Contribution Margin Research Articles

Early Financial Outcomes of Physician Modified Endograft Programs Are Dictated by Device Cost

IntroductionPhysician-modified endografts (PMEGs) have been used for repair of thoracoabdominal aortic aneurysms (TAAAs) for 2 decades with good outcomes but limited financial data. This study compared the financial and clinical outcomes of PMEGs to the Cook Zenith-Fenestrated (ZFEN) graft and open surgical repair (OSR). MethodsA retrospective review of financial and clinical data was performed for all patients who underwent endovascular or OSR of juxtarenal aortic aneurysms and TAAAs from January 2018 to December 2022 at an academic medical center. Clinical presentation, demographics, operative details, and outcomes were reviewed. Financial data was obtained through the institution's finance department. The primary end point was contribution margin (CM). ResultsThirty patients met inclusion criteria, consisting of twelve PMEG, seven ZFEN, and eleven open repairs. PMEG repairs had a total CM of −$110,000 compared to $18,000 for ZFEN and $290,000 for OSR. Aortic and branch artery implants were major cost-drivers for endovascular procedures. Extent II TAAA repairs were the costliest PMEG procedure, with a total device cost of $59,000 per case. PMEG repairs had 30-d and 1-y mortality rates of 8.3% which was not significantly different from ZFEN (0.0%, P = 0.46; 0.0%, P = 0.46) or OSR (9.1%, P = 0.95; 18%, P = 0.51). Average intensive care unit and hospital stay after PMEG repairs were comparable to ZFEN and shorter than OSR. ConclusionsOur study suggests that PMEG repairs yield a negative CM. To make these cases financially viable for hospital systems, device costs will need to be reduced or reimbursement rates increased by approximately $8800.

Is It Getting More Expensive to Treat Patients Who Have a High Comorbidity Burden? Financial Trends in Total Knee Arthroplasty From 2013 to 2021

BackgroundUtilization of total knee arthroplasty (TKA) continues to rise among patients who have a high comorbidity burden (HCB). With changes in reimbursement models over the past decade, it is essential to assess the financial impact of HCB TKA on healthcare systems. This study aimed to examine trends in revenue and costs associated with TKA in HCB patients over time. MethodsOf 14,978 TKA performed at a large, urban academic medical center between 2013 and 2021, we retrospectively analyzed HCB patients (Charlson comorbidity index ≥ 5 and American Society of Anesthesiology scores of 3 or 4). A total of 1,156 HCB TKA patients who had complete financial data were identified. Patient demographics, perioperative data, revenue, costs, and contribution margin were collected for each patient. Changes in these financial values over time, as a percentage of 2013 values, were analyzed. Linear regression was performed with a trend analysis to determine significance. ResultsFrom 2013 to 2021, the percentage of HCB TKAs per year increased from 4.2% in 2013 to 16.5% in 2021 (P < .001). The revenue of TKA in HCB patients remained steady (P = .093), while direct costs increased significantly (32.0%; P = .015), resulting in a decline of contribution margin to a low of 82.3% of 2013 margins. There was no significant change in rates of 90-day complications or home discharge following HCB TKA during the study period. ConclusionsThe results of this study indicate a major rise in cost for TKA among HCB patients, without a corresponding rise in revenue. As more patients who have HCB become candidates for TKA, the negative financial impact on institutions should be considered, as payments to institutions do not adequately reflect patient complexity. A re-evaluation of institutional payments for medically complex TKA patients is warranted to maintain patient access among at-need populations.

