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At least 19 recordsLinked to original sources
PubMed1988

Improved financial management of the radiology department with a microcosting system.

The basic unit of service in radiology is the examination or procedure and its associated costs such as film, medical and surgical supplies, personnel, equipment depreciation, and overhead. The appropriate allocation of all operating costs to the specific examination types is the purpose of the microcosting system. Microcosting programs use data from hospital expense and payroll systems and data from a radiology information management system. These data are loaded into a computer spread sheet program for the microcosting computations. The results from using this system include better understanding of costs, accurate budget projections, confidence in negotiating discounts, and improved efficiency and reduced costs.

Accounting↗
PubMed1992

The origins of hospital microcosting.

This paper begins with a definition of microcosting, including the specification of design criteria and a general model framework. The necessity for micro- as opposed to macro-costing is discussed. Examples of microcosting systems are provided. Relative value scale and case-mix alternatives to microcosting are presented.

Cost Allocation↗
PubMed2025

A microcosting and cost consequence analysis from a randomized controlled trial comparing genome sequencing with exome sequencing for genetic diagnosis.

PURPOSE: Diagnosing rare diseases is costly. The objectives were to microcost exome (ES) and genome sequencing (GS) trios and estimate the incremental costs of GS per additional diagnosis from an institutional payer perspective. METHODS: Trios (proband plus biological parents) that are referred for sequencing were randomly assigned to ES or GS. Laboratory workflow and sequencing were microcosted. Total and category cost per trio were estimated probabilistically. Effectiveness was expressed as diagnostic yield (rates of diagnostic or partially diagnostic variants detected). Incremental costs and effectiveness were calculated. RESULTS: The mean total cost per trio was CAD 2888.79 (95% CI 2567.72, 3492.72) for ES (n = 329) and 4364.02 (95% CI 3984.94, 5013.67) for GS (n = 324). Reagents accounted for 34% and 61% of total costs for ES and GS, respectively. The incremental cost of GS was 1475.23. The diagnostic yield was 35.9% for ES and 32.7% for GS with a difference of 0.032 (95% CI: -0.041, 0.104, P value .397). CONCLUSION: GS demonstrated higher costs and a similar diagnostic yield to ES but was limited by technical capabilities at the time of the study. The study provides comprehensive costs for the economic evaluation comparing alternative diagnostic pathways and impetus for further evaluating variants uniquely detectable by GS.

Humans↗
PubMed1990

Microcost analysis of inpatient dispensing and administration of oral solids.

The labor cost of dispensing, administering, and monitoring unit dose oral solid dosage forms (UDs) in a large teaching hospital was determined by microcost analysis. The costs associated with UDs dispensed by the midnight central pharmacy and by a satellite pharmacy were evaluated by use of both work-sampling and time-and-motion studies. Pharmacy personnel activities were classified as direct, auxiliary, or nonproductive. A nursing productivity index was used to determine the nursing time consumed in the administration and monitoring of UDs. The pharmacy labor cost was lowest ($0.14 each) for UDs dispensed from the central pharmacy in the 24-hour medication cart. For each UD that was not dispensed in the 24-hour cart, the labor cost was $0.25 for the central pharmacy and $1.37 for the satellite pharmacy. It took nurses 223.8 sec to administer and monitor a scheduled UD, for a cost of $0.82. The total nursing time spent per nonscheduled UD for administration and monitoring was 574.2 sec; the cost was $2.11. Microcost analysis can be used to isolate the costs of dispensing oral solids in an inpatient setting.

Chicago↗
PubMed1986

Microcosting method for small-volume injectables.

