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Healthcare Dollar Usage

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Given that we have limited resources, what is the best use of our healthcare dollars? Should expensive treatments be provided to everyone who would benefit from them? If so, who should bear the costs—for instance, should it be third-party insurance, Medicare, Medicaid, or the individuals themselves paying out-of-pocket? There are other important facets to this issue. Should resources be used to provide basic services to the greatest number of people, such as through immunization? Should the drugs be rationed in any way, to keep costs down?

Select an ethical issue such as one of those described above and provide a pro/con comparison of related to the ethics of payment.

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One of the most pressing ethical issues in regard to ethics of payment is whether or not doctors should provide treatment to undocumented immigrants such as those suffering from malignant cancerous tumors. Although the American Medical Association Code of Medical Ethics suggests that physicians should volunteer a portion of their time to assist patients who can't afford to pay for medical services, in regard to oncologists, this is often an unfeasible proposition. Because of the high costs associated with drug therapy, costs of treatment, complexity of delivery of treatment, and other issues associated with cancer treatment, oncologists who want to provide medical care for illegal immigrants who don't have the resources as they feel this is an ethical obligation, are often forced to choose between remaining financially solvent and going under. The Patient Protection and ...

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This solution discusses the usage of healthcare dollars with limited resources.

See Also This Related BrainMass Solution

Accounting: P&L, Cost, Break Even

Posted problems:

Consider the CVP graphs below for two providers operating in a fee-for-service environment: see attached file
a. Assuming the graphs are drawn to the same scale, which provider has the greater
fixed costs? The greater variable cost rate? The greater per unit revenue?
b.Which provider has the greater contribution margin?
c.Which provider needs the higher volume to break even?
d. How would the graphs change if the providers were operating in a discounted fee-for-
service environment? In a capitalized environment?

A. The provider to the right has higher fixed costs (the flat line)
B. The variable cost per unit (the sloping line that starts at the flat line level) is about the same for both but the revenue line (the one that starts at the 0 level) is steeper for the one on the right. So, the contribution margin is greater for the one on the right.
C. The one on the left likely needs higher volume to breakeven since the contribution margin is low and so even though fixed costs are lower, each unit doesn't throw off very much. You can see where the revenue line crosses the total cost line is farther to the right (more units) for the one on the right.
D. In a discounted-for-fee, the revenue line would be lower. In a capitalized environment, the fixed costs line would be higher.

Assume that a radiologist group practice has the following cost structure:

Fixed Costs: $500,000
Variable Cost per procedure: $25
Charge (revenue) per procedure: $100

Furthermore, assume that the group expects to perform 7,500 procedures in the coming year.

a. Construct the group's base case projected P&L statement.
b. What is the group's contribution margin? What is its breakeven point?
c. What volume is required to provide a pretax profit of $100,000? A pretax profit of $200,000?
d. Sketch out a CVP analysis graph depicting the base case situation.
e. Now assume that the practice contracts with one HMO, and the plan proposes a 20 percent discount from charges. Redo questions a, b, c, and d under these conditions.

General Hospital, a not-for-profit acute care facility, has the following cost structure for its inpatient services:

Fixed Costs: $10,000,000
Variable cost per inpatient day: $200
Charge (revenue) per inpatient day: $1,000

The hospital expects to have a patient load of 15,000 inpatient days next year.
a. Construct the hospital's base case projected P&L statement.
b. What is the hospital's breakeven point?
c. What volume is required to provide a profit of $1,000,000? A profit of $500,000?
d. Now assume that 20 percent of the hospital's inpatient days come from a managed care plan that wants a 25 percent discount from charges. Should the hospital agree to the discounted proposal?

You are considering starting a walk-in clinic. Your financial projections for the first year of operations are as follows:

Revenues: $400,000
Wages & Benefits: $220,000
Rent: $5,000
Depreciation: $30,000
Utilities: $2,500
Medical Supplies: $50,000
Administrative Supplies: $10,000

Assume that all costs are fixed, except supply costs, which are variable. Furthermore, assume that the clinic must pay taxes at a 20 percent rate.
a. Construct the clinic's projected P&L statement.
b. What number of visits is required to break even?
c. What number of visits is required to provide you with an after-tax profit of $100,000?

the housekeeping services department of Ruger Clinic, a multi-specialty practice in Toledo, Ohio had $100,000 in direct costs during 2011. These costs must be allocated to Ruger's three revenue-producing patient services departments using the direct method. Two cost drivers are under consideration: patient services revenue and hours of housekeeping services used. The patient services departments generated $5 million in total revenues during 2011, and to support these clinical activities, they used 5,000 hours of housekeeping services.
a. What is the value of the cost pool?
b. What is the allocation rate if:
a. Patient services revenue is used as the cost driver?
b. House of housekeeping services is used as the cost driver?

Refer to Problem 6.1. Assume that the three patient services departments are adult services, pediatric services, and other services. The patients services revenue and house of housekeeping services for departments are:

Department Revenue Housekeeping Hours
Adult Services 3,000,000 1500
Pediatric Services 1,500,000 3000
Other Services 500,000 500
Total 5,000,000 5000

a. What is the dollar allocation to each patient services department if patient services revenue is used as the cost driver?
b. What is the dollar allocation to each patient services department if hours of housekeeping support are used as the cost driver?
c. What is the difference in the allocation to each department between the two drivers?
d. Which of the two drivers is better? Why?

St. Benedict's Hospital has three support departments and four patients services departments. The direct costs to each of the support departments are:
General Admin: $2,000,000
Facilities: $5,000,000
Financial Services: $3,000,000

Selected data for the three support and four patient services department are:

Assume that the hospital uses the direct method for cost allocation. Furthermore, the cost driver for general administration and financial services patient services revenue, while the cost driver for facilities is space utilization.
a. What are the appropriate allocation rates?
b. Use a allocation table similar to Exhibit 6.7 (below) to allocate the hospital's overhead costs to the patient services departments.

Exhibit 6.7

Assume that the hospital uses salary dollars as the cost driver for general administration, housekeeping labor hours as the cost driver for facilities, and patient services revenue as the cost driver for financial services. (The majority of the costs of the facilities department stem from the provision of housekeeping services.)
a. What are the appropriate allocation rates?
b. Use an allocation table similar to the one used for Problem 6.3 to allocate the hospital's overhead costs to the patient services departments.
c. Compare the dollar allocations with those obtained in Problem 6.3. Explain the differences.
d. Which of the two cost driver schemes is better? Explain.

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