Article 1
Review: Chapters 14 and 15 attached and
16 Financial Ratios for Analyzing a Company’s Strengths and Weaknesses (Links to an external site.)
article and the
Financial Ratios (Links to an external site.)
web page.
Background: As the office manager for Dr. Smith and Brown’s, you have the responsibility of ensuring efficient operation of their practices. In your healthcare career, you will need to understand the criteria, and use of comparative data as well as terms such as common-sizing, trend analysis, forecasting and projecting, which requires the analysis of data to make informed decisions.
Write: Complete Comparative Data Template attachment. For this assignment, You are responsible for providing detailed responses to the questions posed in the document. You will also need to provide examples where indicated as well as references formatted per APA guidelines. When you have completed the document template, it should be at least two pages in length.
USE THE ATTACHMENTS TO HELP YOU COMPLETE THE TEMPLATE!!!
DUE 1.9.20 @10 AM EASTERN STANDARD W/ PLAG REPORT
on time
Week4 Assignment
Comparative Data
Prior to beginning this assignment, review Chapter 14 and 15 in the course textbook, Health Care Finance: Basic Tools for the Nonfinancial Managers, 5th edition. These two chapters will assist you in responding accurately to the questions in the table.
Instructions:
Complete the following table by writing detailed and thorough responses to the questions.
Provide examples where indicated. Once the document template is completed, you should have at least two pages. APA formatted citations and references are required. Cite the sources per in the narrative and list the reference in the last box of the table.
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What is meant by common sizing? Provide an example: |
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What is meant by Trend Analysis? Provide an example: |
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What is the difference between forecasting and projecting? |
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What are the three common types of forecasts in a Healthcare Organization? |
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Name the three criteria that must be met for true comparability. Discuss each. |
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What elements of consistency should be considered? Provide an example: |
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Discuss the importance of comparative data and explain the healthcare manager’s responsibility when comparing data |
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Name the four common uses of Comparative Data. Discuss each. |
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Explain Standardized Data Provide an example. |
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List your References: REQUIRED |
Same Year for All Three Hospitals
Hospital 1 Hospital 2 Hospital 3
Current liabilities $100,000 20% $500,000 25% $400,000 80%
Long-term debt 400,000 80% 1,500,000 75% 100,000 20%
Total liabilities $500,000 100% $2,000,000 100% $500,000 100%
14.1 COMMON SIZING
The process of common sizing puts information on the same relative basis. Generally,
common sizing involves converting dollar amounts to percentages. If, for example, total
revenue of $200,000 equals 100%, then radiology revenue of $20,000 will equal 10% of that
total. Converting dollars to percentages allows comparative analysis. In other words,
comparing the percentages allows a common basis of comparison. Common sizing is
sometimes called “vertical analysis” (because the computation of the percentages is
vertical).
Although such comparisons on the basis of percentages can, and should, be performed on
your own organization’s data, comparisons can also be made between or among various
organizations. For example, Table 14–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_1#ch14_tbl1) shows
how common sizing allows a comparison of liabilities for three different hospitals. In each
case, the total liabilities equal 100%. Then the current liabilities of hospital 1, for example,
are divided by total liabilities to find the proportionate percentage attributable to that line
item (100,000 divided by 500,000 equals 20%; 400,000 divided by 500,000 equals 80%).
When all the percentages have been computed, add them to make sure they add to 100%. If
you use a computer, computation of these percentages is available as a spreadsheet function.
Table 14–1 Common Sizing Liability Information
Another example of comparative analysis is contained in Table 14-2
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Same Year for All Three Hospitals
Hospital 1 Hospital 2 Hospital 3
General services expense
Dietary $320,000 40% $1,260,000 42% $450,000 50%
Maintenance 280,000 35% 990,000 33% 135,000 15%
Laundry 80,000 10% 300,000 10% 90,000 10%
Housekeeping 120,000 15% 450,000 15% 225,000 25%
Total GS expense $800,000 100% $3,000,000 100% $900,000 100%
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_1#ch14_tbl2) . In this
case, general services expenses for three hospitals are compared. Once again, the total
expense for each hospital becomes 100%, and the relative percentage for each of the four
line items is computed ($320,000 divided by $800,000 equals 40% and so on). The
advantage of comparative analysis is illustrated by the “laundry” line item, where the dollar
amounts are $80,000, $300,000, and $90,000 respectively. Yet each of these amounts is 10%
of the total expense for the particular hospital.
Table 14–2 Common Sizing Expense Information
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Hospital 1
Year 1 Year 2 Difference
Current liabilities $100,000 20% $150,000 25% $50,000 50%
Long-term debt 400,000 80% 450,000 75% 50,000 12.5%
Total liabilities $500,000 100% $600,000 100% $100,000 –
14.2 TREND ANALYSIS
The process of trend analysis compares figures over several time periods. Once again, dollar
amounts are converted to percentages to obtain a relative basis for purposes of comparison,
but now the comparison is across time. If, for example, radiology revenue was $20,000 this
period but was only $15,000 for the previous period, the difference between the two is
$5,000. The difference of $5,000 equates to a 33.3% difference because trend analysis is
computed on the earlier of the two years: that is, the base year (thus, 5,000 divided by
15,000 equals 33.3%). Trend analysis is sometimes called “horizontal analysis” (because the
computation of the percentage of difference is horizontal).
An example of horizontal analysis is contained in Table 14–3
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_2#ch14_tbl3) . In this
case, the liabilities of hospital 1 for year 1 are compared with the liabilities of hospital 1’s
year 2. Current liabilities, for example, were $100,000 in year 1 and are $150,000 in year 2,
a difference of $50,000. To arrive at a percentage of difference for comparative purposes, the
$50,000 difference is divided by the year 1 base figure of $100,000 to compute the relative
differential (thus, 50,000 divided by 100,000 is 50%).