Modeling combined-cycle power plants in a detailed electricity market model

The efficiency and flexibility of combined-cycle gas turbines (CCGT) are gaining importance in view of more decarbonized energy systems. Therefore, an adequate representation of CCGTs in large-scale energy system models is required. When modeling large-scale energy systems, a trade-off between detailed representation of the technical restrictions and reasonable computing times emerges because of limited computing capacities.We present an approach that accounts for the operational dependencies between the gas and steam turbines of a CCGT but remains applicable in large-scale market models. Duct burners and bypasses that enable the solo operation of steam or gas turbines are also modeled. We implement our approach using the well-established Joint Market Model and apply it in a case study of the German electricity system in 2040.Our modeling approach captures more detailed operation modes, while increases in computation time remain limited. Thus, the approach is advantageous when turbine-wise modeling and analysis of CCGTs is required, e.g. for a detailed analysis of start-ups and operations. The results show no substantial differences between the aggregated market results of five cases investigated. The consideration of bypasses and duct burners yet leads to higher contribution margins for individual CCGTs – with stronger effects observed for more efficient groups.

Simultaneous Versus Staged Bilateral Total Hip Arthroplasty: A Matched Cohort Analysis of Revenue and Contribution Margin

BackgroundThough previous studies have demonstrated improved cost benefits associated with simultaneous versus staged bilateral total hip arthroplasty (simBTHA and staBTHA), further investigation is needed regarding the revenues and contribution margins (CMs) of these procedures. In this study, we compared revenue, CM, and surgical outcomes between simBTHA and staBTHA. MethodsAll patients who underwent simBTHA (both procedures completed the same day) and staBTHA (procedures completed on different days within one year) between 2011 and 2021 at a single high-volume orthopedic specialty hospital were identified. Of the 1,517 identified patients (n = 139 simBTHA, n = 1,378 staBTHA), 232 were included in a 1:1 propensity match based on baseline demographics (116 per cohort). Revenue, costs, CM, and surgical outcomes were compared between cohorts. ResultsCompared to staBTHA, simBTHA procedures had significantly lower total costs (P < .001), direct costs (P < .001), and patient revenue. There was no significant difference in CM between groups (P = .361). Additionally, there were no significant differences in length of stay (P = .173), operative time (P = .438), 90-day readmissions (P = .701), 90-day revisions (P = .313), or all-cause revisions (P = .701) between cohorts. ConclusionsThough simBTHA procedures have lower revenues than staBTHA, they also have lower costs, resulting in similar CM between procedures. As both procedures have similar postoperative complication rates, further research is required to evaluate specifically which patients may benefit from simBTHA versus staBTHA regarding clinical and patient-reported outcomes. Level of EvidenceIII.

Trends in Revenue, Cost, and Contribution Margin of Patients Who Have a High Comorbidity Burden Undergoing Total Hip Arthroplasty From 2013 to 2021

BackgroundWith the increasing utilization of total hip arthroplasty (THA) in patients who have a high comorbidity burden (HCB), coinciding with modifications to reimbursement models over the past decade, an evaluation of the financial impact of HCB on THA over time is warranted. This study aimed to investigate trends in revenue and cost associated with THA in HCB patients. MethodsOf 13,439 patients who had primary, elective THA between 2013 and 2021 at our institution, we retrospectively reviewed 978 patients considered to have HCB (Charlson comorbidity index ≥ 5 and American Society of Anesthesiology scores 3 or 4). We collected patient demographics, perioperative data, revenue, cost, and contribution margin (CM) of the inpatient episode. We analyzed changes as a percentage of 2013 values over time for these financial markers. Linear regression determined trend significance. The final analysis included 978 HCB patients who had complete financial data. ResultsBetween 2013 and 2021, direct costs increased significantly (P = .002), along with a nonsignificant increase in total costs (P = .056). While revenue remained steady during the study period (P = .486), the CM decreased markedly to 38.0% of 2013 values, although not statistically significant (P = .222). Rates of 90-day complications and home discharge remained steady throughout the study period. ConclusionsIncreasing costs for HCB patients undergoing THA were not matched by an equivalent increase in revenue, leading to dwindling CMs throughout the past decade. Re-evaluation of reimbursement models for THA that account for patients’ HCB may be necessary to preserve broad access to care. Level of EvidenceIII.

