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Financial Acumen:Cost Management Tools
Course Objectives
• Describe how healthcare business is different from other types of business
• Understand your department’s financial performance
• Identify the metrics used at the HSO level
• Create a plan for better financial management, focusing on finding and resolving variances
• Practice accessing your monthly reports to perform similar activities to those in class
Review:Videos and Survey
Reimbursement depends on
• Payors/payor mixes
• Patient Population
• Length of Stay
• Readmissions
Our Relationships
• With physicians
• With patients
• Affiliations
Different from other Businesses
• Customers
• Ability to Pay• Per diem
• Fee for Service
• Case Rates
Types of Reimbursement
Video Review: How is healthcare “business” different than other businesses?
Video Review: What is unique about the structure of BJC HealthCare?
Not for Profit
• We reinvest in ourselves
• We share profits internally
• We invest in capital improvements
• We invest in our employees through competitive salaries, benefits, education, and training
Community Benefit
• Expanding/Adding Community Services through our Profits
• Charity care• Education and research• Safety net services• Community health
programs
Different types of HSO
• Community HSOs
• Academic HSOs
Video Review:What are the Key Result Areas at BJC HealthCare?
• Patient Satisfaction/Clinical Quality
• Employee Engagement
• Growth
• Performance Reporting
• Productivity Improvement
• Unit Cost Management
“Meeting financial budgets, having quality outcomes for our patients and the staff being happy with the environment.
These three intertwining things are the crux of our jobs as front-line managers.”
Elaine Thomas-HortonClinical Nurse ManagerBarnes-Jewish Hospital
“Being able to make all the metrics fit is a balancing act. Maintaining good employee engagement scores, good patient satisfaction scores, and meeting your budget is a delicate business.
You can’t go too much on the budget side. You reduce staffing to get under budget, this may make your employee engagement or your patient satisfaction scores decline. It’s all a balancing act.”
Tom ChiarelliDirector of Finance
St. Louis Children’s Hospital
From the HSOs:How do you affect the Key Result Areas at BJC HealthCare?
ActivityNot-for Profit vs. For-Profit
Characteristic Not-for-Profit For-Profit
Must provide community benefit
Profits can be distributed to individuals
Company has to pay taxes
Profits must be reinvested into the company
ActivityNot-for Profit vs. For-Profit
Characteristic Not-for-Profit For-Profit
Must provide community benefit Yes No
Profits can be distributed to individuals
Company has to pay taxes
Profits must be reinvested into the company
ActivityNot-for Profit vs. For-Profit
Characteristic Not-for-Profit For-Profit
Must provide community benefit Yes No
Profits can be distributed to individuals No Yes
Company has to pay taxes
Profits must be reinvested into the company
Characteristic Not-for-Profit For-Profit
Must provide community benefit Yes No
Profits can be distributed to individuals No Yes
Company has to pay taxes No Yes
Profits must be reinvested into the company
ActivityNot-for Profit vs. For-Profit
Characteristic Not-for-Profit For-Profit
Must provide community benefit Yes No
Profits can be distributed to individuals No Yes
Company has to pay taxes No Yes
Profits must be reinvested into the company Yes No
ActivityNot-for Profit vs. For-Profit
55%45%
$500,000,000 in Billed Charges
Total Net Revenue = $230,000,000
Managed Care = 55% reimbursement rate $151,250,000
Managed Care charges = $275,000,000
Government = 35% reimbursement $78,750,000
Government Charges = $225,000,000
Government Charges Managed Care Charges
HSO Performance:Impact of Payor Mix
HSO Performance:Why is there a difference between gross and net revenue?
Current year actual
Current year budget
Prior year actual
Total Gross revenue 88,773 85,058 78,226
Charity Care (392) (488) (337)
Revenue Deductions (38,656) (36,391) (32,974)
Net Patient Revenue 49,725 48,178 44,915
Current year actual
Current year budget
Prior year actual
Total Gross revenue 88,773 85,058 78,226
Charity Care (392) (488) (337)
Revenue Deductions (38,656) (36,391) (32,974)
Net Patient Revenue 49,725 48,178 44,915
HSO Performance:Why is there a difference between gross and net revenue?
Standard RateCharity Cases
– Payor Rates Net Revenue
Gross Revenue = our standard rate we charge for services
Revenue Deductions = difference between our rate and reimbursement
So Net Revenue is Gross Revenue minus Charity Care payments and minus revenue deductions needed because our payors do not pay our full standard fees.
HSO Performance:Operating Margin Percentage
“How much of our revenues did we retain as profit?”