Table 14–3 Trend Analysis for Liabilities
Another example of comparative analysis is contained in Table 14–4
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_2#ch14_tbl4) . In this
case, general services expenses for two years in hospital 1 are compared. The difference
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Hospital 1
Year 1 Year 2 Difference
General services expense
Dietary $320,000 40% $405,000 45% $85,000 26.5%
Maintenance 280,000 35% 270,000 30% (10,000) (3.5)%
Laundry 80,000 10% 45,000 5% (35,000) (43.5)%
Housekeeping 120,000 15% 180,000 20% 60,000 50.0%
Total GS expense $800,000 100% $900,000 100% $100,000 –
between year 1 and year 2 for each line item is computed in dollars; then the dollar
difference figure is divided by the year 1 base figure to obtain a percentage difference for
purposes of comparison. Thus, housekeeping expense in year 1 was $120,000, and in year 2
was $180,000, resulting in a difference of $60,000. The difference amounts to 50% ($60,000
difference divided by $120,000 year 1 equals 50%). In Table 14–4
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_2#ch14_tbl4) , two of
the four line items have negative differences: that is, year 2 was less than year 1, resulting in
a negative figure. Also, the dollar figure difference is $100,000 when added down (subtract
the negative figures from the positive figures; thus, $85,000 plus $60,000 minus $10,000
minus $35,000 equals $100,000). The dollar figure difference is also $100,000 when added
across ($900,000 minus $800,000 equals $100,000).
Table 14–4 Trend Analysis for Expenses
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Comparative Expenses
Account 12-Month
Current
Year
% 12-Month
Prior Year
% Annual
Increase
(Decrease)
% of
Change
Social Security 60,517 4.97 68,177 5.70 (7,660) –12.66
Pension 20,675 1.70 23,473 1.96 (2,798) –13.53
Health Insurance 8,422 0.69 18,507 1.55 (10,085) –119.75
14.3 ANALYZING OPERATING DATA
Comparative analysis is an important tool for managers, and it is worth investing the time to
become familiar with both horizontal and vertical analysis. Managers will generally analyze
their own organization’s data most of the time (rather than performing comparisons against
other organizations). With that fact in mind, we examine operating room operating data (no
pun intended) that incorporate both common sizing and trend analysis.
Table 14–5
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_3#ch14_tbl5) sets out
32 expense items. The expense amount in dollars for each line item is set out for the current
year in the left column (beginning with $60,517). The expense amount in dollars for each
line item is set out for the prior year in the third column of the analysis (beginning with
$68,177). The difference in dollars, labeled “Annual Increase (Decrease),” appears in the
sixth column of the analysis (beginning with [$7,660]). Vertical analysis has been performed
for the current year, and the percentage results appear in the second column (beginning with
4.97%). Vertical analysis has also been performed for the prior year, and those percentage
results appear in the fourth column (beginning with 5.70%). Horizontal analysis has been
performed on each line item, and those percentage items appear in the far right column
(beginning with 12.66%). This table is a good example of the type of operating data reports
that managers receive for planning and control purposes.
Table 14–5 Vertical and Horizontal Analysis for the Operating Room
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Child Care 4,564 0.37 4,334 0.36 230 5.04
Patient
Accounting
155,356 12.76 123,254 10.30 32,102 20.66
Admitting 110,254 9.05 101,040 8.45 9,214 8.36
Medical Records 91,718 7.53 94,304 7.88 (2,586) –2.82
Dietary 27,526 2.26 35,646 2.98 (8,120) –29.50
Medical Waste 2,377 0.20 3,187 0.27 (810) –34.08
Sterile Procedures 78,720 6.46 70,725 5.91 7,995 10.16
Laundry 40,693 3.34 40,463 3.38 230 0.57
Depreciation—
Equipment
87,378 7.18 61,144 5.11 26,234 30.02
Depreciation—
Building
41,377 3.40 45,450 3.80 (4,073) –9.84
Amortization—
Interest
(5,819) –0.48 1,767 0.15 (7,586) 130.37
Insurance 4,216 0.35 7,836 0.65 (3,620) –85.86
Administration 57,966 4.76 56,309 4.71 1,657 2.86
Medical Staff 1,722 0.14 5,130 0.43 (3,408) –
197.91
Community
Relations
49,813 4.09 40,618 3.39 9,195 18.46
Materials
Management
64,573 5.30 72,305 6.04 (7,732) –11.97
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Human Resources 31,066 2.55 13,276 1.11 17,790 57.27
Nursing
Administration
82,471 6.77 92,666 7.75 (10,195) –12.36
Data Processing 17,815 1.46 16,119 1.35 1,696 9.52
Fiscal 17,700 1.45 16,748 1.40 952 5.38
Telephone 2,839 0.23 2,569 0.21 270 9.51
Utilities 26,406 2.17 38,689 3.23 (12,283) –46.52
Plant 77,597 6.37 84,128 7.03 (6,531) –8.42
Environmental
Services
32,874 2.70 37,354 3.12 (4,480) –13.63
Safety 2,016 0.17 2,179 0.18 (163) –8.09
Quality
Management
10,016 0.82 8,146 0.68 1,870 18.67
Medical Staff 9,444 0.78 9,391 0.78 53 0.56
Continuous
Quality
Improvement
4,895 0.40 0 0.00 4,895 100.00
EE Health 569 0.05 1,513 0.13 (944) –
165.91
Total Allocated 1,217,756 100.00 1,196,447 100.00 21,309 1.75
All Other
Expenses
1,211,608 — — — — —
Total Expense 2,429,364 — — — — —
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Comparative analysis is especially important to managers because it creates a common
ground to make judgments for planning, control, and decision-making purposes. Using
comparative data is the subject of the following chapter.
