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At least 19 recordsLinked to original sources

PubMed1996

A professional response to demands for accountability: practical recommendations regarding ethical aspects of patient care. Working Group on Accountability.

Forceful new demands for accountability in medicine are arising from many interested parties. To maintain professional standards, physicians need to establish which demands are desirable and which are not. We adopt a model of stratified accountability that includes three major components: the accountable parties, the subject matter, and the processes for accountability. To begin describing the model, we focus on physicians and health care institutions. We focus on the ethical dimensions of medical practice, both because the difficulty of measuring such behaviors makes this a test case for accountability and because of the importance of ethical standards in maintaining patient trust. We first identify eight widely endorsed content areas for accountability in ethical conduct: medical decision making, confidentiality, fiduciary obligations (including conflicts of interest), responsibilities arising from patient vulnerability, personal standards, equity among patients, cultural representation, and procedures for resolving dilemmas. We then identify the currently most valid and reliable methods for assessing conduct: surveys among all involved parties, testing methods used for accreditation, limited audits, publication of policy, and careful use of report cards. A prototypical survey and report card are illustrated. However, we also note the need for improved accountability assessment methods. We next identify mechanisms for taking responsibility: sharing information, exchanging perspectives, making adjustments, and enforcing standards when necessary. Finally, because this report only begins to describe a small part of the accountability model, we urge explicit identification and development of professional standards for accountability in the many other areas of medicine.

Clinical Competence↗

PubMed1991

Consistency endangered by FASB-GASB (Financial Accounting Standards Board, Government Accounting Standards Board ) dispute.

The Financial Accounting Foundation's (FAF's) November 1989 decision to uphold the 1984 jurisdictional arrangement between the Financial Accounting Standards Board (FASB) and the Government Accounting Standards Board (GASB) leaves little doubt that the healthcare industry will now be subject to two sets of accounting standards. The FAF's decision created a distinction between the accounting practices of government-owned hospitals and non-hospital governmental entities and their adherence to standards set by FASB, GASB, and the American Institute of Certified Public Accountants. A governmental healthcare organization should carefully determine which accounting rules it follows and remain attentive to further GASB developments.

Accounting↗

PubMed1999

Accounting for the effects of accountability.

This article reviews the now extensive research literature addressing the impact of accountability on a wide range of social judgments and choices. It focuses on 4 issues: (a) What impact do various accountability ground rules have on thoughts, feelings, and action? (b) Under what conditions will accountability attenuate, have no effect on, or amplify cognitive biases? (c) Does accountability alter how people think or merely what people say they think? and (d) What goals do accountable decision makers seek to achieve? In addition, this review explores the broader implications of accountability research. It highlights the utility of treating thought as a process of internalized dialogue; the importance of documenting social and institutional boundary conditions on putative cognitive biases; and the potential to craft empirical answers to such applied problems as how to structure accountability relationships in organizations.

Attitude↗

PubMed2000

Prevention validation and accounting platform: a framework for establishing accountability and performance measures of substance abuse prevention programs.

