Healthcare Finance Essay Example for Free

Healthcare Finance Essay Houston Dialysis Center is a department of Houston General Hospital, a full-service, not-for-profit acute care hospital with 325 beds. The bulk of the hospital’s facilities are devoted to inpatient care and emergency services. However, a 100,000 square-foot section of the hospital complex is devoted to outpatient services. Currently, this space has two primary uses. About 80 percent of the space is used by the Outpatient Clinic, which handles all routine outpatient services offered by the hospital. The remaining 20 percent is used by the Dialysis Center. The Dialysis Center performs hemodialysis and peritoneal dialysis, which are alternative processes for removing wastes and excess water from the blood for patients with end-stage renal (kidney) disease. In hemodialysis, blood is pumped from the patient’s arm through a shunt into a dialysis machine, which uses a cleansing solution and an artificial membrane to perform the functions of a healthy kidney. Then, the cleansed blood is pumped back into the patient through a second shunt. In peritoneal dialysis, the cleansing solution is inserted directly into the abdominal cavity through a catheter. The body naturally cleanses the blood through the peritoneum—a thin membrane that lines the abdominal cavity. In general, hemodialysis patients require three dialyses a week, with each treatment lasting about four hours. Patients who use peritoneal dialysis change their own cleansing solutions at home, typically about six times per day. This procedure can be done manually when active or automatically by machine when sleeping. However, the patient’s overall condition, as well as the positioning of the catheter, must be monitored regularly at the Dialysis Center. The hospital allocates facilities costs (which primarily consist of building depreciation and interest on long-term debt) on the basis of square footage. Currently, the facilities cost allocation rate is $15 per square foot, so the facilities cost allocation is 20,000 Ãâ€" $15 = $300,000 for the Dialysis Center and 80,000 Ãâ€" $15 = $1,200,000 for the Outpatient Clinic. All other overhead costs, such as administration, finance, maintenance, and  housekeeping, are lumped together and called â€Å"general overhead.† These costs are allocated on the basis of 10 percent of the revenues of each patient service department. The current allocation of general overhead is $270,000 for the Dialysis Center and $1,600,000 for the Outpatient Clinic, which results in total overhead allocations of $570,000 for the Dialysis Center and $2,800,000 for the Outpatient Clinic. Recent growth in volume of the Outpatient Clinic has created a need for 25 percent more space than currently assigned. Because the Outpatient Clinic is much larger than the Dialysis Center, and because its patients need frequent access to other departments within the hospital, the decision was made to keep the Outpatient Clinic in its current location and to move the Dialysis Center to another location to free up space. Such a move would give the Outpatient Clinic 100,000 square feet, a 25 percent increase. After attempting to find new space for the Dialysis Center within the hospital complex, it was soon determined that a new 20,000 square foot building must be built. This building will be situated two blocks away from the hospital complex, in a location that is much more convenient for dialysis patients (and Center employees) because of ease of parking. The new space, which can be more efficiently utilized than the old space, allows for a substantial increase in patient volume, although it is unclear whether the move will result in additional dialysis patients. The new dialysis facility is expected to cost $3 million. Additionally, furniture and other fixtures, along with relocation expenses of current equipment, would cost $1 million, for a total cost of $4 million. The funds needed for the new facility will be obtained from a 20-year loan at local bank. The loan (including interest) will be paid off over 20 years at a rate of $400,000 per year. Because the specific financing details are known, it is possible to estimate the actual annual facilities costs for the new Dialysis Center, something that is not possible for units located within the hospital complex. Table 1 (see Excel spreadsheet) contains the projected profit and loss (PL)  statement for the Dialysis Center before adjusting for the move. The hospital’s department heads receive annual bonuses on the basis of each department’s contribution to the bottom line (profit). In the past, only direct costs were considered, but the hospital’s chief executive officer (CEO) has decided that bonuses would now be based on full (total) costs. Obviously, the new approach to awarding bonuses, coupled with the potential for increases in indirect cost allocation, is of great concern to Linda Rider, the director of the Dialysis Center. Under the current allocation of indirect costs, Linda would have a reasonable chance at an end-of-year bonus, as the forecast puts the Dialysis Center in the black. However, any increase in the indirect cost allocation would likely put her â€Å"out of the money.† At the next department heads’ meeting, Linda expressed her concern about the impact of any allocation changes on the Dialysis Center’s profitability, so the hospital’s CEO asked the chief financial officer (CFO), Roger Hedgecock, to look into the matter. In essence, the CEO said that the final allocation is up to Roger but that any allocation changes must be made within outpatient services. In other words, any change in cost allocation to the Dialysis Center must be offset by an equal, but opposite, change in the allocation to the Outpatient Clinic. To get started, Roger created Table 2 (see Excel spreadsheet). In creating the table, Roger assumed that the new Dialysis Center would have the same number of stations as the old one, would serve the same number of patients, and would have the same reimbursement rates. Also, operating expenses would differ only slightly from the current situation because the same personnel and equipment would be used. Thus, for all practical purposes, the revenues and direct costs of the Dialysis Center would be unaffected by the move. The data in Table 2 for the expanded Outpatient Clinic are based on the assumption that the expansion would allow volume to increase by 25 percent and that both revenues and direct costs would increase by a like amount. Furthermore, to keep the analysis manageable, the assumption was made that the overall hospital allocation rates for both facilities costs and general overhead would not materially change because of the expansion. Roger knew that his â€Å"trial balloon† allocation, which is shown in Table 2 in the columns labeled â€Å"Initial Allocation,† would create some controversy. In the past, facilities costs were aggregated, so all departments were charged a cost based on the average embedded (historical) cost regardless of the actual age (or value) of the space occupied. Thus, a basement room with no windows was allocated the same facilities costs (per square foot) as was the fifth floor executive suite. Because many department heads thought this approach to be unfair, Roger wanted to begin allocating facilities overhead on a true cost basis. Thus, in his initial allocation, Roger used actual facilities costs ($400,000 per year) as the basis for the allocation to the Dialysis Center. Needless to say, Linda’s response to the initial allocation was less than enthusiastic, but before Roger was able to address Linda’s concerns, he suddenly left the hospital to take a new position in another city. The task of completing the allocation study was given to you, Houston General’s current administrative resident. You believe that any cost allocation system should be perceived as being â€Å"fair,† but you also realize that in practice cost allocation is very complex and somewhat arbitrary. Some department heads argue that the best approach to overhead allocations is the â€Å"Marxist approach,† by which allocations are based on each patient service department’s ability to cover overhead costs, but this approach has its own disadvantages. Considering all the relevant issues, you must develop and justify a new facilities cost allocation scheme for outpatient services. Be prepared to justify your recommendations at the next department heads’ meeting.