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14.4 IMPORTANCE OF FORECASTS
The dictionary defines “to forecast” as “to calculate or predict some future event or condition,
usually as a result of study and analysis of available pertinent data.”
From the manager’s viewpoint, forecasted data are information used for purposes of planning for
the future. Forecasting, to some degree or another, is often required when producing budgets.
(Budgets are the subject of two of the following chapters.) It is pretty simple today to create “what
if” scenarios on the computer. But the important thing for managers to remember is that
assumptions directly affect the results of forecasts.
Forecasts Versus Projections
Forecasts are different than projections, although both are considered to be “prospective” and thus
“future” financial statements. Forecasts are based on assumptions that are expected to exist, and
that reflect actions that are expected to occur. Projections, on the other hand, are views further into
the future. Because they are further into the future, we “project” future events, projects, or
operations using a set of presumed, or hypothetical, assumptions.
We are discussing forecasts in this chapter rather than projections. Therefore, these forecasts are
relatively short term and can be based on realistic assumptions that we expect to exist, along with
actions that we can reasonably expect to occur.
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Forecasting Approaches
The approach to producing a forecast usually involves three different sources of information and
forecast assumptions:
■ The first level derives from the personnel who are directly involved in the department
or unit. They know the operation and can provide important ground-level detail.
■ The second level comes from electronic and statistical information, including trend
analysis. Electronic reports can provide a thicket of information, and there is a skill to
selecting relevant information for forecasting purposes.
■ The third level represents executive-level judgment that is typically applied to a
preliminary rough draft of the forecast. For example, adjusting volume upward or
downward due to the anticipated future impact of local competition would most likely be
an executive-level judgment.
The amount and type of electronic information that is readily available greatly affects the forecast
difficulty. Electronic templates and standardized worksheets may also greatly influence the final
forecast results.
Common Types of Forecasts in Healthcare Organizations
The three most common types of forecasts found in most healthcare organizations include revenue
forecasts, staffing forecasts, and operating expense forecasts. (The operating expense forecast,
which is not as common, would generally cover those operating expenses other than labor.) This
section will discuss revenue and staffing forecasts, as they are what most managers will need to
deal with.
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14.5 OPERATING REVENUE FORECASTS
Operating revenue forecasts are inputs into the operating budget. Forecast types and their
assumptions are discussed in this section.
Types of Revenue Forecasts
Forecasts of revenue will cover varying time periods. Longer-range multi-year forecasts are useful
for executive decision making regarding the future of the organization. Figure 14–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_5#ch14_fig1) illustrates a
multi-year forecast.
Figure 14–1 Five-Year Operating Revenue Forecast.
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A single-year forecast is generally for the coming year and is thus a short-range forecast. Reliable
forecasts of revenue are a vital part of the organization’s planning process and are an input into the
operating budget. Figure 14–2
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_5#ch14_fig2) illustrates a
short-range forecast. Note that the graph in Figure 14–2
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_5#ch14_fig2) could be by
month instead of by quarter as shown.
Figure 14–2 One-Year Operating Revenue Forecast.
Building Revenue Forecast Assumptions
Five important issues regarding revenue forecast assumptions are discussed here.
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Utilization Assumptions
In health care, significant changes in utilization patterns can be occurring that need to be taken into
account in the manager’s forecast assumptions. The inexorable shift to shorter lengths of stay for
hospital inpatients over the last decade is an example of a basic shift in utilization patterns.
Patient Mix Assumptions
It is important to specify anticipated patient mix as well as his or her anticipated utilization or
volume. By “patient mix” we mean whether the individual is a Medicare patient, a Medicaid
patient, a patient covered by private insurance, or a private pay patient. When payers are thus
identified, this information allows the appropriate payments to be associated with the service
utilization assumptions.
Contractual Allowance Assumptions
The forecasted utilization of a service (or its volume) assumption is multiplied by the appropriate
rate, or charges, in order to arrive at forecasted revenue stated in dollars. A word of warning,
however: revenue forecasted at “gross charges” is not a valid figure. Instead, revenue stated at
“allowed charges” is the proper figure to use. Virtually all payers, including Medicare, Medicaid,
and private insurers, will pay a stipulated amount for a particular service. But the amounts these
different payers have agreed to pay for the same service will vary. How to handle the issue?
Through a contractual allowance, as defined here:
■ Gross Charge: Amount for a service as shown on the claim form; a uniform charge
generally greater than most expected payments received for the service.
■ Allowed Charge: Net amount that the particular payer’s contract or participation
agreement will recognize, or “allow,” for a certain service.
■ Contractual Allowance: Difference (between the gross charge and the allowed charge)
that is recorded as a reduction of the gross charge within the accounting cycle.
(It should also be noted that part of the payer’s allowed charge is generally due from the patient,
and the remaining portion of the allowed charge is actually due from the payer.)
Trend Analysis Assumptions
One of the basic purposes of performing trend analysis is to compare data between or among years
and to see the trends. If such trends are found, then it makes sense to take them into account in your
forecast. A word of warning, however: the manager must determine whether the data used for
comparison in the trend analysis are comparable data.
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Payer Change Assumptions
Trend analysis is retrospective; that is, it is using historical data from a past period. Forecasting is
prospective; that is, it is projecting into the future. If changes, say, in regulatory requirements for
payment are made this year, then that fact has to be taken into account.
