DECISION-MAKING ASPECTS OF THE HOSPITAL NEW COST ACCOUNT

Healthcare entities improve their company accounting principles, adjusting them to the applicable legal acts and management’s information requirements. Information from cost accounting is used in reporting and decision-making processes of entities and other stakeholders. In 2021, entities contracting financing of health services with the National Health Fund – the payer – are required to implement new cost accounting principles. The purpose of the article is to identify the decision-making aspects of new cost accounting regulations in medical entities – hospitals – in the context of the dominant groups of operating cost. Based on the literature on the subject and the analysis of the practice of functioning of the existing legal regulations of hospital cost accounting, the following research hypothesis was formulated: the decision- making dimension of the standard of costs in service providers is focused on important areas of costs of health services and procedures valuation. The research tools used were the analysis of the literature on the subject, legal acts, and financial statements of 10 selected hospitals.

The degree of cost accounting development in the context of hospital information system

The article describes the results of research on the model of hospital cost accounting maturity obtained in the second stage of own research. The aim of the conducted research was to identify the premises of cost accounting maturity in the context of the hospital information system. In order to achieve thus defined goal, a research hypothesis was formulated that the level of the maturity of hospital cost accounting depends on the degree of achievement of goals resulting from external and internal information needs of data recip-ients. It has been accepted that external needs determining the maturity of cost accounting arise from formal regulations. In the case of hospitals functioning as independent public health care centers, they have been recommended for use for 27 years. As regards the internal needs, the so called substantive integration of cost and medical data has been defined, among other things. The research shows that both formal regula-tions and managerial needs determine the level of cost accounting maturity. It also indicates that the sub-stantive integration of the collected data serving the needs of the management is more important than the technical integration of hospital information system.

Solving the Value Equation: Assessing Surgeon Performance Using Risk-Adjusted Quality-Cost Diagrams and Surgical Outcomes

Quality-cost diagrams have been used previously to assess interventions and their cost-effectiveness. This study explores the use of risk-adjusted quality-cost diagrams to compare the value provided by surgeons by presenting cost and outcomes simultaneously. Colectomy cases from a single institution captured in the National Surgical Quality Improvement Program database were linked to hospital cost-accounting data to determine costs per encounter. Risk adjustment models were developed and observed average cost and complication rates per surgeon were compared to expected cost and complication rates using the diagrams. Surgeons were surveyed to determine if the diagrams could provide information that would result in practice adjustment. Of 55 surgeons surveyed on the utility of the diagrams, 92% of respondents believed the diagrams were useful. The diagrams seemed intuitive to interpret, and making risk-adjusted comparisons accounted for patient differences in the evaluation.

Time-driven activity-based costing and the impact on cost measurement in the face of health reform.

262 Background: In 2010, the Institute for Cancer Care Innovation (ICCI) began measuring the true cost of cancer care delivery by following the patient treatment cycle from initial referral to survivorship or supportive care. The project was prompted by both internal and external concerns about the rising costs of health care, the ability to demonstrate value for services provided, and potential changes in reimbursement. Hospital cost accounting systems are historically charge-based and are inherently skewed to shift costs towards procedures or encounters that are higher volume and well-reimbursed. However, these systems do not accurately reflect the actual acquisition costs of the resources providing care. Methods: In order to more accurately and transparently capture costs, the ICCI piloted the use of the time-driven activity-based costing (TDABC) methodology. This methodology allowed the team to map the entire patient experience of care while also capturing costs and capacity associated with each activity in the care delivery cycle. Results: To date, the team has created over 150 maps made up of over 6,500 unique activities with associated cost and capacity rates, which make up various costing equations. Actual clinical volumes are then run through the model to produce cost and capacity results. Initial results provided an unexpected view of the costs of various processes occurring within the care delivery cycle with the ability to rank the processes from most to least costly. This provided a unique opportunity to target specific areas for improvement. Additionally, transparency of the costing equations allows for precise modeling of episode-based bundles of care for different diseases and treatments. Conclusions: TDABC provides a more accurate and transparent approach to developing cost and capacity rates for cancer care delivery to aid in identifying the greatest opportunities for improvement, as well as providing a mechanism for creating episode-based bundles of care that are reflective of actual treatment being provided.