Financial impact of donation after circulatory death heart transplantation: A single-center analysis.

Clinical success of donation after circulatory death (DCD) heart transplantation is leading to growing adoption of this technique. In comparison to procurement from a brain-dead donor, DCD requires additional resources. The economic impact of DCD heart transplantation from the hospital perspective is not well known. We compared the financial data of patients who received DCD allografts to those who received a DBD organ at our institution from January 1, 2021 to December 31, 2022. We also compared the cost of ex-situ machine perfusion to in-situ organ perfusion employed during DCD recovery. We performed 58 DBD and 22 DCD heart-alone transplantations during the study period. Out of 22 DCD grafts, 16 were recovered with thoracoabdominal normothermic regional perfusion (TA-NRP) and six with direct procurement followed by normothermic machine perfusion (DP-NMP). The contribution margin per case for DBD versus DCD was $234,362 and $235,440 (P=.72). The direct costs did not significantly differ between the two groups ($171,949 and 186,250; P=.49). In comparing the two methods of procuring hearts from DCD donors, the direct cost of TA-NRP was $155,955 in comparison to $223,399 for DP-NMP (P=.21). This difference translated into a clinically meaningful but not statistically significant greater contribution margin for TA-NRP ($242, 657vs. $175,768; P=.34). Our data showed that the adoption of DCD procurement did not have a negative financial impact on the contribution margin in our institution. Programs considering starting DCD heart transplantation, and those who are currently performing DCD procurement should evaluate their own financial situation.

Optimization of Product Costs in the Food and Beverage Business: A Target Costing Approach

Purpose –The study aims to evaluate the feasibility of implementing the target costing method in a local food and beverage business, aiming to optimize product costs and boost product demand through cost reduction and pricing products below market prices.Design/methodology/approach –Interviews were conducted with business owners to develop standard recipe cards for the four products, and a comparison was made between current costs and target costs. Analysis of standard recipe cards for these products was performed to calculate material cost ratios, unit contributions, and contribution rates. The target costing method was implemented by adjusting the quantities of components and exploring supplier alternatives to reduce costs and increase target cost indices.Findings –The findings revealed that the target costing approach led to varying degrees of cost reduction and improved contribution margins for the four products. However, the desired enhancements in target cost indices were not fully achieved, highlighting the needfor further assessment of supply, pricing, and material sourcing.Discussion –The study highlights the potential of target costing in optimizing costs and stimulating demand in the food and beverage industry. It also suggested that additional research and adjustments might be necessary to fully realize the benefits of the target costing method in specific cases. Furthermore, comparing costs across multiple businesses or considering franchise establishments in future studies could offer more insights into the effectiveness of target costing in different scenarios.

Dollars and Sense: The Financial Argument for Dedicated Posttrauma Center Care.

To demonstrate that the creation of a Center for Trauma Survivorship (CTS) is not cost-prohibitive but is a revenue generator for the institution. A dedicated CTS has been demonstrated to increase adherence with follow-up visits and improve overall aftercare in severely injured patients discharged from the trauma center. A potential impediment to the creation of similar centers is its assumed prohibitive cost. This pre and post-cohort study examines the financial impact of patients treated by the CTS. Patients in the PRE cohort were those treated in the year before CTS inception. Eligibility criteria are trauma patients admitted who are ≥18 years of age and have a New Injury Severity Score ≥16 or intensive care unit stay ≥2 days. Financial data were obtained from the hospital's billing and cost accounting systems for a 1-year time period after discharge. There were 176 patients in the PRE and 256 in the CTS cohort. The CTS cohort generated 1623 subsequent visits versus 748 in the PRE cohort. CTS patients underwent more follow-up surgery in their first year of recovery as compared with the PRE cohort (98 vs 26 procedures). Each CTS patient was responsible for a $7752 increase in net revenue with a positive contribution margin of $4558 compared with those in the PRE group. A dedicated CTS increases subsequent visits and necessary procedures and is a positive revenue source for the trauma center. The presumptive financial burden of a CTS is incorrect and the creation of dedicated centers will improve patients' outcomes and the institution's bottom line.