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14.7 CAPACITY LEVEL ISSUES IN FORECASTING
In the manufacturing industry, capacity levels relate to the production of, say, widgets. In the world
of health care, capacity relates to services; that is, the ability to produce or provide specific
healthcare services.
Space and Equipment Availability
The ability to provide services is automatically limited by the availability of both space and the
proper equipment to provide certain specific services. Forecasts need to take a realistic view of
these capacity levels.
Staffing Availability
Capacity is a tricky assumption to make in staffing forecasts. In some programs, particularly those
in a startup phase, overcapacity (too much staff available for the amount of work required) is a
problem. In some other organizations, under capacity (a chronic lack of adequate staff) is the
problem. Forecasting assumptions, in the best of all worlds, take these difficulties into account. See
the Mini-Case Study that demonstrates this problem of staffing in the context of the Women,
Infants, and Children (WIC) federal program.
Example of Forecasting Maximum Service Capacity
Exhibit 14–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_7#ch14_exhibit1) illustrates
the array of elements that should be taken into account when computing maximum capacity levels.
This computation is important because your forecast should take maximum capacity into account.
(Alternative assumptions can also be made, of course. See the sensitivity analysis discussion in a
following chapter.)
Exhibit 14–1 Capacity Level Checkpoints for an Outpatient Infusion
Center
Outpatient Infusion Center Capacity Level Checkpoints
2
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_9#ch14_ent2)
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# infusion chairs ……………………………… 3 chairs
# staff……………………………………………… 1 RN
# weekly operating hours ……………….. 40 hours
# of hours per patient infusion ………….. average 2 hours (for purposes of this example)
Work Flow Description
For each infusion the nurse must perform the following steps (generalized for this purpose;
actual protocol is more specific):
■ Obtain and review the patient’s chart
■ Obtain and prepare the appropriate drug for infusion
■ Interview the patient
■ Prepare the patient and commence the infusion
■ Monitor and record progress throughout the ongoing infusion
■ Observe the patient upon completion of the infusion
■ Complete charting
Work Flow Comments
It is impossible for one nurse to start patients’ infusions in all three chairs simultaneously. Thus
the theoretical treatment sequence might be as follows:
■ Assume one half-hour for patient number one’s Steps 1 through 4.
■ Once patient number one is at Step 5, the nurse can begin the protocol for
■ patient number two.
■ Assume another one half-hour for patient number two’s Steps 1 through 4.
■ Once patient number two is at Step 5, theoretically the nurse can begin the protocol
for patient number three.
This sequence should work, assuming all factors work smoothly; that is, the appropriate drugs in
the proper amounts are at hand, the patients show up on time, and no one patient demands an
unusual amount of the nurse’s attention. (For example, a new patient will require more
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attention.)
Daily Infusion Center Capacity Level Assumption
Patient scheduling is never entirely smooth, and patient reactions during infusions are never
predictable. Therefore, we realistically assume the following: Chair #1 = 3 patients per day,
Chair #2 = 2 patients per day, and Chair #3 = 2 patients per day, for a daily total of 7 patients
infused.
SUMMARY
In summary, the ultimate accuracy of a forecast rests on the strength of its assumptions.
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14.6 STAFFING FORECASTS
Staffing forecasts are also inputs into the operating budget. We have addressed staffing
computations, costs, and reports in a previous chapter. This section builds upon that information in
order to produce a staffing forecast. Thus forecast considerations, components, and assumptions are
addressed in this section.
Staffing Forecast Considerations
Staffing forecasts are a very common type of forecast required of managers. Three important
considerations when preparing staffing forecasts are discussed here.
Controllable Versus Noncontrollable Expenses
The concept of responsibility centers and controllable versus noncontrollable expenses has been
discussed earlier in this book. Essentially, controllable costs are subject to a manager’s own
decision making, whereas noncontrollable costs are outside that manager’s power. It is extremely
difficult to make staffing forecasts with any degree of accuracy if noncontrollable expenses are
included in the manager’s forecast. The organization’s structure must be recognized and taken into
account when setting up assumptions for staffing forecasts. Shared services across lines of authority
are workable in theory, but often do not work in actuality. Figure 14–3
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_6#ch14_fig3) gives an
example of the essential “business units” under the supervision of a director of nurses. Note the
responsibility centers and the support centers on this organization chart.
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Figure 14–3 Primary Nursing Staff Classification by Line of Authority.
Courtesy of Resource Group, Ltd., Dallas, Texas.
Required Minimum Staff Levels
Regulatory healthcare standards may set minimum staff levels for providing service in a particular
unit. These minimum levels cannot be ignored in the forecast process.
Labor Market Issues in Staffing Forecasts
We most often hear about a chronic lack of adequate staff, and certain parts of the country do have
a continual shortage of certain qualified professional healthcare staff. Yet other parts of the country
can have an overabundance during that same period. The status of the local labor market has a
direct impact on staffing forecasts. The impact is in dollars: when there are plenty of staff available,
the hourly rate to attract staff may go down, but when there is a shortage of available qualified staff,
the hourly rate has to go up. As strange as it may seem, this elemental economic fact is sometimes
not taken into account in forecasting assumptions.
Staffing Forecast Components
In many cases a staffing plan is first created, and the staffing forecast follows after the plan is
reviewed and refined. Four components are typically required, as follows. Figure 14–4
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_6#ch14_fig4) illustrates the
sequence.
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Figure 14–4 Components of the Staffing Forecast.
Scheduling Requirements
Scheduling requirements should encompass all hours and days required to cover each position. For
example, see the exhibit in the discussion about staffing (Chapter 10
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch10#ch10) ) that illustrates a single
security guard position and the number of units required.