Operating Income
Operating Revenue= Operating Margin
Current year actual
Current year budget
Prior year actual
Total Operating Revenue 58,728 57,204 52,662
Total Operating Expense 53,277 52,372 48,701
Operating Income/ Margin 5,451 4,832 8,961
How much of our revenue was profit?
Operating Income
Operating Revenue
= ___%
Example 5,451 58,728 = 9.28%
HSO Performance:Operating Margin Percentage
HSO Performance:Operating Margin Percentage
How much of our revenue was profit?
Operating Income Operating
Revenue = %
Current Year
Last Year
2 Years Ago
Current Year Last Year 2 years Ago
Total Operating Revenue 368,900 372,800 350,700
Total Operating Expense 347,900 348,800 320,700
Operating Income/ Margin 21,000 24,000 30,000
How much of our revenue was profit?
Operating Income Operating
Revenue = ___%
Current Year 21,000 368,900 5.69
Last Year 24,000 372,800 6.43
2 Years Ago 30,000 350,700 8.55
Current Year Last Year 2 Years Ago
Total Operating Revenue 368,900 372,800 350,700
Total Operating Expense 347,900 348,800 320,700
Operating Income/ Margin 21,000 24,000 30,000
HSO Performance:Operating Margin Percentage
HSO Performance:How are Budgets established?
To help set budgets, we look at • HSO history• Projections• Reimbursement• BJC Targets
Two kinds of budgets • Operating • Capital
HSO Performance:How Budgets are Established
• What is it?
• What is it based on?
• Who puts it together?
• What if conditions that
the budget was based
on change?• Who owns it?
Operating Budget:
Capital Budget:
• What is it?
• What is it based on?
• How is it spent?
HSO Performance:How Budgets are Established
Campus Renewal Programs
Base facility renewals/renovations, infrastructure, equipment and base
discretionary I.T.
Strategic Facilities in-cluding major facilities
an equipment pur-chases
Strategic and En-terprise I.T. initia-
tives
Reserved as CEO Contingency to be managed by BJC
9% of Total Revenue
The Numbers Game
The Numbers Game
The Numbers Game
The Numbers Game
OriginalScore
OriginalScore
Percentage ofIncrease
FinalScore
( _____ - _______) / _______ = ________ %
Department Performance
Department Performance:Income Statement
• How much income the department is making or losing.
Department Performance:Income Statement Activity
1. Did this department make money in December? 2. How did actual earnings compare to budgeted
earnings, favorable or unfavorable?3. Were actual earnings favorable or unfavorable for this
month compared to last year? By how much?4. What report line provides this information?5. What types of charges are Inpatient (IP)?6. What types of charges are Outpatient (OP)?7. How did this month’s actuals of Inpatient and
Outpatient revenue compare to last year, favorable or unfavorable?
8. What are some of the “charge capture systems” you use to enter these charges?
9. What are your responsibilities for capturing charges?
Department Performance:Income Statement Activity
HSO Performance:The Income Statement…
10 minute break
It's only a penny…
Department Performance:Your Cost Management Tools
Department Performance:Your Cost Management Tools
Department Performance: Unit Cost
Total Cost
+
Labor Per Stat
Supplies Per Stat
Unit Cost# of Cases
=
=
Department Performance: Calculating Unit Cost
Lab Actual Budgeted Variance
Total Expenses 1,000 1,000 0
Lab Actual Budgeted Variance
Total Expenses 1,000 1,000 0
Volume (Lab Tests) 100 150 (50)
Unit Cost
Unit Cost Variance
We had 50 fewer lab tests than we budgeted, so our volumes were down.
But was our cost per lab test also down?
Department Performance: Calculating Unit Cost
Total Expenses Volume = Unit Cost
1,000 100 10
1,000 150 6.6
Department Performance: Calculating Unit Cost
Lab Actual Budgeted Variance
Total Expenses 1,000 1,000 0
Volume (Lab Tests) 100 150 (50)
Unit Cost 10 6.6
Unit Cost Variance
Unit Cost Variance Budgeted Unit Cost = Unit Cost % Variance
(3.4) 6.6 (51.5%)
Department Performance: Calculating Unit Cost
Lab Actual Budgeted Variance
Total Expenses 1,000 1,000 0
Volume (Lab Tests) 100 150 (50)
Unit Cost 10 6.6 (3.4)
Unit Cost Variance (3.4) 6.6 (51.5%)
Lab Actual Budgeted Variance
Total Expenses 234,365 241,000 6,635
Volume (Lab Tests) 71,000 78,527 (7,527)
Unit Cost
Unit Cost % Variance
Total Expenses Volume = Unit Cost
Unit Cost Variance Budgeted Unit Cost = Cost % Variance
Department Performance: Calculating Unit Cost - Activity
Lab Actual Budgeted Variance
Total Expenses 234,365 241,000 6,635
Volume (Lab Tests) 71,000 78,527 (7,527)
Unit Cost 3.30 3.06 (.24)
Unit Cost % Variance (.24) 3.06 -.078 or (7.8%)
Total Expenses Volume = Unit Cost
Unit Cost Variance Budgeted Unit Cost = Cost % Variance
Department Performance: Calculating Unit Cost - Activity
Department Performance: Next Key Metric - Labor Per Stat
The biggest thing you can control is labor costs. Labor can be 50-70% of your costs.