PENERAPAN TEKNIK MENU ENGINEERING DALAM MENINGKATKAN PENJUALAN DAN KEUNTUNGAN PADA HOTEL SWISSBELL HARBOURBAY BATAM

The objective of this research is to investigate the application of Menu Engineering techniques in improving sales and profits at Swiss-Bell Harbourbay Batam Hotel. The research employs a qualitative methodology, utilizing data collection techniques such as interviews, observations, and strategic analysis using menu engineering. The menu analysis, conducted through menu engineering, revealed a total of 61 food items at Swiss-Café Swiss-Bell Harbourbay Batam, categorized into stars, puzzles, plowhorses, and dogs. Among these, 15 food items fall under the stars classification, constituting 25 of the total menu items. The stars category represents a blend of high menu variety and the highest contribution margin, featuring food items from the Swiss Café. Furthermore, the dogs classification comprises 28 menu items, constituting 46 of the total, indicating the highest quantity among all categories.

The Financial Burden of Patient Comorbidities on Total Hip Arthroplasties—A Matched Cohort Analysis of High Comorbidity Burden and Non–High Comorbidity Burden Patients

BackgroundThe impact of increased patient comorbidities on the cost-effectiveness of total hip arthroplasty (THAs) is lacking. This study aimed to compare revenue, costs, and short-term (90 days) surgical outcomes between patients who have and do not have a high comorbidity burden (HCB). MethodsWe retrospectively reviewed 14,949 patients who underwent an elective, unilateral THA between 2012 and 2021. Patients were stratified into HCB (Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiology scores of 3 or 4) and non-HCB groups, and were further 1:1 propensity matched based on baseline characteristics. Perioperative data, revenue, costs, and contribution margins (CMs) of the inpatient episode were compared between groups. Also, 90-day readmissions and revisions were compared between groups. Of the 11,717 patients who had available financial data (n = 1,017 HCB, n = 10,700 non-HCB), 1,914 patients were included in the final matched analyses (957 per group). ResultsTotal (P < .001) and direct (P < .001) costs were significantly higher for HCB patients. Comparable revenue between cohorts (P = .083) resulted in a significantly decreased CM in the HCB patient group (P < .001). The HCB patients were less likely to be discharged home (P < .001) and had significantly higher 90-day readmission rates (P = .049). ConclusionsIncreased THA costs for HCB patients were not matched by increased revenue, resulting in decreased CM. Higher rates of nonhome discharge and readmissions in the HCB population add to the additional financial burden. Adjustments to the current reimbursement models should better account for the increased financial burden of HCB patients undergoing THA and ensure access to care for all patient populations. Level of evidenceIII.

Production planning in an indoor farm: Using time and space requirements to define an efficient production schedule and farm size

Abstract Indoor agriculture is an innovative and environmentally sustainable approach to high-quality food production, utilizing advanced technology to reduce water usage by 95% and achieve a 100-fold increase in production per unit of land compared to conventional farming systems. These enclosed systems provide year-round production of pesticide-free fresh food, even in cities with less favourable climates, addressing food deserts and creating employment opportunities in urban areas. However, the industry faces significant challenges, primarily stemming from substantial investment and operating costs, exacerbated by a limited understanding of the input-output relationship within these systems. This study employs a bioeconomic framework to establish a foundational production function based on growth cycle duration (time) and required growing area (space). Through a partial budget analysis, a 19-day production schedule was identified to provide the highest contribution margin to profits. Results set the minimum size of this hypothetical lettuce indoor farm at 273 m2, rendering it suitable for installation in urban areas. The farm harvests 118 kg per day, within an 800 m2 growing area distributed across four vertically stacked shelves. Estimates of economic output sensitivity to exogenous factors in the US context are also presented, along with a comparison between cost-minimizing and revenue-maximizing strategies.

