Effect of a Job Demand-Control-Social Support Model on Accounting Professionals' Health Perception

The Job Demand-Control and Job Demand-Control-Support (JDCS) models constitute the theoretical approaches used to analyze the relationship between the characteristics of labor and occupational health. Few studies have investigated the main effects and multiplicative model in relation to the perceived occupational health of professional accountants. Accountants are subject to various types of pressure in performing their work; this pressure influences their health and, ultimately, their ability to perform a job well. The objective of this study is to investigate the effects of job demands on the occupational health of 739 accountants, as well as the role of the moderator that internal resources (locus of control) and external resources (social support) have in occupational health. The proposed hypotheses are tested by applying different models of neural networks using the algorithm of the Extreme Learning Machine. The results confirm the relationship between certain stress factors that affect the health of the accountants, as well as the direct effect that the recognition of superiors in occupational health has. Additionally, the results highlight the moderating effect of professional development and the support of superiors on the job’s demands.

Using Medical Informatics to Improve Clinical Trial Operations

The continued escalation of clinical trial costs is becoming a public health concern. During the past decade, medical research funding peaked and there is growing concern that there may be insufficient resources to test many promising medical products. Recent changes in the regulatory environment create opportunities for the use of medical informatics to improve clinical trial operations and reduce costs. We report on a Medical Informatics Europe 2016 workshop conducted during the Health - Exploring Complexity (HEC) 2016 conference. We review presentation given on Secondary Data Use, eSource, and Data Quality in Clinical Trials and report on the workshop's discussions.

User's Satisfaction of Multiple Accounting Record System

The study hospital had developed a multiple account recording system that generates the accounting information of the consumed materials based on daily nursing records. A questionnaire survey was delivered to further investigate the impact of the system.

METHODS

Four concepts of the system were investigated. (1) Supportive and time saving; (2) impact on workflows and job satisfactions; (3) ease of use; and (4) overall satisfactions.

RESULTS

The system scored 4.03 out of 5 as the highest for helpfulness for daily practices, 3.98 for decrease the time for recording material consumptions, 3.98 for actually changed the way they work.

DISCUSSION

Users mostly expressed positive attitude towards the system.

A modified method of activity-based costing for objectively reducing cost drivers in hospitals

OBJECTIVES

Activity-based costing (ABC) is widely used to precisely allocate indirect costs to medical services. In the ABC method, the indirect cost is divided among the medical services in proportion to the volume of "cost drivers", for example, labor hours and the number of hours of surgery. However, the workload of data collection of cost drivers can be time-consuming and a considerable burden if there are many cost drivers. The authors aim to develop a method for objectively reducing the cost drivers used in the ABC method.

METHODS

In the ABC method, the cost driver is assigned for each activity. We assume that these activities and cost drivers are the best combination. Our method, that is cost driver reduction (CDR), can objectively select surrogates of the cost drivers for each activity in ABC from candidate cost drivers. Concretely, the total indirect cost of an activity is temporarily allocated to the medical services using each candidate of cost drivers. The difference between the costs calculated by each candidate and the proper cost driver used in ABC is calculated to evaluate the similarity by the evaluation function.

RESULTS

We estimated the cost of laboratory tests using our method and revealed that the number of cost drivers could be reduced from seven in the ABC to four. Similarly, the results of cost estimation obtained by our method were as accurate as those calculated using the ABC.

CONCLUSIONS

Our method provides two advantages compared to the ABC method: 1) it provides results that are as accurate as those of the ABC method, and 2) it is simpler to perform complicated estimation of hospital costs.

The relative value of growth

Most executives would say that adding a point of growth and gaining a point of operating-profit margin contribute about equally to shareholder value. Margin improvements hit the bottom line immediately, while growth compounds value over time. But the reality is that the two are rarely equivalent. Growth often is far more valuable than managers think. For some companies, convincing the market that they can grow by just one additional percentage point can be worth six, seven, or even ten points of margin improvement. This article presents a new strategic metric, called the relative value of growth (RVG), which gives managers a clear picture of how growth projects and margin improvement initiatives affect shareholder value. Using basic balance sheet and income sheet data, managers can determine their companies' RVGs, as well as those of their competitors. Calculating RVGs gives managers insights into which corporate strategies are working to deliver value and whether their companies are pulling the most powerful value-creation levers. The author examines a number of well-known companies and explains what their RVG numbers say about their strategies. He reviews the unspoken assumption that growth and profits are incompatible over the long term and shows that a fair number of companies are effective at delivering both. Finally, he explains how managers can use the RVG framework to help them define strategies that balance growth and profitability at both the corporate and business unit levels.