• Labor Per Stat (LPS) - the cost of labor it takes to provide a specific service. Also called:
– Labor per service, or – Labor per patient day.
• LPS formula is similar to Unit Cost formula– Total Labor Cost/# of Cases = Labor Cost
Department Performance: Labor Per Stat
How do you control the biggest thing in your budget?
• Our Labor Per Stat (LPS) Tool:
• Two ways to control your labor / improve the LPS: – Increase volume– Reduce hours
Department Performance:Calculating Labor Per Stat
Lab Actual Budgeted Variance
Total Labor Hours 500 600 100
Volume (Lab Tests) 100 150 (50)
Labor Per Stat 5 4 (1)
Labor Per Stat % Variance
(1) 4 (25%)
Total Labor Hours Volume = Labor Per Stat
Labor Per Stat Variance
Budgeted Labor Per Stat
= % Labor Per Stat Variance
Department Performance:Calculating Labor Per Stat - Activity
Lab Actual Budgeted Variance
Total Expenses 395,960 375,487
Volume (Lab Tests) 73,326 69,923
Unit Cost
Unit Cost % Variance
Total Hours 9,165 9,090
Volume (Lab Tests) 73,326 69,923
Labor Per Stat
Labor Per Stat % Variance
Lab Actual Budgeted Variance
Total Expenses 395,960 375,487 (20,473)
Volume (Lab Tests) 73,326 69,923 3,403
Unit Cost 5.3999 5.37 (.0299)
Unit Cost % Variance (0.56%)
Total Hours 9,165 9,090 (75)
Volume (Lab Tests) 73,326 69,923 3,403
Labor Per Stat .125 .13 .005
Labor Per Stat % Variance
3.8%
Department Performance:Calculating Labor Per Stat - Activity
Department Performance:Last Key Metric – Supply Per Stat
• Supply Per Stat (SPS) - the cost of supplies to provide a specific service. Also called:
– Supplies per service, or – Supplies per patient day
• SPS formula is similar to Unit Cost formula– Total Supplies Cost/# of Cases = Supplies Cost
How do you control the Supplies in your budget?
• What affects the SPS
• Two ways to control your supplies / improve your SPS– look for these items on your Budget Variance Report:
• Big ticket items• Compare quantities
Department Performance:Last Key Metric – Supply Per Stat
Department Performance: Summary
Questions?
• Unit Cost
• Labor per Stat
• Supply per Stat
Let’s Review Important Concepts: FTE
Let’s Review Important Concepts: FTE
FTE Cost: • how much we pay each employee for the FTE they provide.• range of costs
• i.e.premium for weekend-only options
IMPT: • to know how much the FTE is costing your department, as well as • how many FTEs you have for your department. Your department has a designated amount of hours per patient, test, etc. to complete work. If you run over these allotted hours, your department will have a negative FTE balance.
MONITOR: Late clock-outs AND Early clock-insYou must ensure that dollars are not directed away from patient care.
Let’s Review Important Concepts: FTE
FTE Calculator
1 FTE for full year 2080 hours (Leap year 2088 hours)
1 FTE for 31 day month 177 hours (rounded)
1 FTE for 30 day month 171 hours (rounded)
1 FTE for 28 day month 160 hours (rounded)
1 FTE per pay period 80 hours
April YTD Nursing Division 3700 has paid a total of 12450 hours.
How many FTEs have been paid YTD? Total Hours Paid
Hours YTD= FTEs
_______/___ = ____ FTEs
____ hrs Jan ____ hrs Feb ____ hrs Mar
+ ____ hrs Apr___ Hours YTD
Let’s Review Important Concepts: FTE
FTE Calculator
1 FTE for full year 2080 hours (Leap year 2088 hours)
1 FTE for 31 day month 177 hours (rounded)
1 FTE for 30 day month 171 hours (rounded)
1 FTE for 28 day month 160 hours (rounded)
1 FTE per pay period 80 hours
April YTD Nursing Division 3700 has paid a total of 12450 hours.
How many FTEs have been paid YTD? Total Hours Paid
Hours YTD= FTEs
12,450/685 = 18.2 FTEs
177 hrs Jan 160 hrs Feb 177 hrs Mar
+ 171 hrs Apr685 Hours YTD
Let’s Review Important Concepts: Productive/NonProductive
How do you figure out productive/nonproductive?