The Negative Effects of Power Rangers on Children Essay -- Media Viole

The Negative Effects of Power Rangers on Children "Master Sword†¦.. show your power." When Ranger Mike encounters trouble, he calls on his power source for a transformation. He is then empowered with sword in hand ready to fight the giant dinosaur from a distant planet (Haim, 1999). The show continues entertaining children with many more similar scenes of fighting. Children of all ages are attracted Power Rangers' television programs, movies, and toys. Because of the amount of violence, Power Rangers has raised concerns for parents and professionals. Power Rangers are a group of teenagers who discover their call to save the world from injustice. When they need to fight they simply call upon their power, transform into a superhero then fight. They will fight by using karate chops and fancy moves of martial arts—flying and jumping through the air. Other than their karate moves, they are powerless unless they transform into their outfits—each uniform a different color. It is only by their super power god that they can access their powerful swords, and fight the enemy. After every act is won, they of course are unharmed, they transform back into their normal human beings and life goes on (Haim, 1999). Some consider Power Rangers as harmless simply because it is a child's program and just a show. Contrary to this, evidence shows that it does harm children in more than one way. Children are not able to perceive it as fantasy, but rather real because of the real-live people and scenery. Whether the children perceive it as real or not, children are influenced heavily by the show resulting in aggressive behavior. Parents, teachers, and the Christian community notice the increased aggression and are concerned ... ... National Association for the Education of Young Children. --------- and Paige, N.C. (1996). Disempowering The ‘Power Rangers’. Education Digest 61 (9) 17-21. Retrieved October 25, 2001 from MasterFILE Premier database. Marks, A. (1998). What Children See and Do: Studies of violence on TV. Christian Science Monitor 90 (99) 3. Retrieved October 26, 2001 from MAS Ultra School Edition. Stanley, T.L. (2001). Power Rangers Still Have a Kick. Los Angeles Times. Retrieved October 25, 2001, from Newspaper database. Teachers are beginning to fight back against Mighty Morphin Power Pupils. (1995). Curriculum Review 34 (6) 11, Retrieved October 25, 2001 from MasterFILE premier database. White, D. (1999 June). â€Å"Violence is not Child’s Play: Parents fight an uphill battle in teaching non-violence to their children. Christian Social Action 12, 30-32.

