Indirect Expenses Research Articles

A Rational Permit Fee Structure for the Street Right-of-Way Permit Program

This article describes the details of a study carried out to review the city of Cincinnati’s utility cut permit program, compare the city’s street rights-of-way practices and policies with other communities, identify the true costs of permit program, and suggest a new, rational, permit fee structure. An innovative procedure has been developed to assess the monetary impact of utility cuts on street pavement. The proposed fee structure considers all the estimated direct and indirect expenses to support the permit program and to maintain the physical assets. The new structure has been extensively reviewed by the city’s engineers and legal advisors and is being considered for implementation.

Assessing the economic burden of asthma

Assessing the economic burden of asthma

Description and Predictors of Direct and Indirect Costs of Pain Reported by Cancer Patients

The purpose of this study was to describe direct and indirect costs associated with pain in cancer patients and to examine potential predictors of these costs. The study surveyed cancer outpatients about direct costs resulting from pain-related hospitalizations, emergency department visits, physician office visits, and use of analgesic medications and indirect costs related to money spent on pain-related transportation, complementary methods to improve pain management, educational materials, over-the counter medication, domestic support, and childcare. Furthermore, the study examined age, marital status, race, income level, pain severity, pain interference, and presence of breakthrough pain as predictors of direct and indirect costs. Three hundred and seventy-three cancer outpatients were sampled. One hundred and forty-four cancer patients (39%) reported experiencing cancer-related pain and completed the study questionnaires. Seventy-six percent (76%) of the patients had experienced at least one pain-related cost, resulting in an average monthly direct cost of US$ 891/month per patient. Sixty-nine percent (69%) of patients had experienced some type of direct medical cost due to pain, resulting in an average total direct pain-related cost of US$ 825/month per patient. Fifty-seven percent (57%) of patients reported incurring at least one indirect pain-related expense for an average indirect cost of US$ 61/month per patient. Higher pain intensity, greater pain interference, and presence of breakthrough pain predicted higher direct and indirect medical expenses. Younger age and lower income level also predicted higher direct medical expenses.

O uso do custeio baseado em atividades: ABC (Activity Based Costing) nas maiores empresas de Santa Catarina

Devido à globalização da economia, as empresas evoluíram para a produção de enormes variedades de produtos personalizados. Com o intuito de atender às exigências dos clientes, surgiu a necessidade de grandes alterações nos processos tecnológicos. Como conseqüência, os custos indiretos passaram a ser mais significativos, o que implicou um novo método de distribuição desses custos, capaz de distribuir melhor os custos indiretos aos produtos e serviços. A esse método foi dado o nome de custeio baseado em atividades - ABC (Activity Based Costing). Esse método foi investigado por Carlos Yorghi Khoury em 1996, numa pesquisa aplicada às 500 maiores empresas do Brasil. O objetivo deste trabalho foi replicar essa pesquisa nas maiores empresas catarinenses, a fim de observar se esses resultados obtidos assemelham-se aos obtidos na pesquisa com as empresas catarinenses.Nesta pesquisa, dos 200 questionários enviados para as maiores empresas de Santa Catarina, 81 retornaram com as questões respondidas. O trabalho levou a conclusões importantes, como: as empresas de Santa Catarina têm amplo conhecimento do sistema ABC; algumas empresas que implantaram esse sistema já estão desistindo de seu uso, em função da complexidade para apropriar os custos indiretos e as despesas às atividades e estas aos produtos.

Wirtschaftliche Bewertung der Arbeitsunfähigkeit durch muskuloskelettale Erkrankungen

Musculoskeletal disorders are the most expensive form of work disability for companies. In Germany, they are responsible for almost 27% of all production downtimes caused by sick leave from work. The direct and indirect annual expenses of these disorders amount to approximately 24.5 billion Euro for the labor force and approximately 38 billion Euro for the total population. For analytical and practical reasons, measures for prevention of this socioeconomic damage should be implemented in companies.

Problems of case and disease management in outpatient treatment of influenza.