Master Staffing Plan
The master staffing plan should include all units and all hours and days required to cover all
positions within the units. For example, see the exhibit in the discussion about staffing that
illustrates entire units by shift, covering 24 hours per day times 7 days a week.
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Computation Sequence to Annualize the Master Staffing Plan
The annualizing sequence is as follows. (This sequence is illustrated visually in Figure 14–4
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_6#ch14_fig4) . An example
in worksheet form appears in the chapter about staffing.)
■ Compute Productive and Nonproductive Days and Net Paid Days The proportion of
productive days (net paid days) versus nonproductive days (paid days not worked) will
be based on the organization’s policy as to paying for days not worked. For example, see
Step 1 in the Staffing chapter’s exhibit for such a computation, including “Net Paid
Days.” (Holidays, sick days, vacation days, and education days composed the “Paid Days
Not Worked” in the worksheet example within the Staffing chapter’s exhibit.)
■ Convert Net Paid Days Worked to an Annual Factor The total days in the business
year divided by net paid days worked equals a factor. Step 2 in the Staffing chapter’s
exhibit illustrates this computation.
■ Calculate the Annual FTEs Using the Factors Finally, use the factor to calculate the
FTEs required to fully cover the position’s shifts all year long. For example, in the
Staffing chapter’s exhibit, the RN FTE would be 1.6 (1.6106195).
The resulting staffing forecast reflects 24 hour per day 7 days per week annual FTEs to cover all
shifts.
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15.2 COMPARABILITY REQUIREMENTS
True comparability needs to meet three criteria: consistency, verification, and unit measurement.
Each is discussed in this section.
Consistency
Three equally important elements of consistency should be considered as follows.
Time Periods
Time periods should be consistent. For example, a 10-month period should not be compared to a
12-month period. Instead, the 10-month period should be annualized, as described within this
chapter.
Consistent Methodology
The same methods should be used across time periods. For example, the chapter about inventory
discusses the use of two inventory methods: first-in, first-out (FIFO) versus last-in, first-out (LIFO).
The same inventory method—one or the other—should always be used consistently for both the
beginning of the year and the end of the year.
Inflation Factors
Finally, if multiple years are being compared, should inflation be taken into account? The proper
application of an inflation factor is also described within this chapter.
Verification
Basically, can these data be verified? Is it reasonable? If an objective, qualified person reviewed the
data, would he or she arrive at the same conclusion and/or results? You may have to do a few tests
to determine if the data can in fact be verified. If so, you should retain your back-up data, because it
is the evidence that supports your conclusions about verification.
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Monetary Unit Measurement
With regard to comparative data, we should ask: “Is all the information being prepared or under
review measured by the same monetary unit?” In the United States, we would expect all the data to
be expressed in dollars and not in some other currency such as euros (used in much of Europe) or
pounds (used in Britain and the United Kingdom). Most of the manager’s data will automatically
meet this requirement. However, currency conversions are an important part of reporting financial
results for companies that have global operations, and consistency in applying such conversions can
be a significant factor in expressing financial results.
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15.3 A MANAGER’S VIEW OF COMPARATIVE DATA
It is important for the manager to always be aware of whether the data he or she is receiving (or
preparing) are appropriate for comparison. It is equally important for the manager to perform a
comprehensive review, as described here.
The Manager’s Responsibility
Whether you as a manager must either review or prepare required data, your responsibility is to
recall and apply the elements of consistency. Why? Because such data will typically be used for
decision making. If such data are not comparable, then relying upon them can result in poor
decisions, with financial consequences in the future. The actual mechanics of making a comparative
review are equally important. The deconstruction of a comparative budget review follows.
Comparative Budget Review
The manager needs to know how to effectively review comparative data. To do so, the manager
needs to understand, for example, how a budget report format is constructed. In general, the usual
operating expense budget that is under review will have a column for actual expenditures, a column
for budgeted expenditures, and a column for the difference between the two. Usually, the actual
expense column and the budget column will both have a vertical analysis of percentages (as
discussed in the preceding chapter). Each different line item will have a horizontal analysis (also
discussed in the preceding chapter) that measures the amount of the difference against the budget.
Table 15–1 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_3#ch15_tbl1)
illustrates the operating expense budget configuration just described. Notice that the “Difference”
column has both positive and negative numbers in it (the negative numbers being set off with
parentheses). Thus, the positive numbers indicate budget overage, such as the dietary line, which
had an actual expense of $405,000 against a budget figure of $400,000, resulting in a $5,000
difference. The next line is maintenance. This department did not exceed its budget, so the
difference is in parentheses; the maintenance budget amounted to $290,000, and actual expenses
were only $270,000, so the $20,000 difference is in parentheses. In this case, parentheses are good
(under budget) and no parentheses is bad (over budget).
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Hospital 1
Year 2 Actual Year 2 Budget Difference
General Services Expense $ % $ % $ %
Dietary $405,000 45 $400,000 46 $5,000 12.5
Maintenance 270,000 30 290,000 33 (20,000) (6.9)
Laundry 45,000 5 50,000 6 (5,000) (10.0)
Housekeeping 180,000 20 130,000 15 50,000 38.5
Total GS Expense $900,000 100 $870,000 100 $30,000 3.5
Table 15–1 Comparative Analysis of Budget Versus Actual
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PART VI: Construct and Evaluate Budgets
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15.4 USES OF COMPARATIVE DATA
Four common uses of comparisons that the manager will find helpful are discussed in this section.
Compare Current Expenses to Current Budget
Managers are most likely to be responsible for comparing the current expenses of their department,
division, unit, or program to their current budget. Of the four types of comparisons discussed in this
section, this is the one most commonly in use.