Aseguramiento en los regímenes contributivo y subsidiado, e impacto en los prestadores de servicios

The performance of 18 private Health-promoting (EPS) and Family Compensation (CCF) entities, as well as their general balances for 1997, 1998 and 1999, were studied to determine the profit margins achieved by EPS's in their work of administering health insurance. The average behavior of each EPS balance sheet was analyzed to reduce the effect produced by extreme cases; each EPS's value was thus weighted by the number of its affiliated people. The expected behavior of the costs and expenses of companies whose main business is providing health insurance could thus become determined. The main source of operational income for a private EPS is the contributive regime's per capita unit of payment (UPC). Subsidized regime participation and that of other sources of income has decreased year by year. By contrast, public EPS's have shown decreasing participation in income obtained from UPC (contributive and subsidized) and growing dependence on other sources of income; this can be interpreted as being a symptom of weak commercial management. According to the balance sheets provided by the SNS, the EPS (public, private and Family Compensation entities), including the Social Security Institute (ISS), together obtained a total of 4.18 billion pesos operational income in 1999, an increase of 21.7% as compared to 1998. Income received from the ISS amounted to 1.93 billion dollars in 1999 (46% of the total). At 2000 prices, the total amount of operational income was 4.54 billion pesos in 1999 (15.6% real increase). Taking the behavior of 4 EPS's as our reference point (Sanitas, Humana Vivir, Coomeva and Famisanar), it can be concluded that an EPS whose main business is health insurance needs a 17.2% gross margin to cover its operational and non-operational costs and a 1.1% margin before tax.

The contribution of gender-role orientation, work factors and home stressors to psychological well-being and sickness absence in male- and female-dominated occupational groups

The associations of work stress, types of work and gender-role orientation with psychological well-being and sickness absence were investigated in a questionnaire survey of 588 male and female nurses and 387 male and female accountants. We hypothesised that health might be impaired among women working in the male-dominated occupation (accountancy), and men in the female-dominated occupation (nursing), but that effects might be moderated by job strain (perceptions of high demand and low control), work and home hassles, and traditional male (instrumentality) and female (expressivity) psychological characteristics. Responses were analysed from 172 female and 61 male nurses, and from 53 female and 81 male commercial accountants. Female accountants were more likely than other groups to have high anxiety scores on the Hospital Anxiety and Depression Scales, while male nurses had the highest rates of sickness absence. Male nurses and female accountants also reported more work-related hassles than did female nurses and male accountants. Men and women in the same occupation did not differ in job strain or job social support, but nurses reported greater job strain than accountants, due to higher ratings of demands and lower skill utilisation. After adjusting for age, sex, occupation, paid work hours and a measure of social desirability bias, risk of elevated anxiety was independently associated with higher job strain, lower job social support, more work hassles, more domestic responsibility, lower instrumentality and higher expressivity. The association between sex and anxiety was no longer significant after instrumentality had been entered into the regression model. Sickness absence of more than three days over the past 12 months was independently associated with higher job strain, more work hassles, lower instrumentality and higher expressivity. The results suggest that when men and women occupy jobs in which they are in the cultural and numerical minority, there may be adverse health effects that are gender-specific. Psychological traits related to socially constructed gender roles may also be relevant, and mediate in part the differences in psychological well-being between men and women.

What if pediatric residents could bill for their outpatient services?

OBJECTIVE

We prospectively studied the potential of billing and coding practices of pediatric residents in outpatient clinics and extrapolated our results to assess the financial implications of billing inaccuracies. Using Medicare as a common measure of "currency," we also used the relative value unit (RVU) and ambulatory payment class methodologies as means of assessing the productivity and financial value of resident-staffed pediatric clinics.

METHODS

Residents were asked to submit voluntarily shadow billing forms and documentation of outpatient clinic visits. Documentation of work was assessed by a blinded reviewer, and current procedure terminology evaluation and management codes were assigned. Comparisons between resident codes and calculated codes were made. Financial implications of physician productivity were calculated in terms of dollar amounts and RVUs. Resource intensity was measured using the ambulatory payment class methodology.

RESULTS

A total of 344 charts were reviewed. Coding agreement for health maintenance visits was 86%, whereas agreement for acute care visits was 38%. Eighty-three percent of coding disagreement in the latter group was resulting from undercoding by residents. Errors accounted for a 4.79% difference in potential reimbursement for all visit types and a 19.10% difference for acute care visits. No significant differences in shadow billing discrepancies were found between different levels of training. Residents were predicted to generate $67 230, $87 593, and $96 072 in Medicare revenue in the outpatient clinic setting during each successive year of training. On average, residents generated 1.17 +/- 0.01 and 0.81 +/- 0.02 work RVUs for each health maintenance visit and office visit, respectively. Annual productivity from outpatient clinic settings was estimated at 548, 735, and 893 work RVUs in the postgraduate levels 1, 2, and 3, respectively.

