1、 外文翻译 原文 Cost-Containment and Cost-Management Strategies Material Source: Author: Alan f. Goldberg ,William P. Fleming The leadership and boards of trustees of all healthcare organizations are the ultimate stewards of the limited resources available to best meet community needs. The strategic planni
2、ng process leads the organization down a clear path of setting priorities, making choices, and taking action. The day a new cancer center opens or the latest technology arrives is an exciting one for the community. After the ribbon cutting, these new programs become the responsibility of the hospita
3、ls service line directors or clinical managers. Their staffing is based on projections and other assumptions that may or may not be on point but have a direct impact on the operations and finances of the organization. As part of normal decision making for a hospitals new initiatives, a payer mix and
4、 revenue stream were predicted. Now two significant environmental events have made projections more uncertain and put aggressive cost management on center stage: the economic downturn and payment reform. The economic downturn affecting hospitals began in the fall of 2008. Its broad impact on the org
5、anization was described by Goldberg and Petasnick (2010): With credit markets drying up, unemployment rising, consumer confidence eroding, and employee morale shaken, healthcare system executives had their hands full. The combined result of the turmoil made the old adage “cash is king“ truer than ev
6、er. As consumers pulled back and individuals lost health insurance, hospitals experienced losses in volume for elective, nonemergent healthcare. Financial operating results suffered. Meanwhile, losses in investment values eliminated the safety net reserves created by nonoperating income. Many hospit
7、als and healthcare systems were forced to consider or enact layoffs and postpone or cancel capital-intensive projects. All were required to rethink their strategic plans. Because of the economic downturn and high unemployment, which led to income declines and individuals losing job-based healthcare
8、coverage, Medicaid enrollment is projected to increase 10.5 percent in fiscal 2010. When you couple this with significant declines in state and federal revenue, there is a shortfall in meeting financial obligations. Not surprisingly, Medicaid cost containment is being put into place. Thirty-two stat
9、es plan to reduce or freeze provider payments in fiscal 2010 and 48 states will do so in 2011 (National Governors Association 2010). With the passage of healthcare reformthe Patient Protection and Affordable Care Act signed into law March 23, 2010major expansions to cover the uninsured are scheduled
10、 to take place on January 1, 2014. Though this brings clarity to elements of longer-term financial planning for the uninsured, the underinsured, and those with bad debt, payment reform means there will be trade-offs. Anticipated provider cuts in the next few years means there will be no surge in rev
11、enue in 2014. The difficult economy has created an environment where this need is well understood by the stakeholders. As a result, patients and employees know the financial challenges their hospitals face. One outcome of the act is the intense interest in cost-containment and costmanagement strateg
12、ies. Much of this interest is driven by the need to achieve an organization-established financial goal and bridge the gap when requests and planned expenditures exceed available funds. However, cost management has grown far beyond the purview of finance as payment reform initiatives have an impact o