Influenza needs to be made subject to a rigorous disease management system, since the number of persons affected is very large even in a normal influenza season. In Germany, there are as many as 10,000 fatalities a year. In pandemics, the figure may be several orders higher. The quality of healthcare can be increased by means of a high vaccination rate and timely use of antiviral agents such as zanamivir and oseltamivir. This makes it possible to save on antibiotics and indirect costs. Studies of recent years provide enough evidence for guidelines. Given timely treatment, there is no need for cross-sectoral healthcare, because the family doctor can handle both the vaccination program and the antiviral therapy. If an influenza wave is confirmed by official statistics, clinical diagnosis alone is sufficient. The course of the illness can be influenced by the insured person's own initiative. Readiness to be vaccinated and the timely start of treatment depend on the extent to which the insured person is informed. The disease involves high financial cost in terms of indirect expenses. The possible vaccination and treatment measures should therefore be propagated within companies as well.

Why Should Pediatricians Use RBRVS-based Fee Schedules?

Why Should Pediatricians Use RBRVS-based Fee Schedules?

"Halstedian 2" residency training: bridging the generation gap.

The turn of the century has brought more than a new millennium. It has placed a spotlight on a medical system in crisis. This has not been of sudden onset but an insidious process that has occurred during the last 2 decades for most of the nation. What makes the effect of this crisis so alarming is the fact that it emerged from what was considered a gilded era. A period of overall financial surplus and exponential growth had occurred in practically all aspects of medicine, with increased disbursement of direct and indirect medical expenses, expansion of clinical practices with unprecedented profits, increased medical school enrollment, an increase in the number of residents, and enhanced research programs. Concomitant with this phenomenon were skyrocketing medical costs. With these costs as high as 15% of the gross national product, the medical field became fertile ground for a multitude of managed care initiatives that often promoted goals in competition with the discipline of health care delivery. Many managed care ventures embraced a policy of proprietary issues ahead of service, in keeping with the business motto There is no mission without a margin [profit].

Cost of intensive care in a Norwegian University hospital 1997–1999

AimThe present study was performed in order to document costs of intensive care in a Norwegian university hospital and to perform an average cost-effectiveness study using the expected remaining life-years in survivors after 18 months.Materials and methodsPatients admitted to the general intensive care unit (ICU) at Haukeland University Hospital from 1997 to 1999 were followed up to 18 months post ICU using data from the Norwegian Peoples' registry. Our ICU patients have a further mortality equal to the average population in Norway from that time. By creating an age-matched and sex-matched sample of the general Norwegian population equal to survivors 18 months after ICU treatment, we could find the expected further survival time for each ICU survivor. Direct and indirect ICU expenses in the study period were retrieved using a 'top-down' method. Outcome assessment was performed using the total ICU expenses in the period divided by the sum of the life expectancy (years) in survivors after 18 months.ResultsThe total ICU costs (converted to 2001 values) were € 16,697,415, excluding the costs of radiology and the use of operating theatres, which were both impossible to retrieve. A total of 1051 patients were treated, of whom 60.9% survived up to 18 months. Further total life expectancies were 24,428 years. The average costs of an ICU day and stay per patient were € 2601 and € 14,223, respectively, and the average cost per year of survival per patient was € 684.DiscussionThe absolute costs were found to be higher than recent European ICU studies reporting on the cost of ICU treatment. However, the price of a further life-year in survivors was lower and was comparable with other medical treatment.

Apskaita ir įmonės valdymas

Pastaraisiais dešimtmečiais visame pasaulyje daug dirbama tobulinant ir harmonizuojant apskaitą. Pasiekti rezultatai iš esmės pakeitė apskaitos reikšmę įmonei valdyti. Lietuvoje tik prieš dešimt metų pradėta diegti apskaitą, atitinkančią rinkos ekonomikos sąlygas. Nors pasiekta nemažai, apskaitos galimybės iki galo neišnaudojamos, ypač priimant strateginius valdymo sprendimus. Į apskaitą vis dar žiūrima kaip į faktų techninio registravimo priemonę. Iš dalies taip yra dėl to, kad vadybininkai neišmano visų apskaitos galimybių, o buhalteriai nežino vadybininkų poreikių. Kartais ir pačių buhalterių kvalifikacija nepasiekė tokio lygio, kad jie galėtų pateikti originalių pasiūlymų.Straipsnyje siekiama atskleisti apskaitos galimybes ir naujausių jos laimėjimų reikšmę racionalizuojant ir tobulinant įmonės veiklą.