The field of substance abuse prevention has neither an overarching conceptual framework nor a set of shared terminologies for establishing the accountability and performance outcome measures of substance abuse prevention services rendered. Hence, there is a wide gap between what we currently have as data on one hand and information that are required to meet the performance goals and accountability measures set by the Government Performance and Results Act of 1993 on the other. The task before us is: How can we establish the accountability and performance measures of substance abuse prevention programs and transform the field of prevention into prevention science? The intent of this volume is to serve that purpose and accelerate the processes of this transformation by identifying the requisite components of the transformation (i.e., theory, methodology, convention on terms, and data) and by introducing an open forum called, Prevention Validation and Accounting (PREVA) Platform. The entire PREVA Platform (for short, the Platform) is designed as an analytic framework, which is formulated by a collectivity of common concepts, terminologies, accounting units, protocols for counting the units, data elements, and operationalizations of various constructs, and other summary measures intended to bring about an efficient and effective measurement of process input, program capacity, process output, performance outcome, and societal impact of substance abuse prevention programs. The measurement units and summary data elements are designed to be measured across time and across jurisdictions, i.e., from local to regional to state to national levels. In the Platform, the process input is captured by two dimensions of time and capital. Time is conceptualized in terms of service delivery time and time spent for research and development. Capital is measured by the monies expended for the delivery of program activities during a fiscal or reporting period. Program capacity is captured by fourteen measurement units, tapping into the dimensions of staff resources and community assets. Staff resources are, in turn, operationalized in terms of staff size, staff certification status, staff turnover rate, and the accreditation status of a provider agency. Community assets are operationalized by the number of community centers accessible to the funded agency, number of formalized teams or antidrug coalitions active in the catchment area, and other social/human services providers with whom the prevention agency has formalized networks. The totality of process output from all sources of program activities is reduced to eighteen classes of measures. These are operationalized by thirty-three summary measures. Some of these include: total count of events facilitated; total number of clients served; average number of clients served per event; clients served by single and multiple program sessions; classification of target population in terms of the severity of risk as defined by the Institute of Medicine; age groups and race/ethnicity of clients served; number of program participants retained by recurring programs; number of clients who have completed the program; penetration rates to the target population; client attrition rates; average referral rates per provider per time interval; referral success rates; and so on. All process output measures specified in the Platform are derived from two broad classes of events classified as either products or services. The collectivity of these measures is expected to present a cost-effective, parsimonious, yet comprehensive picture of the entire spectrum of the process output, i.e., "what came out of the program as program activities". For the measurement of performance outcomes, two types of data are incorporated into the Platform: outcome data from individuals and the behavior (or performance) of social indicators from aggregated data bases. Individual data are used to evaluate the outcome of substance abuse programs

Accounting↗

PubMed2000

[Cost accounting for gastrectomy under critical path--the usefulness of direct accounting of personnel expenses and a guide to shortening hospital stay].

In this study, cost accounting was made for a surgical case of gastrectomy according to critical path (path) and the economic contribution of the path was determined. In addition, changes in the cost percentage with changes in number of hospital days were simulated. Basically, cost accounting was done by means of cost accounting by departments, which meets the concept of direct cost accounting of administered accounts. Personnel expenses were calculated by means of both direct and indirect calculations. In the direct method, the total hours personnel participated were recorded for calculation. In the indirect method, personnel expenses were calculated from the ratio of the income of the surgical department to that of other departments. Purchase prices for all materials and drugs used were recorded to check buying costs. According to the direct calculating method, the personnel expenses came to approximately 300,000 yen, total cost was approximately 700,000 yen, and the cost percentage was 59%. According to the indirect method, the personnel expenses were approximately 540,000 yen and the total cost was approximately 940,000 yen, the cost percentage being 80%. A simulation study of changes in the cost with changes in hospital days revealed that the cost percentages were assessed to be approximately 53% in 19 hospital days and approximately 45% in 12 hospital days.

Costs and Cost Analysis↗

PubMed1995

AICPA (American Institute of Certified Public Accountants) seeks comments on proposed accounting changes.

The American Institute of Certified Public Accountants has exposed for public comment a revised version of its accounting and auditing guide--Audits of Providers of Health Care Services. The guide covers accounting, auditing, and financial reporting in healthcare organizations and is being revised primarily to address the changing healthcare environment and changes mandated by the Financial Accounting Standards Board. This article provides an overview of some of the more significant proposed changes. The comment period ends August 14, 1995.

Accounting↗

PubMed1985

Patient accounts: getting it from all sides and PPS, UB-82, and DRGs. Roundtable on patient accounts management.