13、n quality and process improvement and now carry financial rewards or penalties. Pertinent examples include payment denial for readmission of certain diagnoses within 30 days of discharge and bonus payments for early adoption of electronic health records (U.S. Congress 2010, 2009). Beyond making inte
14、rnal comparisons of performance to budget, flexing resources to meet changing patient volumes and requirements, and comparing ones organization to similar institutions and available databases, how does one manage cost? It all starts with tools and programs such as labor resource benchmarking and ana
15、lysis of the management span of control. In practice, benchmarking is a nonstandardized term. For most, benchmarking means some kind of comparison, such as an organization benchmarking itself to a best-practice organization: 1. Benchmarking is a process where our results are compared to a database o
16、f similar institutions. 2. Benchmarking is where our organization tracks and compares to itself. 3. Benchmarking is where our organization is compared to a performance standard set by an outside organization. Cost management depends on staffing management decisions, which are best supported by bench
17、mark process number three. Typically, 60 percent of a hospitals expense is labor, with a majority of that expense in nursing. In many organizations this process is driven by operations or finance and is an intricate part of ongoing management and focus of the dashboard. The benchmarking described in
18、 number three should not be a one-time process, but rather should be done by an outside organization on an ongoing basis. Many hospitals appear to have bloated management ranks based on analysis of title, pay grade, or who attends manager meetings. Although it is common in finance or IT to find indi
19、viduals who are called manager or director and who manage Programs and not staff, in other departments managers should have direct reports to earn this designation. Span-of-control studies have concluded that, based on hospital organizational charts and position title, too many managers often do not
20、 have enough staff reporting to them. This finding is based strictly on job titles and organization charts. When the actual job is examined and defined, benchmarking experts often find it is not a management-level position, and if it is reclassified the hospitals span of control falls within the cor
21、rect range. As a staff retention strategy, titles have inflated over time to justify pay levels for key staff doing jobs that the normal pay grade system in human resources do not recognize. This organizational behavior leads to too many management layers within the organization. Norwood Hospital in
22、 Massachusetts is a 264-bed facility with a full range of patient care services, including its Small Miracles Family Birthing Center, a modern emergency department, up-to-date radiation oncology services, extensive endoscopic services, advanced laparoscopic and neurological surgery, and a cardiac ca
23、theterization lab. The hospital provides exceptional care to the more than 300,000 people in Norwood and 16 surrounding communities. It is located in the competitive Boston market. A new era began when Norwood Hospital became Caritas Norwood Hospital in 1997 after acquisition by Caritas Christi Heal
24、th Care, the second-largest healthcare system in New England. In 2009, the official name was changed to Norwood Hospital, A Caritas Family Hospital. In a recently announced precedent-setting deal, Caritas Christi Health Care was purchased by Cerberus Capital Management, a private equity firm. With o