Same day discharge colon surgery: is it financially worth it?

Same day discharge (SDD) for colorectal surgery shows increasing promise in the era of enhanced recovery after surgery protocols and minimally invasive surgery. It has become increasingly relevant due to the constraints posed by the COVID-19 pandemic. The aim of this study was to compare SDD and postoperative day 1 (POD1) discharge to understand the clinical outcomes and financial impact on factors such as cost, charge, revenue, contribution margin and readmission. A retrospective review of colectomies was performed at a single institution over a 2-year period (n = 143). Two populations were identified: SDD (n = 51) and POD1 (n = 92). Patients were selected by International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) and Diagnosis Related Grouper (DRG) codes. There was a statistically significant difference favouring SDD in total hospital cost (p < 0.0001), average direct costs (p < 0.0001) and average charges (p < 0.0016). SDD average hospital costs were $8699 (values in USD throughout) compared with $11 652 for POD 1 (p < 0.0001), and average SDD hospital charges were $85 506 compared with $97 008 for POD1 (p < 0.0016). The net revenue for SDD was $22 319 while for POD1 it was $26 173 (p = 0.14). Upon comparison of contribution margins (SDD $13 620 vs. POD1 $14 522), the difference was not statistically significant (p = 0.73). There were no identified statistically significant differences in operating room time, robotic console time, readmission rates or surgical complications. Amidst the pandemic-related constraints, we found that SDD was associated with lower hospital costs and comparable contribution margins compared with POD1. Additionally, the study was unable to identify any significant difference between operating time, readmissions, and surgical complications when performing SDD.

Growing tobacco on a small rural property: analysis of cost, volume and profit

Most of the exported tobacco is grown in the South region, totaling 96.8% of national production. The crop is produced on small rural properties with an average area of ​​14.2 hectares. However, the management of small rural properties is deficient. The agricultural costs involved in production are little known, causing a deficiency in the management of the business. Rural farmers also need planning and budgeting to assist in decision making, in addition to having some knowledge of accounting tools. Considering the lack of these factors in rural areas, the objective of this article is to demonstrate in a managerial way what is the Cost, Volume and Profit of the tobacco culture in a small rural property located in the Municipality of Prudentópolis-PR. Through a qualitative and quantitative approach. As a result, it was identified that the property presented low profitability due to the high costs and low sales price obtained. Finally, with all the cost and expense data collected and organized, it is possible to calculate the cost and profit volume with a focus on the variable costing method. The value of the calculation of the Accounting, Economic-Financial Break-even Point was obtained, as well as the Safety and Contribution Margin, as well as the Operational Leverage that were presented to the farmers, since they did not have full control over the costs, they were unaware of the calculation of the depreciation known only to them as “possible wear and tear of the goods”.

ANALYSIS OF IMPLEMENTATION OF COSTS, VOLUMES AND PROFITS AT PT JOBUBU JARUM MINAHASA TBK AND PT KIAN SANTANG MULIATAMA TBK

This research aims to analyze the financial reports of PT Jobubu Jarum Minahasa Tbk and PT Kian Santang Muliatama Tbk for 2021 and 2022. The analysis focuses on contribution margin, break even point, margin of safety, profit planning, operating leverage and shut down point. Data collection methods include library research. The research results show an increase in the profitability of both companies from 2021 to 2022. The analysis provides in-depth insight into the companies' financial and operational performance. It can be concluded that PT Jobubu Jarum Minahasa Tbk has a better contribution margin, break even point and maximum profit than PT Kian Santang Muliatama Tbk. However, PT Kian Santang Muliatama Tbk has more efficient operating leverage. Overall, the analysis shows better financial and operational performance of PT Jobubu Jarum Minahasa Tbk in 2021 and 2022.