The costs of preparing different small-volume injectables (SVIs) in a centralized i.v. admixture pharmacy in a 650-bed teaching hospital were calculated using a microcosting method. The types of SVIs produced and methods of preparation were identified. Time-and-motion and work-sampling studies were performed to determine the amount of pharmacist and technician time spent in SVI production, auxiliary activities, and nonproductive activities. The costs of material and equipment used were calculated, and waste-cost factors based on percentages of wasted SVIs were determined. To determine the final cost per unit prepared, the calculated costs were added and multiplied by the appropriate waste factors. On the average, it took 5.57 minutes of total personnel time to prepare an SVI. It took an average of 192.4 seconds and 16.6 seconds for the technicians and pharmacists, respectively, to reconstitute a vial of powder and prepare an SVI in a minibag. Bulk prepacked items and admixtures prepared from vials of powder for reconstitution and stored in minibags were, respectively, the least and most expensive SVIs. By using microcosting methods to determine the cost of preparing SVIs, this institution discovered that the cost figures were much higher than it had anticipated. These data can be used to improve productivity and cost efficiency and to compare the costs of in-house and commercially available preparations.

Costs and Cost Analysis↗
PubMed1988

Microcost analysis of the prescription dispensing process in an outpatient hospital pharmacy.

The costs involved in dispensing a prescription in an outpatient pharmacy at a 450-bed teaching hospital were studied. Work sampling was used to determine pharmacist and technician time involved in dispensing a prescription, and other direct and indirect costs involved in dispensing a prescription were isolated. The cost per prescription was calculated as the total of personnel costs for dispensing plus other costs, excluding the cost of the drug. Average of 2.68 and 3.37 minutes of pharmacist and technician time, respectively, were directly involved in dispensing each prescription. The standard auxiliary times per prescription were calculated to be 1.17 minutes and 4.66 minutes for the two groups, respectively. Total pharmacy personnel time consumed in dispensing a prescription was 13.33 minutes. Total calculated personnel cost included in dispensing a prescription was +3.14. Adding to this figure other direct and indirect costs resulted in a total cost of +5.42 for dispensing a prescription. Although the time and cost figures identified are unique to this outpatient pharmacy, other institutions can use these microcosting techniques to provide data that can be useful in the negotiation of contracts for the provision of pharmaceutical services to ambulatory patients.

Costs and Cost Analysis↗
PubMed2001

A microcosting analysis of zoledronic acid and pamidronate therapy in patients with metastatic bone disease.

Our goal was to calculate resource use associated with administration of zoledronic acid, compared with pamidronate, as palliative care for patients with metastatic bone lesions. We conducted a time-and-motion study of therapy administration at each of three outpatient chemotherapy infusion sites participating in clinical trials of zoledronic acid and pamidronate. We developed a data-collection instrument to record all staff effort and patient resource use in drug administration. The main outcome measures were (a) direct costs of therapy administration per patient and (b) opportunity benefits expressed as the availability of resources gained per year. The average visit time for patients receiving the study dose of zoledronic acid, 4 mg, was 1 h, 6 min, compared to 2 h, 52 min for patients receiving a 90-mg dose of pamidronate. Infusion time accounted for much of the difference. In the base-case analysis, total direct costs per patient were $728 for zoledronic acid and $776 for pamidronate. The opportunity benefit for infusion of zoledronic acid vs pamidronate in the base case was 1.8 chairs per day, or 426 chairs per 240-workday year. Results were sensitive to changes in infusion facility size, days of operation, and average number of patients treated. Shorter infusion time associated with the administration of zoledronic acid, compared with pamidronate, yields substantial time savings for patients, as well as opportunity benefits for outpatient oncology facilities.

Antineoplastic Agents↗
PubMedDate not supplied

Pricing hospital units of service using microcosting techniques.

Traditionally, pricing of hospital-based ancillary and diagnostic services has been a reactionary response to a cost-based budgeting system. Revenue objectives have been determined by budgeted costs, new development, contractual allowances, and required net income. Since hospitals have found it difficult to accurately measure the costs of specific services, price setting has been reserved solely for senior management or for the financial division. Thus, operating managers and their professional (medico-administrative) counterparts have had little opportunity to participate in the price-setting process and, for the most part, have had little understanding of the cost components which should be analyzed before the rates are set. A great deal of confusion and questioning has developed surrounding the establishment of prices at the departmental level. Although hospitals have given some consideration to market forces, this element in the new competitive environment will have a greater impact on the services purchased by the various payors.

Budgets↗
PubMed1987

Hospital cost accounting and the new imperative.