Table 15–1 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_3#ch15_tbl1)
illustrates a comparison of actual expenses versus budgeted expenses. This format reflects both
dollars and percentages, as is most common. Table 15–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_3#ch15_tbl1) shows the
grand totals for each department (Dietary, Maintenance, etc.) contained in General Services
expense for this hospital. There is, of course, a detailed budget for each of these departments that
adds up to the totals shown on Table 15–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_3#ch15_tbl1) . Thus, for
example, all the detailed expenses of the Laundry department (labor, supplies, etc.) are contained in
a supporting detailed budget whose total actual expenses amount to $45,000 and whose total
budgeted expenses amount to $50,000.
The department manager will be responsible for analyzing and managing the detailed budgets of his
or her own department. A manager at a higher level in the organization—the chief financial officer
(CFO), perhaps—will be responsible for making a comparative analysis of the overall operations of
the organization. This comparative analysis at a higher level will condense each department’s
details into a departmental grand total, as shown in Table 15–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_3#ch15_tbl1) , for
convenience and clarity in review.
The CFO may also convert this comparative data into charts or graphs in order to “tell the story” in
a more visual manner. For example, the total General Service expense in Table 15–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_3#ch15_tbl1) can be readily
converted into a graph. Figure 15–1
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig1) illustrates such
a graph.
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Figure 15–1 A Comparison of Hospital One’s Budgeted and Actual Expenses.
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Compare Current Actual Expenses to Prior Periods in Own Organization
Trend analysis, as explained in the preceding chapter, allows comparison of current actual expenses
to expenses incurred in prior periods of the same organization. For example, consider total general
services expenses of $800,000 for year 1 and $900,000 for year 2. The CFO could easily convert
this information into a graph, as shown in Figure 15–2
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig2) . This
information might be even more valuable for decision-making input if the CFO used five years
instead of the two years that are shown here.
Figure 15–2 A Comparison of Hospital One’s Expenses Over Time.
Compare to Other Organizations
Common sizing, as explained in the preceding chapter, allows comparison of your organization to
other similar organizations. To illustrate, refer to the table in a preceding chapter (Table 14–1
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(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_1#ch14_tbl1) ) entitled
“Common Sizing Liability Information.” Here we see the liabilities of three hospitals that are the
same size expressed in both dollars and in percentages. Therefore, our CFO can convert the
percentages into an informative graph, as shown in Figure 15–3
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig3) .
Figure 15–3 A Comparison of Three 100-Bed Hospitals’ Long-Term Debt.
Be warned that the basis for some comparisons will be neither useful nor valid. For example, see
Figure 15–4 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig4) .
Here we have a graph of the grand totals from the table in a preceding chapter (Table 14–2
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch14_sect1_1#ch14_tbl2) ) entitled
“Common Sizing Expense Information.” The percentages shown are for the General Services
departments of each hospital and have been common sized to percentages, as is perfectly correct.
However, Figure 15–4
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig4) attempts to
compare the total General Services expense (the total of all four general services departments) in
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dollars. As we can see here, hospital 1 and hospital 3 are both 100 beds, while hospital 2 is 400
beds. Obviously a 400-bed hospital will incur much more expense than a 100-bed hospital, so this
graph cannot possibly show a valid comparison among the three organizations.
Figure 15–4 A Comparison of Three Hospitals’ Total Expenses.
Instead, the CFO should find a standard measure that can be used as a valid basis for comparison.
In this case, he or she can choose size (number of beds) for this purpose. The resulting graph is
shown in Figure 15–5
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig5) . As you can
see, hospital 1’s cost per bed is $8,000, computed as follows. The total expense of $800,000 for
hospital 1 is divided by 100 beds (its size) to arrive at the $8,000 expense per bed shown on the
graph in Figure 15–5
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig5) . Hospital 2
($3,000,000 total expense divided by 400 beds to equal $7,500 per bed) and hospital 3 ($900,000
total expense divided by 100 beds to equal $9,000 per bed) have the same computations performed
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on their equivalent figures.
Figure 15–5 A Comparison of Three Hospitals’ Expenses per Bed.
In actual fact, another step in this computation should be performed in order to make the
comparisons completely valid. A per-bed computation implies inpatient expenses incurred, because
beds are occupied by admitted inpatients. (Outpatients, on the other hand, use a different mix of
services.) Therefore, a more accurate comparison would adjust the overall total expense using one
subtotal for inpatients and another subtotal for outpatients. Let us assume, for purposes of
illustration, that the CFO of hospital 1 has determined that 70% of General Services expense can be
attributed to inpatients and that the remaining 30% can be attributed to outpatients. Let us further
assume that hospital 1’s General Services expense of $800,000 as shown, is indeed a hospital-wide
expense. The CFO would then multiply $800,000 by 70% to arrive at $420,000, representing the
inpatient portion of General Services expense.
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Compare to Industry Standards
In the example just given in the paragraph above, the CFO has computed his or her own hospital’s
percentage of inpatient versus outpatient utilization of General Services expense. But this CFO may
not have any way to know these equivalent percentages for hospitals 2 and 3. If this is the case,
computing the per-bed expense using overall expense, as shown in Figure 15–5
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig5) , may be the
only way to show a three-hospital comparison.
The CFO, however, can use the 70% inpatient and 30% outpatient expense breakdown for another
type of comparison. It should be possible to find industry standards that break out inpatient versus
outpatient expense percentages. The use of industry standards is of particular use for decision
making because it positions the particular organization within a large grouping of facilities that
provide a similar set of services.