Analisis Cost Volume Profit Sebagai Dasar Perencanaan Laba Yang Diharapkan

Cost Volume Profit Analysis as a Basis for Expected Profit Planning (Case Study of Privately Owned Business "Ifamoy Home Industri"). Under the guidance of A company needs profit planning to help management determine the level of profit it wants to obtain, with Cost Volume Profit analysis which focuses on various factors that influence changes in profit components at the Ifamoy Home Industry company. This research aims to determine the application of Cost Volume Profit Analysis in the Ifamoy Home Industry. This research uses descriptive research. The data collection technique used is the Observation and Documentation Technique on existing income data at Ifamoy Home Industry. The results of this research show that the Total Calculation Profit is IDR. 828,000,0000.00, with a total Contribution Margin of IDR. 1,670,000,000 with a ratio of 0.8%, with a Total Break Even Point of Rp. 512,000,000, with a total margin of safety of Rp. 1,568,000,000, with a ratio of 75%, with profit planning to increase by (20%) in 2023 resulting in a profit of Rp. 2,508,200,000.

The Financial Feasibility of Bilateral Total Knee Arthroplasty: A Matched Cohort Analyses of Revenue and Contribution Margin Between Simultaneous and Staged Procedures

BackgroundFinancial analyses of simultaneous bilateral total knee arthroplasty versus staged bilateral total knee arthroplasty (simBTKA and staBTKA, respectively) have shown improved cost-effectiveness of simBTKA, though revenue and contribution margin (CM) for these procedures have not been investigated. Our analyses compared surgical outcomes, revenues, and CMs between simBTKA and staBTKA. MethodsWe retrospectively reviewed all patients who underwent simBTKA (both procedures done on the same day) and staBTKA (procedures done on a different day within one year) between 2012 and 2021. Patients were 1:1 propensity matched based on baseline characteristics. Surgical outcomes, as well as revenue, cost, and CM of the inpatient episode were compared between groups. Of the 2,357 patients evaluated (n = 595 simBTKA, n = 1,762 staBTKA), 410 were included in final matched analyses (205 per group). ResultsTotal (P < .001) and direct (P < .001) costs were significantly lower for simBTKA procedures compared to overall costs of both staBTKA procedures. Significantly lower revenue for simBTKA procedures (P < .001), resulted in comparable CM between groups (P = .477). Postoperative complications including 90-day readmission (P = 1.000), 90-day revision (P = 1.000) and all-cause revision at latest follow-up (P = .083) were similar between groups. ConclusionsIn our propensity-matched cohort, lower costs for simBTKA compared to staBTKA were matched by lower revenues, with a resulting similar CM between procedures. Given that postoperative complication rates were similar, both procedures had comparable cost-effectiveness. Future research is needed to identify patients for whom simBTKA may represent a better surgical intervention compared to staBTKA with respect to clinical and patient reported outcomes.

Analisis Biaya Produksi Berbasis Pendekatan Variable Costing pada UMKM Catering Dapur Mutiara

The purpose of this research is to analyze how to estimate production costs at the Dapur Mutiara Catering business in October 2023 using a variable costing approach. Cost analysis with the variable costing method is a calculation of production costs that only includes variable cost elements. The method used in the research is a qualitative method with a case study approach. Through cost analysis and preparation of income statements, the study concludes that the sales value of Dapur Mutiara in October 2023 was Rp 20,332,000 with total variable costs to produce the products is Rp 15,113,000, thus in that period the contribution margin value was Rp 5,219,000 with a contribution profit ratio on sales reaching 25.67%. Meanwhile, the total fixed costs reached Rp 500,000, resulting in a net profit value of Rp 4,719,000. Thus, the profit target of 35% targeted by the business owner has not been achieved because the percentage value of net profit on sales is only 23.21%, this happens because the production costs are too high and the selling price is set too low