Government regulatory structures, prospective payment mechanisms, a more competitive environment, and attempts to link cost accounting principles to planning, budgeting, and fiscal control all have served as catalysts for hospitals to increase their reliance and emphasis on cost accounting. Current hospital accounting systems are relatively inexpensive to develop and maintain, and they fulfill the financial reporting requirements mandated by Medicare and other third-party payers. These systems, however, do not provide information on what specific service units cost, and managers must have this information to make optimal trade-offs between quality, availability, and cost of medical services. Most health care organizations have a predetermined charge for each type of service, but the charge may not accurately portray the cost of providing the service. Knowing true costs will enable managers to select the most cost-effective method of treating a patient; know the financial implications of adding tests or procedures; relate costs to established norms of care; establish ranges of acceptable costs in various diagnostic groups; negotiate more successfully with rate review organizations and health maintenance organizations; and vigorously market and advertise the services that most contribute to the organization's overall financial health. The goal of microcosting is to determine the full cost of providing specific service units. The microcosting process comprises three components: data collection, cost modeling, and cost analysis. Microcosting is used to determine full costs for 20 percent of the hospital's procedures that are responsible for generating 80 percent of the hospital's gross revenue. Full costs are established by adding labor costs, materials costs, equipment depreciation costs, departmental overhead costs, and corporate overhead costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Accounting↗
PubMedDate not supplied

Laboratory manager's financial handbook. Cost accounting: the road map to financial success.

Cost accounting is the most basic element of the laboratory's financial management structure. Historically, cost accounting in the nonmedical world referred to accumulating and assigning costs to units of production and departments, primarily for inventory valuation and income determination. In the health industry, microcost accounting is distinguishable from macrocost (management/internal) accounting and serves multiple purposes. Microcost accounting pertains to gathering and providing information for decision making. The range of decisions include managing recurring operations, making nonrecurring strategic decisions, and formulating major organizational policies. Macrocost accounting fulfills the legal requirements of reporting to stockholders, auditors, governmental agencies, and other external parties.

Accounting↗
PubMed2025

The cost and cost trajectory of genome sequencing and bioinformatics analysis for Indigenous children with suspected rare diseases.

PURPOSE: Indigenous peoples are underrepresented in reference genome libraries. Consequently, rare disease diagnosis may require bespoke bioinformatics analyses of genome sequences. Establishing diagnostic cost is crucial to support policy development for equitable diagnosis of rare diseases. We estimated the cost and cost trajectory of diagnostic genome sequencing and bioinformatics for Indigenous participants with suspected rare diseases. METHODS: We conducted a microcosting study of Indigenous children and their families receiving genome sequencing through Canada's Silent Genomes Project. Invoice data informed the costs of genome sequencing. We conducted a time-and-motion study for bioinformatics analyses, including labor, computing, and data storage costs. RESULTS: With standard bioinformatics, costs ranged from C$3645 (SD: 455) for singletons to C$7402 (SD: 566) for trios. With advanced, bespoke bioinformatics, costs ranged from C$5344 (SD: 634) for singletons to C$9760 (SD: 822) for trios. Genome sequencing was a primary cost driver; however, sequencing costs decreased by 61% over 4 years. Bioinformatics costs ranged from 21.3% to 58.3% of the total costs. The time required for bioinformatics ranged from 71 hours to 215 hours for standard and advanced analyses, respectively. CONCLUSION: Genome sequencing costs decreased over time. Bioinformatics is a significant cost driver, particularly for bespoke analyses arising from nonrepresentative reference libraries.

Humans↗
PubMedDate not supplied

Cost of treating heart failure in an Irish teaching hospital.