Healthcare organizations are particularly well suited to use industry standards because both the
federal and state governments release a wealth of public information and statistics regarding the
provision of health care. Figure 15–6
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_4#ch15_fig6) illustrates the
CFO’s graph using such a standard. (The figures shown are for illustration only and do not reflect
an actual standard.)
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Figure 15–6 A Comparison of Hospital One’s GS Inpatient Expenses with Industry Standards.
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1
Expenses
Account Account 10 Month Annualized 12 Month
Social Security 50,431 60,517
Pension 17,229 20,675
Health Insurance 7,018 8,42
2
Child Care 3,803 4,564
Patient Accounting 129,463 155,356
Admitting 91,878 110,254
Medical Records 76,432 91,718
Dietary 22,938 27,526
Medical Waste 1,981 2,377
Sterile Procedures 65,600 78,720
Laundry 33,911 40,69
3
Depreciation—Equipment 72,815 87,378
Depreciation—Building 34,481 41,377
Amortization—Interest (4,849) (5,819)
Insurance 3,513 4,216
Administration 48,305 57,966
Medical Staff 1,435 1,722
Community Relations 41,511 49,813
Materials Management 53,811 64,573
Human Resources 25,888 31,066
Nursing Administration 68,726 82,471
15.5 MAKING DATA COMPARABLE
This section discusses annualizing partial-year expenses, along with using inflation factors, standardized measures, and currency measures. The manager needs to
know how to make data comparable as a basis for properly preparing and/or reviewing budgets and reports.
Annualizing
Because comparability requires consistency, the manager needs to know how to annualize partial-year expenses. Table 15–2
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15_tbl2) sets out the actual 10-month expenses for the operating room. But these expenses
are going to be compared against a 12-month budget. What to do? The actual 10-month expenses are converted, or annualized, to a 12-month basis, as shown in the
second column of Table 15–2 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15_tbl2) .
Table 15–2 Annualizing Operating Room Partial-Year Expense
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Data Processing 14,846 17,815
Fiscal 14,750 17,700
Telephone 2,366 2,839
Utilities 22,005 26,406
Plant 64,664 77,597
Environmental Services 27,395 32,874
Safety 1,680 2,016
Quality Management 8,347 10,016
Medical Staff 7,870 9,444
Continuous Quality Improvement 4,079 4,895
EE Health 474 569
Total Allocated 1,014,796 1,217,756
All Other Expenses 1,009,673 1,211,608
Total Expense 2,024,469 2,429,364
Reproduced with the permission of Wolters Kluwer Law & Business from J.J. Baker, Activity-Based Costing and Activity-Based Management for Health Care, p.
190, © 1998, Aspen Publishers, Inc.
These computations were performed on a computer spreadsheet; however, the calculation is as follows. Using the first line as an example, $50,431 is 10-months worth
of expenses; therefore, 1 month’s expense is one-tenth of $50,431, or $5,043. To annualize for 12-months worth of expenses, the 10-month total of $50,431 is
increased by 2 more months at $5,043 apiece ($50,431 plus $5,043 for month 11, plus another $5,043 for month 12, equals $60,517, the annualized 12-month figure
for the year).
Inflation Factors
Inflation means “an increase in the volume of money and credit relative to available goods and services resulting in a continuing rise in the general price level.”
An inflation factor is used to compute the effect of inflation.
Let’s assume that hospital 1’s General Services expenses for year 1 were $800,000, versus $900,000 for year 2. We can assume that these amounts reflect actual dollars
expended in each year. But let us also now assume that inflation caused these expenses to rise by 5% in year 2. If the Chief Financial Officer (CFO) decides to take
such inflation into account, a government source will be available to provide the appropriate inflation rate. (The 5% in our example is for illustration only and does not
reflect an actual rate.)
The inflation factor for this example is expressed as a factor of 1.05 (1.00 plus 5% [expressed as.05] equals 1.05). The CFO might apply the inflation factor to year 1 in
order to give it a spending power basis equivalent to that of year 2. (Applying an inflation factor for a two-year comparison is not usually the case, but let us assume
the CFO has a good reason for doing so in this case.) The computation would thus be $800,000 year 1 expense times the 1.05 inflation factor equals an inflation-
adjusted year 1 expense figure of $840,000.
However, if the CFO wants to apply an inflation factor to a whole series of years, he or she must account for the cumulative effect over time. An example appears in
Table l5–3 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15_tbl3) . We assume a base of $500,000 and an annual inflation rate of 10%.
The inflation factor for the first year is 10%, converted to 1.10, just as in the previous example, and $500,000 multiplied by 1.10 equals $550,000 in nominal dollars.
1
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SOURCE OF FACTOR IN COLUMN C BELOW: From the Compound Interest Look-Up Table “The Future Amount of $1.00” (Appendix 13-B
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch13_app2#ch13_app2) )
Year Factors as shown at 10%
1 1.100
2 1.210
3 1.331
4 1.464
(A) (B) (C) (D)
Year Real
Dollars
Cumulative Inflation Factor*
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15tabfn1)
Nominal Dollars**
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15tabfn2)
1 $500,000 (1.10) = 1.100 $550,000
2 500,000 (1.10) = 1.210 605,000
3 500,000 (1.10) = 1.331 665,500
4 500,000 (1.10) = 1.464 732,050
*Assume an annual inflation rate of 10%. Thus 1.00 + 0.10 = the 1.10 factor in Column C.