25、perating margins typically a bit above or below breakeven each year, cost management has always been a priority. Norwood Hospital focuses on these key principles for its departments, service lines, and managers: Create an environment of transparency where the information is shared and comments and q
26、uestions are encouraged. Create an environment where the managers are expected to achieve or exceed their goals, such as clinical and patient excellence and performance, and take steps to flex staff and other resources to meet the demands of changing volume. Provide the managers with timely data, in
27、cluding custom-developed labor benchmarks, revised and updated by consultants on site with continued outside periodic review, so the productivity goals and expectations are clear. Managers benefit from access to state-of-the-art productivity information and the ability to compare data and experience
28、s with other peer hospitals in the Caritas Christi Health Care system. Those comparisons can be particularly helpful; they are done in a system frameworksystem groups of health information management directors or patient care executivesand one-on-one. This analysis leads to managers who have the inf
29、ormation, tools, and resources to manage their areas and perform to expectations. As a result of using this information: Managers are expected to achieve staff targets and control overtime, use of perdiems, and agency personnel, or to identify why these factors arent controlled and develop an action
30、 plan for solutions. Managers see other managers results and can question why they are not achieving their benchmarks. A spirited discussion ensues through e-mail and other exchanges. A sense of community is created for management, yet accountability is still the focus. Poor performance has ramifica
31、tions. Here are some examples of how Norwood Hospital has increased productivity: Early enabling of EMR technology in a community setting Use of value engineering, better workflow, and systems flow in redesigned areas such as the emergency department Use of external customized productivity benchmark
32、s to measure and monitor labor resources Norwood Hospital also has conducted a span-of-control project to identify the need for management or staff reductions if overages are identified. To achieve continued success, these reviews have to establish the baseline benchmarks. Benchmarks are then refres
33、hed as new programs and technology are implemented. Without this refreshing, FTE creepan increase in full-time-equivalent staff because leadership wont deny unjustified FTE requestscan occur. At Norwood Hospital and the Caritas Christi Health Care system, the expectation is to provide the highest qu
34、ality patient eare with dignity; with all the changes coming to healthcare, meeting that expectation will continue to be a financial challenge. System functions such as finance, human resources, and IT are consolidated and centrally located. Functions are outsourced as appropriate. It is not a one-s
35、ize-fits-all system strategy, and it recognizes the need for local management input and control on specific issues. So many cost-containment strategies exist that each one could have its own article devoted to it. However, if an organization wants the most benefit in the shortest time frame, it shou
36、ld concentrate on performing an on-site labor resource benchmarking and a span-of-control analysis. REFERENCES Goldberg, A, 1. and W. D. Petasnick. 2010. “Managing in a Downturn: How Do You Manage in a Global Financial Recession? journal of Healthcare Management 55 (3): 149-153. National Covernors A
