成本控制和成本管理戰(zhàn)略【外文翻譯】

1、<p><b>　　外文翻譯</b></p><p><b>　　原文</b></p><p>　　Cost-Containment and Cost-Management Strategies</p><p>　　Material Source: Author: Alan f.

2、Goldberg ,William P. Fleming</p><p>　　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 stra

3、tegic planning 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 comm

4、unity.</p><p>　　After the ribbon cutting, these new programs become the responsibility of the hospital's service line directors or clinical managers. Their staffing is based on projections and other as

5、sumptions that may or may not be on point but have a direct impact on the operations and finances of the organization. </p><p>　　As part of normal decision making for a hospital's new initiatives, a paye

6、r mix and 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.</p&g

7、t;<p>　　The economic downturn affecting hospitals began in the fall of 2008. Its broad impact on the organization was described by Goldberg and Petasnick (2010):</p><p>　　With credit markets drying up

8、, 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

9、 ever. 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 va

10、lues eliminated the safety net reserves c</p><p>　　Because of the economic downturn and high unemployment, which led to income declines and individuals losing job-based healthcare coverage, Medicaid enrollme

11、nt is projected to increase 10.5 percent in fiscal 2010.</p><p>　　When you couple this with significant declines in state and federal revenue, there is a shortfall in meeting financial obligations. Not surpr

12、isingly, Medicaid cost containment is being put into place. Thirty-two states plan to reduce or freeze provider payments in fiscal 2010 and 48 states will do so in 2011 (National Governors Association 2010).</p>&

13、lt;p>　　With the passage of healthcare reform—the Patient Protection and Affordable Care Act signed into law March 23, 2010—major expansions to cover the uninsured are scheduled to take place on January 1, 2014. Though

14、 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 ye

15、ars means there will be no surge in revenue in 2014. The difficult eco</p><p>　　One outcome of the act is the intense interest in cost-containment and costmanagement strategies. Much of this interest is driv

16、en 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

17、as payment reform initiatives have an impact on quality and process improvement and now carry financial rewards or penalties. Pertinent examples include </p><p>　　Beyond making internal comparisons of perfor

18、mance to budget, flexing resources to meet changing patient volumes and requirements, and comparing one's organization to similar institutions and available databases, how does one manage cost? It all starts with too

19、ls and programs such as labor resource benchmarking and analysis of the management span of control.</p><p>　　In practice, benchmarking is a nonstandardized term. For most, benchmarking means some kind of com

20、parison, such as an organization benchmarking itself to a best-practice organization:</p><p>　　1. Benchmarking is a process where our results are compared to a database of similar institutions.</p>&l

21、t;p>　　2. Benchmarking is where our organization tracks and compares to itself.</p><p>　　3. Benchmarking is where our organization is compared to a performance standard set by an outside organization.</

22、p><p>　　Cost management depends on staffing management decisions, which are best supported by benchmark process number three. Typically, 60 percent of a hospital's expense is labor, with a majority of that

23、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 number three should not b

24、e a one-time process, but rather should be done by an outside organization on an o</p><p>　　Many hospitals appear to have bloated management ranks based on analysis of title, pay grade, or who attends manage

25、r meetings. Although it is common in finance or IT to find individuals who are called manager or director and who manage Programs and not staff, in other departments managers should have direct reports to earn this desig

26、nation.</p><p>　　Span-of-control studies have concluded that, based on hospital organizational charts and position title, too many managers often do not have enough staff reporting to them. This finding is

27、 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 hospital's span

28、 of control falls within the correct range. As a staff retention strategy, titles have inflate</p><p>　　Norwood Hospital in Massachusetts is a 264-bed facility with a full range of patient care services, inc

29、luding 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 cathet

30、erization 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.</p><p>　　A new era began when

31、Norwood Hospital became Caritas Norwood Hospital in 1997 after acquisition by Caritas Christi Health Care, the second-largest healthcare system in New England. In 2009, the official name was changed to Norwood Hospital,

32、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.</p><p>　　With operating margins typ

33、ically 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:</p><p>　　? Crea

34、te an environment of transparency where the information is shared and comments and questions are encouraged.</p><p>　　? Create an environment where the managers are expected to achieve or exceed their goals,

35、 such as clinical and patient excellence and performance, and take steps to flex staff and other resources to meet the demands of changing volume.</p><p>　　? Provide the managers with timely data, including

36、custom-developed labor benchmarks, revised and updated by consultants on site with continued outside periodic review, so the productivity goals and expectations are clear.</p><p>　　Managers benefit from acce

37、ss to state-of-the-art productivity information and the ability to compare data and experiences with other peer hospitals in the Caritas Christi Health Care system. Those comparisons can be particularly helpful; they are