**Column D “Nominal Dollars” equals Column B times Column C.
Table 15–3 Applying a Cumulative Inflation Factor
Beyond the first year, however, we must determine the cumulative inflation factor. For this purpose we turn to the Compound Interest Table. It shows “The Future
Amount of $1.00,” and appears in Appendix B of the chapter about time value of money. “The Future Amount of $1.00” table has years down the left side (vertical)
and percentages across the top (horizontal). We find the 10% column and read down it for years one, two, three, and so on.
As shown in Table 15–3.2 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15_tbl3.2) , the factor for year 2 is 1.210, for year 3 is 1.331,
and so on. We carry those factors to column C of Table 15–3.1 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15_tbl3) . Now we multiply
the $500,000 in column B times the factor for each year to arrive at the cumulative inflated amount in column D. Thus $500,000 times the year 2 factor of 1.210 equals
$605,000, and so on.
Table 15–3.2
1
2
3
4
https://content.ashford.edu/books/Baker.6866.18.1/sections/ch13_app2%23ch13_app2
https://content.ashford.edu/books/Baker.6866.18.1/sections/ch15_sect1_5%23ch15tabfn1
https://content.ashford.edu/books/Baker.6866.18.1/sections/ch15_sect1_5%23ch15tabfn2
https://content.ashford.edu/books/Baker.6866.18.1/sections/ch15_sect1_5%23ch15_tbl3.2
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Country (or Area) Currency
Canada Canadian dollar
China Yuan
Euro Area Euro
Japan Yen
Mexico Peso
United Kingdom Pound
Exhibit 15–1 Foreign Currency Examples
Currency Measures
Monetary unit measurement, and the related currency measures and currency conversions, are typically beyond most manager’s responsibilities. Nevertheless, it is
important for the manager to understand that consistency in applying such measures and conversions will be a significant factor in expressing financial results of
companies that have global operations.
Therefore, for comparative purposes we must determine if all the information being prepared or under review is measured by the same monetary unit. A few foreign
currency examples are illustrated in Exhibit 15–1 (http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_5#ch15_exhibit1) . Currencies are typically
converted for financial reporting purposes using the U.S.dollar foreign exchange rates as of a certain date.
Exchange rates may be expressed in two ways: “in U.S. dollars” or “per U.S. dollars.” For example, assume the euro is trading at 1.3333 in U.S. dollars and at 0.7500
per U.S. dollars. That means if you were spending your U.S. dollar in, say, France (part of the “euro area”), it would take a third as much (1.33) in your dollars to buy
products priced in euros. If your French friend, on the other hand, was spending euros for products priced in U.S. dollars, he or she could buy one-quarter more for his
or her money (because the U.S. dollar would be worth only three quarters [0.7500] of the euro at that particular exchange rate).
A final word about standardized measures. Standardized measures aid comparability. They especially assist in performance measurement. Types of standardized
measures include the typical hospital per-bed measure along with work load measures.
There is, of course, a whole array of uses for standardized measures. Managed care plans, for example, may use a standard set of measures that are applied to every
physician who contracts with the plan. Each physician then receives a report from the plan that illustrates his or her performance.
Finally, electronic medical records (as further discussed in following chapters) depend upon standardized input. The input into various fields is standardized (and thus
made comparable) by the very nature of the electronic system design.
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15.6 CONSTRUCTING CHARTS TO SHOW THE DATA
Managers use charts to explain their projects and to report their results. Thus constructing accurate
and effective charts is a valuable skill.
Types of Charts
There are four basic chart styles as follows:
■ Column chart
■ Pie chart
■ Bar chart
■ Line chart
The column chart’s data is presented in vertical columns. The pie chart is typically circular (like a
pie, thus its name). The bar chart presents data in horizontal bars. The line chart generally uses
multiple lines that track along a grid. Figures 15-7
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_6#ch15_fig7) , 15-8,
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_6#ch15_fig8) and 15-9
(http://content.thuzelearning.com/books/Baker.6866.18.1/sections/ch15_sect1_6#ch15_fig9) illustrate
examples of the pie chart, bar chart, and line chart respectively.
https://content.ashford.edu/books/Baker.6866.18.1/sections/ch15_sect1_6%23ch15_fig7
https://content.ashford.edu/books/Baker.6866.18.1/sections/ch15_sect1_6%23ch15_fig8
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Figure 15–7 Distribution of DRG 0xx Cases by Physician.
Modified from R. Hankins & J.J. Baker, Management Accounting for Health Care Organizations (Sudbury, MA: Jones &
Bartlett 2004). p. 375.
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Figure 15–8 Cost per Case by Physician for DRG 0xx.
Modified from R. Hankins & J.J. Baker, Management Accounting for Health Care Organizations (Sudbury, MA: Jones &
Bartlett 2004). p. 376.
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Figure 15–9 Total Cost per Case by Physician for DRG 0xx.
Modified from R. Hankins & J.J. Baker, Management Accounting for Health Care Organizations (Sudbury, MA: Jones &
Bartlett 2004). p. 377
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Chart Content and Format
Constructing the chart means answering a series of questions about content and format, as follows:
■ What is the subject of the chart?
■ What are the specific elements to be included?
■ What type of chart will best serve my purpose?
■ Is the information accurate and consistent?
■ If applicable, is the information comparable?
■ What are the dimensions of the chart?
■ If applicable, what is the span between high and low?
Chart Templates
A variety of chart templates are now available online. They are generally found within office suite
programs. Each template typically offers a drop-down menu for specifics of the format and a
second drop-down menu for the chart’s data input. Electronic templates also provide quick and easy
color choices for your chart presentation. You can experiment with various colors to reach the best
combination for your project.
To summarize, the chart you construct can be simple or elaborate. It can be black and white or it
can be multi-colored. But whatever its style, your chart must contain accurate and comparable data.