improve the accuracy of cost analysis by improving the way cost tracking to cost objects. Activity Based Costing is used for different cost objects of individual products, interrelated product groups and individual customers. This system is useful when company ops is complex with many product types and manufacturing processes. Keywords: Activity Based Costing, conventional system, cost object, product cost, cost of product

Patient-level information and costing systems (PLICSs): a mixed-methods study of current practice and future potential for the NHS health economy

BackgroundTraditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patient-level information and costing systems (PLICSs). Monitor (the economic regulator for health care) proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings.ObjectiveOur main aim was to investigate the use of PLICSs.MethodsWe surveyed all English foundation trusts and NHS trusts, and undertook four case studies of foundation trusts. Three trusts were generalist and one was specialist. We also surveyed commissioning support units to explore the potential for PLICSs in commissioning.FindingsThe most significant use of PLICSs was cost improvement within the trusts. There was only modest utilisation of PLICSs to allocate resources across services and settings. We found that trusts had separate reporting systems for costs and clinical outcomes, engendering little use for PLICSs to link cost with quality. Although there was significant potential for PLICSs in commissioning, 74% of survey respondents at trusts considered their PLICS data to be commercially sensitive and only 5% shared the data with commissioners. The use of PLICSs in community services was, generally, embryonic because of the absence of units of health care for which payment can be made, service definitions and robust data collection systems. The lack of PLICS data for community services, allied with the commercial sensitivity issue, resulted in little PLICS presence in collaborative cross-organisational initiatives, whether between trusts or across acute and community services. PLICS data relate to activities along the patient pathway. Such costs make sense to clinicians. We found that PLICSs had created greater clinical engagement in resource management despite the fact that the trust finance function had actively communicated PLICSs as a new costing tool and often required its use in, for example, business cases for clinical investment. Operational financial management at the trusts was undertaken through service line reporting (SLR) and traditional directorate budgets. PLICSs were considered more of a strategic tool.ConclusionsBoth PLICSs and SLR identify and interrogate service line profitability. Although trusts currently cross-subsidise to support loss-making areas under the tariff, they are actively considering disinvesting in unprofitable service lines. Financial pressure within the NHS, along with its current competitive, business-oriented ethos, induces trusts to act in their own interests rather than those of the whole health economy. However, many policy commentators suggest that care integration is needed to improve patient care and reduce costs. Although the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) requires both competition and the collaboration needed to achieve care integration, the two are not always compatible. We conclude that competitive forces are dominant in driving the current uses of PLICSs. Future research should interrogate the use of PLICSs inNew Care Models – Vanguard Sites(NHS England.New Care Models – Vanguard Sites. NHS England; 2015) and initiatives to deliver the ‘Five Year Forward View’ (Monitor and NHS England.Reforming the Payment System for NHS Services: Supporting the Five Year Forward View. London: Monitor; 2015).FundingThe National Institute for Health Research Health Services and Delivery Research programme.