Analisis laba jangka pendek pada UD Trikora Manado

Short-term profit is the income a company receives in a performance measure during a certain time. Short-term profit components consist of break-even point, margin of safety, contribution margin, shut-down point and degree of operating leverage. The aim of this research is to determine short-term profit analysis at UD Trikora Manado. This type of research uses a qualitative descriptive method with qualitative data and quantitative data. The data source used is primary data with interview and documentation data collection. The results of this research show that the break-even point shows that UD Trikora is above the break-even point, the margin of safety shows that UD Trikora has still reached the safe limit. Contribution margin can cover fixed costs and make a profit. Shut down point shows that UD Trikora is above Shut down point so the company is still worth continuing and degree of operating leverage shows that if the company experiences a 1% increase in sales, then the company's opportunity to make a profit in 2021 and 2022 is equal to 1.18%.

The Financial Implications of Pancreatic Surgery: The Hospital Is the Big Winner, Not the Surgeon!

High-volume pancreatic surgery centers require a significant investment in expertise, time, and resources to achieve optimal patient outcomes. A detailed understanding of the economics of major pancreatic surgery is limited among many clinicians and hospital administrators. A greater consideration of these financial aspects may in fact have implications for enhancing clinical care and for a broader sustainability of high-volume pancreatic surgery programs. In this retrospective observational study, patients who underwent pancreaticoduodenectomy (PD), total pancreatectomy, or distal pancreatectomy at one academic medical center during the fiscal year 2021 were evaluated. Detailed hospital charges and professional fees were obtained for patients using the Qlik perioperative database. Clinical data for the study cohort were gathered from a prospectively maintained, IRB-approved pancreatic surgery database. Charges for the 91-day perioperative period were included. A P < 0.05 was considered significant. During the study period, 159 evaluable patients underwent 1 of 3 designated pancreatic resections included in the analysis. Ninety-seven patients (61%) were diagnosed with adenocarcinoma and 70% (n = 110) underwent PD. The total charges (combined professional and hospital charges) for the cohort encompassing the entire perioperative period were $20,661,759. The median charge per patient was $130,306 (interquartile range [IQR], $34,534). The median direct cost of care was $23,219 (IQR, $6321) and the median contribution margin per case was $10,092 (IQR, $22,949). The median surgeon professional fee charges were $7700 per patient (IQR, $1296) as compared to $3453 (IQR, $1,144) for professional fee receipts (45% of the surgeon charge). The differences between the professional fee charges and receipts per patient were also considerable for other health care professionals such as anesthesiologists ($4945 charges vs $1406 receipts [28%]) and pathologists ($3035 charges vs $680 receipts [22%]). The surgeon professional fees were only 6% of the total charges, while the professional fees for anesthesiology and pathology were 4% and 2% of the total charges, respectively. Supply charges were 3% of the total charges. Longer operative time was correlated with increased hospital and anesthesia charges, without a significant increase in surgeon charges (P < 0.001, P < 0.001, and P = 0.2, respectively). Male sex, diabetes, and low serum albumin correlated with greater total hospital charges (P = 0.01, P = 0.01, and P = 0.03, respectively). The role of the surgeon in the perioperative clinical care of major pancreatic resection patients is crucial and important and is by no means limited to the operative day. Nevertheless, in the context of the current US health care system, the reimbursement to the surgeon in the form of professional fees is a relatively small fraction of the total health care receipts for these patients. This imbalance necessitates a substantial financial partnership between hospitals and their pancreatic surgery units to ensure the long-term viability of these programs.

Performance Analysis of Trading Company Through Cost Volume Profit (A Case Study of Salt Trading Corporation Limited)

The objective of the research is to analyze the performance of a Trading Company through cost-volume-profit with reference to Salt Trading Corporation Limited. The major goal of this paper is to scrutinize the financial performance from 2069-70, as well as its influence on the economic growth of Nepal. According to the findings, Salt Trading Corporation has a low contribution margin, low P/V ratio, high breakeven point, and low margin of safety. It further indicates that cost and breakeven point have a positive correlation as sales price and breakeven point have a negative correlation. The company's condition is very poor and requires effective improvement in the given situation.