Last Updated on August 24, 2024 by admin
Hospitals, nursing facilities and retirement homes
Management accounting is important for hospitals, nursing facilities and retirement homes because patients and insurance organizations require proof of the costs of treatment. The main object of analysis is the individual case of a particular patient. Invoicing is usually based on (legally) regulated tariffs.
External case-related services (e.g. X-rays) can be assigned to the “case” (person treated). Many purchases from the hospital pharmacy and aids from the hospital warehouse can also be assigned to the case. In a production company, one would speak of external service and direct material costs, which are charged directly to the product, i.e. the case, using warehouse withdrawal slips or vendor invoices.
Services from the kitchen, especially special catering or drinks, can also be recorded on a case-by-case basis.
In cost accounting, purchases of medicines or auxiliary materials for cost centers, e.g. a nursing or bed ward, which cannot be allocated directly to the individual case, are referred to as material overheads. These items are included in the proportional planned cost rate of the respective cost center, e.g. an inpatient ward.
Personnel costs are usually the most important cost type in a hospital. They are planned and reported by cost center. By recording services, it is possible to determine how many working hours are used directly for the care of individual patients (case-related proportional costs) and what proportion of hours is used for operational readiness (fixed costs of the cost centers).
The availability of a surgical suite incurs fixed costs of service readiness such as rent, imputed depreciation and maintenance of the installed equipment and facilities as well as basic cleaning. These costs cannot be allocated to an individual operation on the basis of causation. They are incurred in order to carry out operations at all.
The surgical team must ensure that all the equipment required for a particular operation is in working order and that the cutlery and aids are ready for use. These persons must be present during the operation so that they can provide immediate support in the event of complications. The same applies, mutatis mutandis, to the anesthesia team and to cleaning and disinfection after each operation.
The costs incurred for these functions are proportional costs of the operation, they are caused by the case.
If management accounting of a hospital is to be set up, the requirements of a manufacturing company can be assumed in many areas. However, some special features must be taken into account for the system:
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- The master data must not only be collected on a customer-specific basis, but also on a case-specific basis.
- External services are usually ordered on a case-specific basis, not item-specific
- Inventory levels must be continuously updated for both aids and medicines (pharmacy).
- The time spent by staff in surgery and medicine should also be recorded per case as far as possible. In nursing, this is only possible to a limited extent, as the workload can rarely be measured per patient.
- The amount of work required for a decision-relevant management accounting system in a hospital is greater than in other economic sectors.
This effort is worthwhile for the following reasons:
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- Better decision-making basis for the management staff, especially for the control of service readiness costs and directly case-dependent costs,
- Meaningful, performance-related calculations for negotiations with health insurers and state funding bodies,
- Possibility of cost control in the cost centers, taking into account the current level of activity.