BACKGROUND: The prevalence of heart failure is 3 to 20 per 1,000 population, but may exceed 100 per 1,000 in the over 65 age group. Some 1-2% of the total healthcare budget is consumed in the management of heart failure. AIM: As hospital costs account for approximately 70% of this expenditure we determined the cost of treating heart failure in an Irish teaching hospital. METHODS: Cost evaluation was from the hospital perspective using a microcosting detailed collection of resources used. RESULTS: The average cost of a hospital admission for cardiac failure was IR 2,146 Pounds. The average cost per day was IR 193 Pounds. Approximately 75% of hospital costs were associated with ward costs. Medications accounted for 3.5% of total costs. CONCLUSION: The availability of Irish cost data is essential for the assessment of the cost-effectiveness of therapeutic interventions for the treatment of heart failure in our healthcare system.

Aged↗
PubMed2005

Cost-effectiveness analysis of weekday and weeknight or weekend shifts for assessment of appendicitis.

BACKGROUND: Assessment of appendicitis during a weeknight or weekend shift (after-hours period, AHP) might be more costly and less effective than its assessment on a weekday shift (standard hours period, SHP) because of increased costs (staff premium fees) and perforation risk (longer delays and less experience of fellows). OBJECTIVES: The objectives were to compare the costs and effectiveness of assessing children with suspected appendicitis who required a laparotomy and had US or CT after-hours with those of assessing children during standard hours, and to evaluate the importance of diagnostic imaging (DI) within the overall costs. MATERIALS AND METHODS: We retrospectively microcosted resource use within six areas of a tertiary hospital (emergency [ED], diagnostic imaging (DI), surgery, wards, transport, and pathology) in a tertiary hospital. About 41 children (1.8-17 years) in the AHP and 35 (2.9-16 years) in the SHP were evaluated. Work shift effectiveness was measured with a histological score that assessed the severity of appendicitis (non-perforated appendicitis: scores 1-3; perforated appendicitis: score 4). RESULTS: The SHP was less costly and more effective regardless of whether the calculation included US or CT costs only. For a salary-based fee schedule, 733 US dollars were saved per case of perforated appendicitis averted in the SHP. For a fee-for-service payment schedule, 847 dollars were saved. Within the overall budget, the highest costs were those incurred on the ward for both shifts. The average cost per patient in DI ranged from 2 to 5% of the total costs in both shifts. Most perforation cases were found in the AHP (31.7%, AHP vs. 17.1%, SHP), which resulted in higher ward costs for patients in the AHP. CONCLUSION: A higher proportion of severe cases was seen in the AHP, which led to its higher costs. As a result, the SHP dominated the AHP, being less costly and more effective regardless of the fee schedule applied. The DI costs contributed little to the overall cost of the assessment of appendicitis.

Adolescent↗
PubMed2004

Comparison of estimated medical costs among patients who are defined as having rheumatoid arthritis using three different standards.

Accurate estimation of medical care costs raises a host of challenging issues. We examined whether pure administrative claims data without clinical validation of diagnosis allow reasonable estimation of disease-related costs in rheumatoid arthritis (RA). Three patient groups were examined: patients with clinically confirmed RA (group A, n=338), patients with likely RA (administrative claims data reported the diagnosis of RA and patients were treated with disease modifying antirheumatic drugs, DMARDs; group B, n=303), and patients with possible RA (same as group B but patients had no DMARD treatment; group C, n=685). The payer's perspective was taken for this analysis. Only direct costs were included in the analysis. Cost data and data for several covariates were obtained from a major German statutory health insurance plan, the AOK Niedersachsen. A patient-per-patient microcosting approach was performed. A repeated measures, fixed effects model was applied to examine differences between the three study groups. Mean+/-SEM annual RA-related direct costs were euro 2,017+/-183 per patient-year in group A, euro 1,763+/-192 in group B, and euro 805+/-58 in group C. Outpatient (inpatient) costs were euro 1,636 (328) in group A, euro 1344 (340) in group B, and euro 546 (136) in group C. DMARD costs were by far the single most important cost driver in groups A and B. The difference in total RA-related direct cost between groups A and B was not significant whereas the differences between groups A and C (group B and C respectively), were significant. Pure administrative claims data allowed for an accurate estimate of disease-related costs in RA patients that received DMARD therapy. However, the high number of patients for whom administrative claims data listed the diagnosis RA, but no DMARD treatment was given poses a challenge for further research.

Adult↗