37、ssociation. 2010. Fiscal Survey of States. Washington, DC: National Association of State Budget Officers. U.S. Congress. House. 2010. Patient Protection and Affordable Care Act. 111th Cong., 2nd sess. Public Law 111-148, sec. 3 025. U.S. Congress. House. Tlie American Recovery and Reinvestment Act o
38、f 2009. 111th Cong., 1st sess. Public Law 111-5, sec. 4101 and 4102. 译文 成本控制和成本管理战略 资料来源 : 作者： Alan f. Goldberg ,William P. Fleming 领导和各医疗机构的受托人委员会 是在 以最好地满足社会需要的有限资源的 最终管家。在战略规划过程的领导下组织确定优先次序，作出选择，并采取明确的行动路径。 等到那 一天新的癌症中心开设 或 最新的技术 到 来， 也是会成为 令人兴奋的社区之一。 剪彩后，这些新方案成为医院的董事或临床服务项目经理的责任。他们的预测是基于工作人员和其他假
39、设，可能会或可能不会 在那个 点上，但在行动和组织的财政状况 会 产生直接影响。 作为医院的新举措 正式决定的一部分 ， 可以 对 付款人的收入来源结构和决策进行预测。现在，有两个重大环境事件 使得 预测更加不确定， 从 成本管理 的挑战来说是 ：经济低迷和支付方式改革。 在 2008 年 秋天 经济低迷 开始 影响医院。它对组织的影响 可以用 Goldberg 和Petasnick（ 2010 年） 来描述 ：随着信贷市场枯竭，失业上升，消费者信心削弱，以及员工士气动摇，医疗制度行政人员忙的不可开交。该风暴的综合结果 使那句 古老的格言 “现金为王 ”比任何时候都更真实。由于消费者 收回 和
40、个人失去的健康保险， 使 医院经历了为选修 、 非急诊医疗服务 的 巨额损失。财务经营业绩受到影响。同时 ，取消了投资价值损失 由 安全网建立 的 储备营业外收入。许多医院和医疗系统都不得不考虑裁员，推迟或制定或取消资本密集型项目。 所有都 被要求重新考虑其战略计划。 由于经济不景气 和 较高的 失业率，导致收入下降和个人失去 在 工作的基础上的医疗保险，医疗保险人数预计将在 2010 财年增加 10.5 个百分点。 当你 在 这个州和联邦 收入都有显著 下降， 就 有短缺 来 满足财政义务。毫不奇怪，医疗费用控制正在到位。三十二个国家计划以减少或冻结 2010 财年的供应商付款 ， 在 20
41、11 年 48 个州将 采取这样的措施 （全国州长协会 2010 年）。 随着医疗改革 的 ， 2010 年 3 月 23 日病人 保护 和支付得起的医疗保障法案通过 并 成为法律， 同时开始 大规模扩建，以支付定于 2014 年 1 月 1 日的地方投保。虽然这 会为 无医疗保险，保险不足，与不良债务带来清晰的长期财务规划，支付改革意味着将有 有所权衡 。在未来数年的预期削减意味着供应商在 2014年的收入将不会激增。困难的经济 时期 创造了一个 使 广大利益相关者的 很好 理解 的 环境。因此，病人和医院的员工知道他们面临的财政挑战。 该法律的 其中 一个结果是 对 成本控制和成本管理战略
42、的浓厚兴趣。这种关注多半是需要实现一个组织的金融目标， 在 要求和计划支出超 过可用资金 时 缩小差距。然而，成本管理已经成长远远超出职权范围内的金融 ， 作为支付改革措施 深深 影响质量和 进程的提高 ，现在 也会带来财政 奖励或处罚。相关的例子包括通过对某些早期诊断入院后 30 天出院，并拒绝支付奖金 的 电子健康记录（美国国会 2010 年， 2009 年） 除了内部的性能比较预算，收缩资源以满足不断变化病人数量和要求，并比较自己的组织机构和现有同类数据库，一个管理成本如何？这一切都始于基准，如劳动力资源的控制和管理跨度分析工具和方案。 在实践中，标杆是一个非标准化的术语。对于大多数，标
43、杆基准等手段本身作为一个最 佳实践组织组织的一些比较，类型： 1 标杆是在我们的研究结果相比，同类院校数据库的过程。 2 标杆管理是我们的跟踪和比较组织本身。 3 标杆管理是我们的组织相比，性能标准由外部机构设置。 成本管理取决于人事管理决策，这是最好的基准进程排名第三的支持。通常情况下， 60 医院的费用百分之劳动，一组在护理费用占多数。在这个过程中许多组织是由业务或者财务管理是一个持续的和复杂的仪表板的重点部分。基准测试中排名第三的描述不应该是一次性的过程，而是应该由一个外部机构持续进行。 许多医院似乎已经臃肿的管理队伍的基础上题分析，薪酬等级，或者谁参加经理会议。虽然这是在金融共同或它来
44、寻找谁被称为经理或主管，谁个人管理等部门管理人员应直接报告，获得这个称号方案，而不是工作人员。 斯潘的控制研究得出结论认为，根据医院的组织结构图与职称，有太多的经理人往往没有足够的工作人员向他们汇报。这一发现是基于严格的职称和组织结构图。这一发现是基于严格的职称和组织结构图。当实际的工作是审查和确定，标杆专家经常发现这是不是管理水平位置，如果是重新归类医院的控制范围内正确的范围内。由于工作人员留用策略，职称有 夸大随着时间的推移证明这样做的主要工作支付正常工资的等级制度在人力资源工作人员不承认的水平。这种组织行为导致组织内部的管理层次太多。 在马萨诸塞州诺伍德医院 ， 位于波士顿的市场竞争 ，
45、 是一个有病人护理服务 以及 现代化的急诊室， 它 包括家庭分娩中心 ， 最多最新的放射肿瘤科服务，丰富的内镜服务，先进的腹腔镜手术和神经系统全套 264 个床位的设施，以及心导管室。医院提供特殊照顾的人超过 30 万和 16 诺伍德周边社区。 当在 1997 年成为诺伍德医院后，一个新的时代开始了 。 由明爱基督保健，在新英格兰地区的第二大收购明爱医疗体系诺伍德 医院。 ， 2009 年，正式更名为诺伍德香港明爱家庭医院。在最近公布的先例处理 中 ，明爱基督保健购买了Cerberus 资本管理私人股权公司。 通过 经营 利润 通常是位高于或低于盈亏平衡，每年的利润，成本管理一直是一个优先事项
46、。诺伍德医院侧重于为政府部门，这些服务项目主要原则和经理 ： 建立一个透明的环境下的信息共享，鼓励 提出 意见和问题。 创造一个经理人有望实现或超过他们的目标，如病人的临床和卓越性能，并采取弹性工作人员和其他资源措施，以满足不断变化的环境容量的要求。 提供及时的数据，包括定制开发的劳工标准，修订和 更新，现场咨询外继续进行定期审查，因此，生产力的目标和期望是明确 。 经理人受益于 得到 国家的最先进生产力的信息和 对 数据进行比较的能力，并与香港明爱基督医疗体系医院 分享 其他同行的经验。这些比较特别有帮助，他们是在一个系统框架， 特别是 一对 一 系统的健康信息管理病人护理管理人员 。这一分
47、析导致经理拥有信息 、 工具和资源来管理其地区和执行的期望。由于使用这些信息的结果 ： 经理人员的目标 希望 实现 目标 和控制加班费 、 perdiems 的 使用 、 机构人员或确定这些因素为什么不能得到控制，并制定一项行动计划，寻求解决办法。 经理看到 其他经理的结果，可以问为什么他们没有达到他们的基准 。 一个通过电子邮件和其他交流热烈的讨论随之而来。社区意识是管理造就的，但责任仍是重点 ，是 一年来表现欠佳的后果 。 以下是如何提高生产力诺伍德医院拥有一些例子： 早期的一个社区环境中启用电子病历技术 利用价值工程，更好的工作流程，重新设计的领域和系统流程，如急诊科 外部客户生产力的基
48、准来衡量和监控劳动力资源 如果确定 了 超支的需要诺伍德医院也 会 进行整体范围的控制项目，确定为管理或裁减工作人员 。 为了实现持续的成功，这些评论必须建立基线基准。然后刷新为基准的新方 案和技术实施 。 如果没有这个令人耳目一新，工作人员增加 的 FTE 会有所变化 ，因为领导人不会拒绝不合理的 FTE 的请求 。 诺伍德明爱医院和基督医疗制度 体系 ，期望 能够为病人 提供最高质量的 服务 ， 随着医疗 保健 的变化，这些 预期将继续成为一个金融挑战。系统的功能，如财务 、 人力资源和 IT 位于市中心 ，而 适当的功能外包 ， 这不是一个放之四海而皆准的系统战略，它认识到地方管理有关具体问题的投入和控制的需要。 因此，许多的成本控制策略存在，每个人可以有自己的文章专门为它投入。但是，如果一个组织希望在最短的时间内最大的利益，它应该集中精力 对 现场劳动力资源基准和跨度 进行 控制分析。