CONCLUSION

When pediatric residents are not trained adequately in proper coding practices, the potential for billing discrepancies is high and potential reimbursement differences may be substantial. Discussion of financial issues should be considered in curriculum development.

Using simple multiple regression to establish labor rates

Multiple-regression methodology allows healthcare financial managers to set standard rates of pay, thereby enabling them to better control costs. The process for implementing multiple regression is simple. The first step is to calculate the betas, or weights the marketplace gives each job characteristic to determine pay. Data on betas can be purchased, or a regression can be run on market data to calculate the betas. Next, the job descriptions should be reviewed and job incumbents interviewed, and then job characteristics for each job should be ranked on a scale of 1 to 5 to obtain the independent variables, or X values. Then, betas and X values should be entered into the salary formula to obtain standard hourly rates. The proposed standard rates should be verified through market salary surveys.

Solo general practitioners and specialists

A solo practitioner is the sole owner of and the only dentist in a dental practice and also is the most common type of dental practitioner in the United States. The authors provide a brief look at solo general practitioners' and specialists' characteristics, including employment status, number of employees, time spent in the office, number of patient visits per week, gross billings, net income and practice expenses.

The learning curve and the health care industry

This article will examine the learning curve and its potential impact on the health care industry. Although the learning curve has traditionally been applied to the manufacturing industry, a labor-intensive industry like health care is a prime candidate for the benefits of the learning curve. Specifically, we will look at past research on the learning curve and discuss what effects learning might have on health care costs and outcomes in the current health care environment.

Determining laboratory value: Part 2

This article describes how to determine a fair market value for a dental laboratory. Part one defined fair market value, addressed how value is perceived and how to prepare for laboratory evaluation. Part two addresses how to apply an appropriate valuation methodology to determine worth.

An analysis of the adoption of managerial innovation: cost accounting systems in hospitals

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.

Measuring financial performance: an overview of financial statements

Financial management has emerged as a critical component in the long-term viability of today's ranches and farms. Proper and timely financial reporting and analysis of financial statements are valuable tools that agricultural producers can use to monitor, coordinate, and plan their operational production and marketing schemes and strategies. A side note to preparation of financial statements. With the concerns over lender liability issues associated with statements either assisted with or prepared by a lending officer, agricultural producers will be responsible for preparing their own statements. The lending institutions may prepare their own statements in their assessment of the financial condition of a business and or individual, but, ultimately, the responsibility of financial statements is the borrower's. Some of the material presented in this article provides important input for use in such analytical programs as the National Cattlemen's Association, Integrated Resource Committees, and Standard Performance Analysis (SPA). SPA techniques and associated software have been or currently are under development for cow-calf, stocker, seedstock, and sheep enterprises. Critical to the analysis is having complete and correct financial statements. These analytical programs build on the financial statements. These analytical programs build on the financial statements as recommended by the FFSTF. Proper financial reporting is critical not only to a SPA assessment but also to the overall financial management of today's farms and ranches. Recognizing the importance of financial management in production agriculture is not enough, taking a proactive stance in one's financial plan is paramount to success. Failure to do so will only enhance the exit rates of producers from production agriculture.

SPA: marketing and financial performance measures for the cow-calf enterprise

The Standardized Performance Analysis (SPA) process can be an important business analysis activity. This article outlines the important considerations in terms of the process, necessary data, and interpretations and limitations of SPA measures of performance. A case ranch example is used to illustrate the SPA process.

Using cost accounting in a medical group practice. An application using the resource-based relative value scale

With the presence of managed care increasing in our health care environment, today's practice administrator needs a method to determine whether the negotiated fee schedule, capitation rate, etc., is adequate. The only true method to make this determination is to undertake a cost study of physician activity. However, this approach could be tedious, cumbersome and beyond the resources of the practice. The author demonstrates a method to approximate the cost of a physician's activity by identifying the cost of a relative value. The relative value scale used is the resource-based relative value scale (RBRVS). The article also proposes other applications: comparative analysis, allocation of capitation payments and fee schedule development.

Relation between physician characteristics and prescribing for elderly people in New Brunswick

OBJECTIVE

To determine whether there is a relation between physician characteristics and prescribing for elderly patients.

DESIGN

Descriptive study linking two provincial databases.

SETTING

New Brunswick.