PAR1: COST OF ASTHMA IN CHILDREN IN VLADIVOSTOK

OBJECTIVES: Estimation the cost of asthma in children in Vladivostok. METHODS: In cost of disease we determined direct expenses: pharmacotherapy, hospital, out-patient and emergency expenditures; indirect expenses: disability pension, temporary invalidity of parents and quality of child's life with asthma in Vladivostok during 1995–1998. 645 families with asthmatic children filled in a questionnarie. RESULTS: Family expenses on pharmacotherapy of asthmatic child during the 1996 year averaged 1520,81 roubles (rb) ($303), in 1998—increased to 2149,45 rb at the expense of basic therapy. In 1996 direct family expenses on asthmatic child was 10,98 ± 1,33% of annual income, in 1998—13,70 ± 1,46% and bulk of the expenditures was pharmacotherapy. 1159 children with asthma in 1995 had 618 cases of hospitalization, total duration was 16 058 days. One child with asthma in 1995 year had 13,64 ± 1,0 days of hospitalization, in 1998—8,81 ± 0,92. Volume of hospitalization depended on heaviness of disease. In 1996 among 22 651 emergency cases in city 230 (1,02%) was to asthmatic children. In 1998 this index was decreased to 109. In 1996 out-patient expenses one asthmatic child was 223,05 ± 32,50 rb, in 1998—272,46 ± 36,96 rb. In 1997–1998 expenses for allergologist and pulmonologist are increased. In 1996 among 1028 asthmatic children 37 got disability pension (270 rb in month). Total family expenses on asthmatic child in Vladivostok in 1996 was 4070,84 ± 86,70 rb ($810,83 ± 10,63), in 1997—4767,58 ± 69,94 rb ($821,99 ± 8,46), in 1998—4203,58 ± 46,24 rb. In 1996 on asthmatic child in Vladivostok bulk of the expenditures was hospitalization, in 1998—pharmacotherapy. CONCLUSION: Introduction in Vladivostok in 1997–1998 the National program of treatment asthma in children resulted in wide use of basic therapy, increasing family expenses asthmatic child on pharmacotherapy and decreasing municipal expenses on hospitalization, emergency care and indirect losses of family.

The evolution of medicare financing policy for graduate medical education and implications for PM&R: A commentary

Currently, the only explicit payers for graduate medical education (GME) in the United States are the federal and state governments. Of these, Medicare is by far the largest and most predictable payer. Through the prospective payment system, Medicare reimburses teaching institutions for both their direct and indirect costs associated with their GME programs. Because a well-educated workforce benefits patients covered by private, as well as public insurance, various proposals have been advanced to establish an all-payer pool to distribute the financial burden more equitably. Furthermore, Medicare policy affects physician supply. There is increasing recognition of potential physician oversupply, raising policy questions about the government's longstanding support of GME. In comparison with other specialties, physical medical and rehabilitation (PM&R) may receive more favorable treatment under future GME funding plans, for 2 reasons. First, under the formulas used by Medicare, PM&R training slots typically bring in more indirect revenue to teaching hospitals than is consumed in indirect expenses. This makes PM&R a relatively more attractive program to retain in the face of mandated reductions in training slots. Second, in many parts of the country, PM&R is not threatened by oversupply, making cuts less likely. Nevertheless, the high percentage of non-US medical graduates entering PM&R training may make the specialty vulnerable to future reductions in funded training slots.