Activity: Productive RN Hours per Patient Day
Actual Budget Variance
Volume 200 225
Prod RN Hours 1380 1385
Prod RN Hours/Pt Day 6.9 6.15
How many productive RN Hours could have been used with a volume of 200 pt days and still deliver 6.15 Productive RN hours per pt. day?
Actual Budget Variance
Volume 200 225 (11.1%)
Prod RN Hours 1380 1385 0.36%
Prod RN Hours/Pt Day 6.9 6.15 (12.2%) Formula (6.15 – 6.90) / 6.15 = (12.2%)
How many productive RN Hours could have been used with a volume of 200 pt days and still deliver 6.15 Productive RN hours per pt. day?
Formula: 200 (pt days) X 6.15 (Bud Prod RN Hrs per Pt Days) = 1230 Prod RN Hrs earned
Activity: Productive RN Hours per Patient Day
Adjusted to Volume Activity
• If the actual total census was 450 patient days, how many productive RN hours could be paid and still deliver 7.00 budgeted productive RN hours per patient day?
• If the actual total census was 350 patient days, how many productive RN
hours could be paid and still deliver 7.00 budgeted productive RN hours per patient day?
Nursing Division 2500 has a budgeted census of 400 patient days and 7.00 budget productive RN hours per patient day.
Let’s Review Important Concepts:Accruals
Let’s Review Important Concepts:Accruals
September October
Operating Room receives implants on patients (volume recorded) and bills them (revenue recorded).
Invoice paid for spine implants – accrual reversed.
Accrual is made to record when the expense was incurred, if it hasn’t been paid.
Net impact to October is 0.
Let’s Review Important Concepts:Accruals
December January
Invoice dated 12/15/2012 for $1000 was received on 12/25/12 by the manager for approval.
Accounts Payable pays invoice on 1/5/2013.
Invoice sent to Accounts Payable for payment.
Let’s Review Important Concepts:Accounts Payable (AP)
Purchase orders needed for most items. Invoices are sent directly to AP for coding.
Exception: Direct pay invoices (primarily for services).You code these and send to AP for payment.
To send:Send an email to "MYBJCINVOICES". Each invoice should have a
separate pdf file. You may attach up to 5 separate invoice files in one email.
Send a fax to 314-747-1860. There should be a separate fax for each invoice.
If we have questions or encounter problems regarding Cardinal invoices, please contact Carol Payne in AP.
If you would like to set up a Recurring Payment, please email Angelina Williams in AP directly after completing the Recurring payment form found in PeopleSoft.
What to do with your Variances?
• Start by determining why it occurred.
• What are some things you could try to mitigate issues you’ve found?
• What are some examples you’ve tried?
Variances not addressed proactively will accumulate.
Actions to take to manage expenses
How do you prepare when you will be asked for explanations?• When you find a variance, dig in and look for causes• Determine steps of what you will to correct it
Make sure you:• Know your numbers
• Be able to explain your numbers: “Volume was up, I had to bring people in and pay them overtime. I expect another month like this because it’s wintertime.”
• Have ideas on how to mitigate costs
Follow UpCost Management Action Plan
• Create a way to transfer this knowledge into your job.– What steps will you take?
• Fill out Action Plan• Include a timeline for implementation.
– Email form to your manager/director one week from today.
• CLL will send you a reminder email to you and your manager/director 2, 4 and 6 weeks later with follow up questions/activities regarding your form.
• Class credit to be given after the form has been received.
Resources:Finance Support
• Finance Operations (from BJH)
• Financial/Capital Analysis
• Patient Access
• Patient Financial Services
• Health Information Management
• Compliance Officer
• Utilization Review Dept - works w/managers to figure out issues
Know Your Business
• Review Course Objectives– What is one thing you will do differently?
• Explain what impacts your business financially – We need to take good care of our patient
but we need to be good stewards
of our resources.
• Know that what you do everyday affects our bottom line– Treat this as if its your own money.
– Good management of your finances
looks good on your performance review.
Your turn!Accessing Monthly Reports
Accessing Monthly Financial ReportsSteps 1 & 2
Accessing Monthly Financial ReportsSteps 3 & 4
Accessing Monthly Financial ReportsSteps 5 & 6
Accessing Monthly Financial ReportsStep 7
Accessing Monthly Financial ReportsStep 8
Accessing Monthly Financial ReportsStep 9
Accessing Monthly Financial ReportsSteps 10 & 11
Accessing Monthly Financial ReportsStep 12
Accessing Monthly Financial ReportsSteps 13 & 14