Patient accounts management today is facing new challenges. And the patient accounts manager is beseiged by a multitude of threats and opportunities, forcing the manager to seek ways to improve productivity, maintain cash flow, and enhance working relationships. In response, HFMA conducted a roundtable discussion with patient accounts managers from the American Guild of Patient Account Management and HFMA to determine some of these threats and opportunities confronting the manager. This article presents the highlights of that discussion.

Accounting↗

PubMed1997

Accountability and the accounting regime in the public sector. Some messages from the NHS.

In the UK, the government is keen to introduce private sector procedures into the public sector. The latest stage of this process has been to suggest the adoption of accruals accounting by those parts of the public sector where it is not already operated. This approach to accounting was introduced into the NHS as part of the reforms which implemented a quasi-market to match the demands of purchasers of health care with its providers. Outlines the assumptions which underlie accruals accounting and considers whether the environment created for NHS Trusts is sufficiently like that of the private sector to justify its use. Shows that the initial ideas of the extent to which Trusts could mimic private sector organizations have not been fulfilled in practice, and concludes that it is not possible to justify the use of accruals accounting in the public sector simply on the grounds that as it is the technique used in the private sector it must be superior to the available alternatives.

Accounting↗

PubMed1989

FASB (Financial Accounting Standards Board) proposal changes retiree healthcare benefit accounting.

The Financial Accounting Standards Board (FASB) recently issued an exposure draft (ED) of a standard that would change the way organizations account for their employees' post-retirement healthcare benefits. According to the ED, organizations would have to switch from cash accounting to accrual accounting for post-retirement benefits as well as record their retiree healthcare liabilities on their balance sheets by 1992.

Accounting↗

PubMed1994

FASB (Financial Accounting Standards Board) issues new accounting rules for debt and equity securities.

The Financial Accounting Standards Board (FASB) recently issued a new statement that requires all companies to change their methods of accounting for debt and equity securities. Rather than allowing organizations to use a historical cost approach in accounting for such financial instruments, FASB Statement No. 115 requires organizations to adopt a market value approach. The provisions of this statement will affect significantly organizations in the healthcare industry that have large investment portfolios.

Accounting↗

PubMed1989

The other shoe drops--FASB (Financial Accounting Standards Board) issues its proposed statement on employers' accounting for postretirement medical benefits.

The Financial Accounting Standards Board recently issued an exposure draft dealing with employers' accounting for postretirement medical or life insurance benefits. Mr. Melbinger explains the implications of these proposed changes in accounting procedures and discusses the status of case law dealing with employers' rights to modify or terminate retiree medical coverage.

Accounting↗

PubMedDate not supplied

Reconsidering clinical accountability. An examination of some dilemmas inherent in efforts to bolster clinician accountability.

The paper critically appraises current efforts to bolster the accountability of clinicians. The paper opens with an examination of the values, meaning and rules which underpin different accountability systems. Against this background we canvass conceptual, practical and ethical issues which need to be addressed if efforts to extend the accountability of clinicians are to meet with success.

Ethics, Medical↗

PubMed1992

A systematic method of accountability. Sound policies allow facilities to account for the level of charity care they provide.

Charity care policies can help hospitals accurately determine, define, and account for the level of charity care they provide. This information will help hospitals budget appropriately and measure trends that will ultimately affect the organization's viability. State governments, the federal government, and the Internal Revenue Service are more closely scrutinizing not-for-profit hospitals' tax-exempt status. As a result, the American Institute of Certified Public Accountants (AICPA) has revised its requirement to report on charity care. To meet the AICPA's requirement, healthcare providers must develop their own definition of charity and determine criteria for providing care free or at a reduced rate. Setting policies to support the organization's definition of charity is necessary for the development of internal systems that promote the early identification of individuals seeking healthcare who will be unable to pay for services. Several policy implications may result from the facility's charity care determination process. For example, patients exhibiting extreme hardship might still be eligible to receive charity care even though their income and assets exceed the hospital's income guidelines. An organization planning to develop a charity care policy must first thoroughly assess its current charity care practices and cost accounting capabilities. Obtaining input from all the departments involved in the development of the charity care policy is necessary to make the transition as smooth as possible.