Why Pediatricians Should Use RBRVS-based Fee Schedules

Why Pediatricians Should Use RBRVS-based Fee Schedules

Hospital costs of pediatric intensive care

To characterize hospital costs of pediatric intensive care and to determine which demographic and disease characteristics are associated with cost. Prospective cohort study. A 20-bed pediatric intensive care unit (PICU) in an urban university-affiliated teaching children's hospital. All children (n = 1,376) admitted to the multidisciplinary PICU during the fiscal year 1994. None. Demographics, diagnoses, organ failure, Pediatric Risk of Mortality score, length of stay (LOS), and outcome were recorded. All hospital charges were obtained. The actual hospital costs were calculated by two separate methods. First, we converted the itemized patient charges into costs, using corresponding cost-to-charge ratios for each charge. In addition, we examined all direct and indirect expenses for the PICU. Univariate and multivariate regression analyses were used to determine the correlates to cost. The study population was similar to that of other studies of pediatric intensive care. The PICU was 86% efficient. The total cost for PICU care was $16,983,323. Average cost per admission was $12,342 +/- $22,313, and average cost per patient day was $2,264 +/- $868. The cost because of the PICU location (room cost) was 52.1% of all costs, and cost of laboratory studies was 18.3%. Respiratory therapy, pharmacy services, and radiology each accounted for between 6% and 8%. Total cost was most closely related to LOS, but severity of illness (Pediatric Risk of Mortality), diagnosis, and organ failure were also significant. Severity of illness was the most important factor in determining the variation in daily costs. Increased severity of illness was associated with higher laboratory and diagnostic study costs. We found little difference in the PICU room cost when calculated by adding direct and indirect expenses, compared with that obtained by using the cost-to-charge ratio. The maintenance of the specialty location and its personnel is the most costly component of pediatric intensive care. The strongest correlate with total cost for pediatric intensive care is LOS, but if costs are normalized for LOS, severity of illness best explains cost variation among patients. These data may serve as the basis for additional studies of resource allocation and consumption in the future.

Um modelo de reconciliação de dados para o custeio baseado-em-atividades (ABC)

A mudança na estrutura dos custos, em função de novas tecnologias de produção, de uma maior diversificação imposta pela competitividade empresarial e da redução dos custos de medição, criou condições para o aparecimento de técnicas de gerenciamento de custos voltadas para a captação mais precisa das despesas indiretas que cada produto consome. Nesse mister destaca-se o Custeio Baseadoem- Atividades/Gerenciamento Baseado-em-Atividades (ABC/ABM) como uma das técnicas mais importantes surgidas nos últimos anos, que proporciona uma estimativa mais precisa das despesas indiretas reais que incidem em cada produto. Existem, contudo, certos custos cuja obtenção é difícil mesmo com a utilização de técnicas como o ABC. Isso se deve não só pela impossibilidade, em alguns casos, de serem determinados com adequada exatidão, como, em outros, pelo fato de o investimento na sua medição ultrapassar o benefício a ser obtido com ele. Nesse sentido, o presente trabalho desenvolve, para o fluxo de custos de uma empresa, inspirado na reconciliação de dados utilizada nos processos das plantas químicas, um modelo para a determinação de todos os custos indiretos, partindo do conhecimento preciso de alguns dos custos que compõem o citado fluxo de custos. O modelo desenvolvido utiliza programação matemática não-linear.

Manage indirect practice expense the way you practice medicine: with information.

Surgeons are increasingly faced with the pressures of maintaining the highest quality of patient care, while at the same time maintaining financial viability. The purpose of this project was to provide a framework for analyzing practice costs for colorectal surgeons using an activity-based cost accounting model. A survey of 11 practices that were diverse in terms of geography, managed care penetration, academic vs. private practice style, and case distribution was performed. In activity-based costing the assignment of typical costs such as staff salaries are assigned to the appropriate business process. The business processes employed in this study were service patients in the office, perform in-office procedures, schedule cases in facilities, service patients in the hospital, insurance authorization, maintain medical records, billing, collections, resolve billing disputes, interaction with third parties, maintain professional education, sustain and manage the practice, maintain the facility, teaching and research, and performing drug studies. The final step is to assign the cost associated with all appropriate business processes to the appropriate cost object. The cost objects in this study were defined as a charge office visit, no-charge office visit, charge hospital visit, in-office procedures, in-facility procedures, and performing drug studies. The data were then analyzed to allow a comparison of four similar practices within the study group. The data demonstrated that the cost of seeing a charge office visit ranged from $55 to $105. Similarly, the cost of seeing a no-charge office visit during the global period ranged from $43 to $100. The study analyzed possible explanations for the wide variability in these costs. It is essential that physicians clearly understand the sources of expenses generated by the operation of their practices. A clear comprehension of costs will lead colorectal surgeons to make appropriate decisions regarding such important issues as office staffing ratios, office square footage, and instrumentation acquisitions.