PARTICIPANTS

All general practitioners (GPs) in New Brunswick who ordered at least 200 prescriptions for elderly beneficiaries of the New Brunswick Prescription Drug Program between Apr. 1, 1990, and Mar. 31, 1991; eligible GPs accounted for 376 (40%) of all physicians with a general licence in New Brunswick.

MAIN OUTCOME MEASURES

GPs' personal and professional characteristics (age, sex, family practice accreditation, country of training and number of years in practice), practice characteristics (number of practice days, number of patients seen and medical services provided per day, average amount of billing per patient, total number of patients seen and their average age, and total amount of billings) and number of prescriptions by category of drug.

RESULTS

High prescribers and low prescribers did not differ significantly in age, number of years in practice, mean practice size or patient age. Compared with the low prescribers the high prescribers were more likely to be male, have been trained in Canada and be qualified by the Canadian College of Family Physicians. Also, they had more practice days, saw more patients per day, performed more services per day, billed more per patient and billed on average 30% more during the study period. Overall, the high prescribers ordered on average 45% more prescriptions than the low prescribers.

CONCLUSION

There is a significant relation between certain physician characteristics and prescribing behaviour. Further study is required to examine the relation between these variables and patient outcomes.

Accounting practice diversity in the healthcare industry

A recent study examining accounting practices currently being used to prepare annual hospital financial statements indicates relatively little diversity, regardless of organizational type or size. The study's findings should interest those concerned with healthcare accounting and financial reporting issues, especially healthcare administrators and members of standards setting boards who participate in accounting policy deliberations.

Knowing your costs: the key to financial success of ambulatory surgery centers under prospective payment

The need for ambulatory surgery centers to have accurate cost accounting systems will only continue to grow in the years to come and such systems can only improve the quality of decisions made for these facilities. With the advent of prospective payment for ambulatory services and continued escalating health care expenditures by government and commercial payors, continued rate cutting can be expected. Therefore, ASCs must know their costs, be able to compare costs to payments, and be able to respond to this information accordingly. Consequently, a strong cost accounting system is an essential vehicle for ambulatory surgery centers that wish to successfully venture into the mid-1990s and beyond.

Balancing the budget in the specialty group practice clinical laboratory

A four-physician group had developed a very successful practice model, but cost accounting was not well-developed as general ledger and accounts payable activities were performed using manual methods and financial statements were prepared on a spreadsheet program. The purpose of this case study is to describe the steps taken to develop a cost management system for the laboratory and the corrective action taken to reduce a loss from operations.

Perceptions of new AICPA (American Institute of Certified Public Accountants) audit guide

A survey was conducted by authors Bitter and Cassidy to assess hospital providers' and auditors' perceptions of the reporting requirements of the new Audits of Providers of Health Care Services guide published by the American Institute of Certified Public Accountants. Responses indicated that there is still much dissent in the healthcare community as to what is useful information and what the effects of the new guide will be on hospital providers, auditors, and users.

Determinants of the uncompensated care burden of rural and urban hospitals in Florida

It has been projected that over the next decade as many as 700 hospitals will close due to financial pressures created at least in part by the problem of uncompensated care. Many analysts contend that smaller, rural hospitals will be disproportionately represented among those which close. This investigation uses data collected from over 14,000 inpatient records from 130 representative hospitals in Florida to examine the degree to which rural hospitals experience an uncompensated care problem which differs in source, or magnitude, from that experienced by urban institutions. The analyses show that 150 days following the provision of service, the mean per capita outstanding amount was $18 higher for patients seen in rural hospitals than those seen in urban hospitals. Further, the odds of a rural hospital patient having some outstanding balance 150 days after service had been rendered ranged from 1.2 to 1.3 times those for patients seen in urban hospitals. The location difference is not eliminated by controlling for sociodemographic differences of the patients or the circumstances surrounding the type and/or source of admission. The single most important predictor of having outstanding hospital charges is possession of health insurance. Patients with no coverage are 38.6 times more likely to have some nonzero outstanding balance than patients with some form of insurance coverage. After controlling for sociodemographic, economic, and circumstances surrounding admission, the odds increase from 38.6 to 73.6. The critical role played by insurance is further evidenced by noting that the odds of someone with third party insurance coverage having an unresolved amount greater than or equal to $250 is only .024 and only slightly higher (.048) for government coverage.

Using ratios to measure hospital financial performance: can the process be simplified?

Evaluation of a hospital's financial condition is often contingent upon the analysis of financial ratios. This study of 114 Illinois hospitals sought to simplify the financial assessment process by exploring the empirical dimensions that underlie 25 financial ratios. Results of a factor analytic solution suggest that there are five underlying factors which account for approximately 77% of the total variance. Uses of summative scaled measures in health services financial management and research are discussed.