Budgets↗

PubMed1989

[Characteristics of population groups applying for the services of cost-accounting polyclinics as a factor in the planning of paid services (data of the cost-accounting polyclinics of Moscow)].

Socioeconomic characteristics of population groups and causes of their applications for aid into cost-accounting consultative and diagnostic general polyclinics are described. The obtained results reveal that the existing system of tariffs for the services provided by paid polyclinics ensures their accessibility to all population groups irrespective of their income. Further development of the network of cost-accounting polyclinics makes it necessary to analyze the relation and character of medical care provided by the territorial polyclinical network and cost-accounting polyclinics.

Adult↗

PubMed2000

Accounting and accountability: observations on the AHERF settlements.

Recent enforcement proceedings involving health care and accounting--relating primarily to the Allegheny Health, Education and Research Foundation (AHERF)--have sparked renewed interest in the activities of the U.S. Securities and Exchange Commission in the municipal securities market. Officials and accountants who are working for public-sector issuers in the healthcare industry have responsibilities under the Federal securities laws. Other issues of relevance include disclosure in the secondary market as well as upon initial issuance, and the significance of antifraud actions in other areas.

Accounting↗

PubMed1989

Being accountable for care of the poor. CHA's social accountability budget helps facilities keep track of charitable activity.

The Catholic Health Association's social accountability budget is a set of tools to help Catholic healthcare facilities plan for, administer, and report benefits provided to their communities, especially the poor. It defines a full roster of community benefits that a healthcare organization may provide. The benefits fall into three major categories: activities and services, policies and procedures, and community leadership. The social accountability budget also presents guidelines for assessing the facility's existing services, activities, policies, and procedures and discusses how the facility can conduct or be part of a community needs assessment. Information collected through this assessment is used in the planning and budgeting processes. This ensures that uncompensated care and charitable services receive consideration along with traditional planning and budgeting items. Additional guidelines show the facility how to track and measure its services to the community. The final step, often absent from Catholic healthcare facilities' programs, is reporting community benefits.

Budgets↗

PubMed1984

Medicare changes create accounting, reporting, and auditing problems. Task Force on Federal Health Care Legislation, American Institute of Certified Public Accountants.

Hospital auditors and financial officers must adjust and react to the changing financial healthcare environment brought about by PPS. A close review of accounting systems, reporting methods, auditing procedures, and internal control systems should be made to determine that assets are safe-guarded and financial information is presented in conformity with GAAP. This article identified new problems and suggested solutions. Old tasks may no longer be necessary. For example, retroactive adjustments are not as important as they used to be. Estimates for capital and outpatient costs may continue to be required, but elaborate cost-finding techniques may no longer be necessary to estimate retroactive adjustments for reimbursable items. We recommend that prior to beginning an audit of a hospital's financial statements, each hospital's financial officers and its auditors discuss the possible accounting, reporting, and auditing implications as a result of PPS.

Financial Audit↗

PubMed2004

Cost accounting for end-of-life care: recommendations to the field by the Cost Accounting Workgroup.

Accurate measurement of economic costs is prerequisite to progress in improving the care delivered to Americans during the last stage of life. The Robert Wood Johnson Excellence in End-of-Life Care national program assembled a Cost Accounting Workgroup to identify accurate and meaningful methods to measure palliative and end-of-life health care use and costs. Eight key issues were identified: (1) planning the cost analysis; (2) identifying the perspective for cost analysis; (3) describing the end-of-life care program; (4) identifying the appropriate comparison group; (5) defining the period of care to be studied; (6) identifying the units of health care services; (7) assigning monetary values to health care service units; and (8) calculating costs. Economic principles of cost measurement and cost measurement issues encountered by practitioners were reviewed and incorporated into a set of recommendations.

Accounting↗