Strategies for Success among OPOs: A Study of Three Organ Procurement Organizations

Productivity among organ procurement organizations varies widely in the US, and the pressure to determine critical success factors increases as the organ pool shrinks and managed care expands. This study compared three successful organ procurement organizations, identified commonalities among them in cost of doing business, and examined direct and indirect expenses, staffing, specialized requestor programs, and professional and public education programs. The three organ procurement organizations were chosen because of their performance in terms of donors per million population, complexity, and size. The following key indicators were compared and analyzed: annual operating budget, size and composition of staff, funds and resources invested in professional education versus public education, tissue recovery operations, results of minority initiatives, and employee compensation programs.

Mental health services of the future: Managed care, unmanaged care, mismanaged care

Abstract Rising costs. Treatable disorders. No treatment for many. High indirect expenses. The response to this contemporary set of circumstances has been managed mental health care. The transition from fee‐for‐service to managed behavioral health services has meant the industrialization of mental health care, an entirely new culture for providers, and a melding of the traditional public and private sectors. This article examines the evolution of managed behavioral healthcare from the point of view of how and why it occurred, what it means for providers, how it will impact on the seriously mentally ill, ways in which pay ors and providers can reach consensus on future directions, and the risks inherent in this process.

EVA® FOR BANKS: VALUE CREATION, RISK MANAGEMENT, AND PROFITABILITY MEASUREMENT

This article presents a complete ranking of America's 100 largest bank holding companies according to their shareholder value added. This research, the first of its kind for the banking industry, defines an EVA measurement for banks and presents evidence of EVA's stronger correlation with bank market values than traditional accounting measures like ROA and ROE.Besides developing EVA and MVA as analytical tools for viewing the economic performance of the organization from a shareholder perspective, the authors also present a framework for calculating EVA at all levels of the organization, including lines of business, functional departments, products, customer segments, and customer relationships. The implementation of an EVA profitability measurement system at the business unit (or lower) level requires methods for three critical tasks: (1) transfer pricing of funds; (2) allocation of indirect expenses; and (3) allocation of economic capital. Although solutions to the first two are fairly straightforward, the allocation of capital to business units is a major challenge for banks today. In contrast to the complex, “bottom‐up” approach used by a number of large banks in implementing their RAROC systems, the authors propose a greatly simplified, “top‐down” approach that requires calculation of only the volatility of a business's operating profit (or NOPAT). The advantage of using NOPAT volatility is that it allows EVA analysis at any level of the organization in a way that captures the volatility effects from all sources of risk (credit, interest rates, liquidity, or operations).While such a top‐down approach is clearly not meant to take the place of a comprehensive, bottom‐up RAROC analysis, it is intended to provide a complement–a high‐level “check” on the detailed, bottom‐up risk management procedures and controls now in place at most banks. Moreover, for those banks that have developed extensive funds transfer pricing, cost allocation, and RAROCstyle capital allocation systems, the EVA financial management system can either be integrated with those systems or serve as an independent economic assessment of the bank's business risks and returns.

The Lung Health Study

Chronic obstructive pulmonary disease (COPD) is a major and growing health problem throughout the world. In the United States, close to 13 million people were recognized to have the condition in 1986, 1 but even this staggering number is probably an underestimate. 2 Its annual cost was more than $12 billion in direct and indirect medical expenses in 1990. It is now the fourth leading cause of death in this country, with a mortality of more than 90 000 in 1991. 3 These figures do not reveal an equally vital statistic, the great physical limitation and suffering of many of these patients in the last years of their lives. The principal etiologic factor, and by far the most potent one, cigarette smoking, has been known for decades. Moreover, the classic studies of Fletcher et al in the United Kingdom 4 and the studies of many others See also p 1497.