Health Care Budgeting and Financial Management

In today's chaotic health reform environment, it is especially important for non-financial health care managers to have a practical guide to the tools and concepts they need to manage their human, supply, and equipment resources. Today's health care managers, frequently, were yesterday's technicians, physicians, and nurses. This puts them in an interesting predicament, since they know the health care side of the business but often lack the financial management skills necessary to create budgets and manage finances in a health care setting. In this guide, William J. Ward Jr. offers easy-to-understand explanations of basic accounting concepts, including cash flow, operating cost and cost behavior, revenue and reimbursement, and so much more. Providing clearly presented financial information in the context of health care, Ward's book is a one-stop desk reference that provides practical, useful tools and knowledge that readers can immediately put to use. It will help managers, directors, and clinical leaders who work in hospitals, physician practices, and other provider organizations to effectively manage their financial resources on a day-to-day basis, providing guidance for essential tasks such as preparing budgets, managing their departments, and making decisions around financial issues.

William J. Ward Jr.

Preface Acknowledgments Introduction 1. Welcome to Health Care and Financial Management Defining Financial Management Strategies for Success Paradigms to Guide Performance Today's Health Care Dilemma The Public's Expectations How Health Care Is Financed Is There a Solution? Critical Players in the Health Care Dilemma The Real Problem What Is Really Needed? The Management Balancing Act 2. Basic Business and Accounting Concepts Asset Valuation The Purpose of Accounting Approaches to Recording Transactions Basic Terminology Basic Accounting Concepts Summary 3. Cost and Cost Behavior Understanding Cost Behavior The Nature of Operating Costs Important Cost Concepts Fixed versus Variable Costs Real-World Implications Direct and Indirect Costs Cost Accounting Manufacturing versus Health Care Cost Accounting versus Financial Accounting Accounting for Costs Overhead Cost Allocation The Fallacy of Cost Allocation Important Caveats 4. Revenue and Reimbursement Health Care Reimbursement Methodologies Setting Prices Billing and Collecting Summary 5. Introduction to Budgeting Budget Definition A Detailed Plan Resources Acquiring and Using Resources A Specific Time Period A Plan for the Future Formal and Measurable Terms Types of Budgets Reasons to Prepare a Budget Who Prepares the Budget? The Flow of Information Important Planning Documents Some Points to Keep in Mind The Numbers Game Justifying the Need Where to Begin Sources of Budget Information 6. The Operating Budget Interrelationships Sources of Information An Orderly Approach Statement of Goals and Objectives The Volume Budget The Revenue Budget The Staffing Budget Supplies and Services Budget Base Period Adjustments 7. The Capital Budget Capital Acquisition The Questioning Technique Capital Budget Review Committee The Review Process Packaging the Request Justifying the Request Selection Process Making Balanced Decisions Sources of Funds Stretching Limited Funds Constraints 8. The Cash Budget Cash Inflows and Outflows Roles in Budgeting and Managing Cash Cash Flow Considerations Conclusion 9. Financial Statements The Balance Sheet The Income Statement The Cash Flow Statement The Annual Audit Examining the Financial Statements Financial Ratios Summary 10. Performance Measurement Why Organizations Report on Performance Characteristics of Good Performance Reports Reading the Reports How to Look at the Numbers Some Important Points to Remember Dashboards and Balanced Scorecards The Value of the Dashboards Strategic versus Operational Rapidly Available, Reasonably Sound Data Leading versus Trailing Indicators Populating the Dashboard Making Dashboards More Useful Important Characteristics One Final Choice 11. Analytical Tools Variance Analysis Types of Variances When to Look How to Look Some Cautions Forecasting Decision Analyses Working Backward Gross versus Net Revenue Ad Hoc Financial Analysis Organizing the Financial Analysis 12. Improving Performance Productivity Factors That Influence Productivity The Right Mind-Set Benchmarking Bilateral Performance Mapping Process Flow Analysis Productivity and Efficiency Improving Efficiency Managing Throughput Resource Use Standards A Final Thought 13. Revenue and Expense Strategies Revenue Enhancement Expense Control and Reduction The Participative Approach The Centralized Approach 14. Presenting Financial and Budget Data Preparing for the Meeting Presentation Qualities Strategies for Budget Meeting Success Developing a Business Plan Implementation and Action Planning 15. The Business Case for Quality and Patient Safety Connecting Clinical Quality Improvement and Financial Outcomes The Process of Care The Misleading Literature The Health Care Business Model Making the Pitch Avoiding the Minefield Points to Keep in Mind 16. Now What Do I Do? Knowledge of the Business Planning and Vigilance A Businesslike Approach The Desire to Manage Obstacles to Success Suggestions for Success Changing Management Focus 17. Some Final Thoughts The Challenge for Leaders and Managers The Proper Role of the Government Some Ideas Appendices 1. Typical Audit Opinion Letter 2. Practice Problems 3. Practice Problems Solutions 4. Formulary 5. Present Value Table 6. Glossary 7. Major Diagnostic Categories Index