Knowledge Management Essay

It involves applying the collective knowledge and abilities of the entire workforce to achieve specific organizational objectives. State agencies should feel free to adapt and use information and tools on the following pages as necessary within their organization. It is provided to be a starting point for sharing knowledge and experience, allowing those who remain with the organization to continue providing quality service. Capturing and sharing critical knowledge and expertise should be occurring continuously among employees. In many cases, however, it is not and this need becomes pressing when a valued employee is preparing to retire or change positions. When an organization is considering implementing a knowledge transfer plan it is important to answer several questions: 1. Is the organization going to fill the vacant position or reassign the duties? 2. Are all the duties of the position still important to the mission of the organization? 3. Is there a need to update the position description? 4. Will the position change, remain as is, or be eliminated once the employee leaves? What is knowledge transfer? David DeLong’s book â€Å"Lost Knowledge† describes knowledge as the â€Å"capacity for effective actions or decision-making in the context of organizational activity†. Accordingly, lost knowledge would decrease this vital capacity and help undermine organizational effectiveness and performance. The goal of transferring knowledge to others [known as Knowledge Transfer] is to: 1. Identify key positions and people where potential knowledge loss is most imminent. 2. Assess how critical the knowledge loss will be. Develop a plan of action to ensure the capture of that critical knowledge and a plan of action to transfer it. Why is knowledge transfer important? A significant percentage of the state’s workforce is nearing retirement age over the next ten years. These employees have acquired a tremendous amount of knowledge about how things work, how to get things done and who to go to when problems arise. Losing their expertise and experience could significantly reduce efficiency, resulting in costly mistakes, unexpected quality problems, or significant disruptions in services and/or performance. In addition, faster turnover among younger employees and more competitive recruiting and compensation packages add significantly to the mounting concern about the state’s ability to sustain acceptable levels of performance. What are the benefits of a knowledge transfer program? Knowledge transfer [KT] programs prevent critical knowledge loss by focusing on key areas. Some of the immediate benefits of KT programs are: 1. They provide reusable documentation of the knowledge required in certain positions or job roles. 2. They result in immediate learning and knowledge transfer when carried out by individuals who can either use the transferred knowledge themselves or have responsibility for hiring, training, mentoring, coaching or managing people within an organizational unit. 3. They reduce the impact of employee departure. 4. They integrate staffing, training, job and organization redesign, process improvements and other responses. 5. They aid in succession planning. 6. They prevent the loss of knowledge held only in employees’ heads when they leave the organization or retire. They enhance career development. Generally Accepted Definitions for Knowledge Management and Transfer Knowledge Management (KM) refers to practices used by organizations to find, create, and distribute knowledge for reuse, awareness, and learning across the organization. Knowledge Management programs are typically tied to organizational objectives and are intended to lead to the achievement of specific outcomes such as shared intelligence, improved performance, or higher levels of innovation. Knowledge Transfer (an aspect of Knowledge Management) has always existed in one form or another through on-the-job discussions with peers, apprenticeship, and maintenance of agency libraries, professional training and mentoring programs. Since the late twentieth century, technology has played a vital role in Knowledge Transfer through the creation of knowledge bases, expert systems, and other knowledge repositories. To understand knowledge management and knowledge transfer, it is helpful to examine the differences between data, information, and knowledge. Data is discrete, objective facts. Data is the raw material for creating information. By itself, data carries no judgment, interpretation or meaning. Information is data that is organized, patterned and/or categorized. It has been sorted, analyzed and displayed, and is communicated through various means. Information changes the way a person perceives something, thus, affecting judgment or behavior. Knowledge is what is known. It is richer and more meaningful than information. Knowledge is gained through experience, reasoning, intuition, and learning. Because knowledge is intuitive, it is difficult to structure, can be hard to capture on machines, and is a challenge to transfer. We often speak of a â€Å"knowledgeable person,† and by that we mean someone who is well informed, and thoroughly versed in a given area. We expand our knowledge when others share theirs with us. We create new knowledge when we pool our knowledge together.

Proper Use of Entrez-vous in French

The comic strip Non Sequitur  by Wiley Miller held a  Great Non-Sequitur Sign-Off Contest, where readers were invited to send in suggestions for the sign in front of the Au Naturel Deli, behind the door of which lurked a bear with a cleaver. The winning entry, from Mary Cameron of Leander, Texas, had text scrawled on the sign outside that read Entrà ©e:  Vous. Most people might apply a double-entendre to the phrase in this context, which might be translated as Todays Entrà ©e: You.  This is a very cute and clever realization of the comic!  Ã¢â‚¬â€¹ Confusion of Entrà ©e and Entrez But to understand the double-meaning of this suggested comic, the reader would need to understand the  homophonous entrez vous, which is often used by non-native French speakers to mean Come in. So the sign in this comic would be read with a homonymic understanding as both Come in and Todays Main Dish: You.   Language Use Differences The problem is that entrez  vous  in French doesnt quite mean what non-native French speakers use as its literal translation.  When the phrase is broken down, the French verb  entrer is not reflexive; the correct way to say Come in is simply entrez  in the formal and plural you conjugation of the verb. So if the sign in this comic were to indicate that a passerby should enter the shop, itd simply read Entrez, and as a result lose its comedic nature. Neither of these words should be confused with  entre which translates to in or between in English and doesnt have the same pronunciation because the e at the end is essentially silent.  An example of the use of this word might be ...à §a reste entre nous,  meaning this stays between us, perhaps implicative of a confidential conversation.   When to Use Entrez-Vous For non-native French speakers, this begs the question if there is ever an appropriate use of  the phrase entrez vous  in the French language. The only time you might use entrez vous in French would be in the case of a question. Saying Entrez-vous? is similar to asking Are you coming in?  or even What about coming in? and is more casual and conversational in nature.   If youre thinking of using entrà ©e vous or entrez-vous  interchangeably, even for humor, bear in mind that it will likely not be understood by native French speakers as very humorous. Rather, its typically seen as a grammatical error.