Newly appointed director of the Lambert Medical Center (LMC) a large metropolitan hospital was reviewing the financial report for the most recent quarter.

Newly appointed director of the Lambert Medical Center (LMC) a large metropolitan hospital was reviewing the financial report for the most recent quarter.

Paula Barneck the newly appointed director of the Lambert Medical Center (LMC) a large metropolitan hospital was reviewing the financial report for the most recent quarter. The hospital had again shown a loss. For the past several years it had been struggling financially. The financial problems had begun with the introduction of the federal governments new diagnostic-related group (DRG) reimbursement system. Under this system the government mandated fixed fees for specific treatments or illnesses. The fixed fees were supposed to represent what the procedures should cost and differed from the traditional cost objective of the patient day of prior years. Although no formal assessment had been made the general feeling of hospital management was that the DRG reimbursement was hurting LMCs financial state. The increasing popularity of health maintenance organizations (HMOs) and physician provider organizations (PPOs) was also harming the hospitals financial well-being. In HMOs physicians who are employed full time are usually located in a clinic owned by the HMO and subscribers must use these physicians services. In PPOs hospitals provide contracts with a group of physicians in private practice. These physicians usually serve non-PPO patients as well as PPO patients. The PPO patient can select any physician from the list of physicians under contract with the particular PPO. The PPO approach usually offers a greater selection of physicians and tends to preserve the patients traditional freedom of choice. More and more of the hospitals potential patients were joining HMOs and PPOs and unfortunately LMC was not capturing its fair share of the HMO and PPO business. HMOs and PPOs routinely asked for bids on hospital services and provided their business to the lowest bidder. In too many cases LMC had not won that work. Paula had accepted the position of hospital administrator knowing that she was expected to produce dramatic improvements in LMCs financial state. She was convinced that she needed more information about the hospitals product costing methods. Only by having accurate cost information for the various procedures offered by the hospital could she evaluate the effects of DRG reimbursement and the hospitals bidding strategy. Paula requested a meeting with Eric Rose the hospitals controller. Their conversation follows: PAULA:Eric as you know we recently lost a bid on some laboratory tests that would be performed on a regular basis for a local HMO. In fact I was told by the director of the HMO that we had the highest bid of the three submitted. I know the identity of the other two hospitals that submitted bids and I have a hard time believing that their costs for these tests are any lower than ours. Describe exactly how we determine the cost of these lab procedures. 7-2 ERIC:First we classify all departments as either revenue-producing centers or service centers. Next the costs of the service centers are allocated to the revenue producing centers. The costs directly traceable to the revenue-producing centers are then added to the allocated costs to obtain the total cost of operating the revenue-producing center. This total cost is divided by the total revenues of the revenue-producing center to obtain a cost-to-charges ratio. Finally the cost of a particular procedure is computed by multiplying the charge for that procedure by the cost-tocharges ratio. PAULA:Let me see if I understand. The costs of laundry housekeeping maintenance and other service departments are allocated to all of the revenue-producing departments. Lets assume that the lab receives $100 000 as its share of these allocated costs. The $100 000 is then added to the direct costslets assume these are also $100 000to obtain total operating costs of $200 000. If the laboratory earns revenues of $250 000 the cost-to-charges ratio is 0.80 ($200 000/$250 000). Finally if I want to know the cost of a particular lab procedure say a blood test for which we normally charge $20 then all I do is multiply the cost-to-charges ratio of 0.8 by $20 to obtain the cost of $16. Am I right? ERIC:Absolutely. In the laboratory testing bid that we just lost our bid was at cost as computed using our cost-to-charges formula. Perhaps the other hospitals are biddin

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