38、 done in a system framework—system groups of health information management directors or patient care executives—and one-on-one. This analysis leads to managers who have the information, tools, and resources to manage the

39、ir areas and perform to expectatio</p><p>　　? Managers are expected to achieve staff targets and control overtime, use of perdiems, and agency personnel, or to identify why these factors aren't controlle

40、d and develop an action plan for solutions.</p><p>　　? Managers see other managers' results and can question why they are not achieving their benchmarks. A spirited discussion ensues through e-mail and

41、other exchanges. A sense of community is created for management, yet accountability is still the focus. Poor performance has ramifications.</p><p>　　Here are some examples of how Norwood Hospital has increas

42、ed productivity:</p><p>　　? Early enabling of EMR technology in a community setting</p><p>　　? Use of value engineering, better workflow, and systems flow in redesigned areas such as the emergen

43、cy department</p><p>　　? Use of external customized productivity benchmarks to measure and monitor labor resources</p><p>　　Norwood Hospital also has conducted a span-of-control project to ident

44、ify 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 refreshed as new programs and technol

45、ogy are implemented. Without this refreshing, FTE creep—an increase in full-time-equivalent staff because leadership won't deny unjustified FTE requests—can occur.</p><p>　　At Norwood Hospital and the Ca

46、ritas Christi Health Care system, the expectation is to provide the highest quality patient eare with dignity; with all the changes coming to healthcare, meeting that expectation will continue to be a financial challenge

47、. System functions such as finance, human resources, and IT are consolidated and centrally located. Functions are outsourced as appropriate. It is not a one-size-fits-all system strategy, and it recognizes the need for l

48、ocal management input and cont</p><p>　　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 ti

49、me frame, it should concentrate on performing an on-site labor resource benchmarking and a span-of-control analysis.</p><p>　　REFERENCES</p><p>　　Goldberg, A, 1. and W. D. Petasnick. 2010. "

50、;Managing in a Downturn: How Do You Manage in a Global Financial Recession?' journal of Healthcare Management 55 (3): 149-153.</p><p>　　National Covernors Association. 2010. Fiscal Survey of States. Wash

51、ington, DC: National Association of State Budget Officers.</p><p>　　U.S. Congress. House. 2010. Patient Protection and Affordable Care Act. 111th Cong., 2nd sess. Public Law 111-148, sec. 3 025.</p>

52、<p>　　U.S. Congress. House. Tlie American Recovery and Reinvestment Act of 2009. 111th Cong., 1st sess. Public Law 111-5, sec. 4101 and 4102.</p><p><b>　　譯文</b></p><p>　　成本控制和成

53、本管理戰(zhàn)略</p><p>　　資料來源: 作者：Alan f. Goldberg ,William P. Fleming</p><p>　　領導和各醫(yī)療機構的受托人委員會是在以最好地滿足社會需要的有限資源的最終管家。在戰(zhàn)略規(guī)劃過程的領導下組織確定優(yōu)先次序，作出選擇，并采取明確的行動路徑。等到那一天新的癌癥中心開設或最新的技術到來，也是會成為令

54、人興奮的社區(qū)之一。</p><p>　　剪彩后，這些新方案成為醫(yī)院的董事或臨床服務項目經理的責任。他們的預測是基于工作人員和其他假設，可能會或可能不會在那個點上，但在行動和組織的財政狀況會產生直接影響。</p><p>　　作為醫(yī)院的新舉措正式決定的一部分，可以對付款人的收入來源結構和決策進行預測?，F(xiàn)在，有兩個重大環(huán)境事件使得預測更加不確定，從成本管理的挑戰(zhàn)來說是：經濟低迷和支付方式改革。

55、</p><p>　　在2008年秋天經濟低迷開始影響醫(yī)院。它對組織的影響可以用Goldberg和Petasnick（2010年）來描述：隨著信貸市場枯竭，失業(yè)上升，消費者信心削弱，以及員工士氣動搖，醫(yī)療制度行政人員忙的不可開交。該風暴的綜合結果使那句古老的格言“現(xiàn)金為王”比任何時候都更真實。由于消費者收回和個人失去的健康保險，使醫(yī)院經歷了為選修、非急診醫(yī)療服務的巨額損失。財務經營業(yè)績受到影響。同時，取消了投資價

56、值損失由安全網(wǎng)建立的儲備營業(yè)外收入。許多醫(yī)院和醫(yī)療系統(tǒng)都不得不考慮裁員，推遲或制定或取消資本密集型項目。所有都被要求重新考慮其戰(zhàn)略計劃。</p><p>　　由于經濟不景氣和 較高的失業(yè)率，導致收入下降和個人失去在工作的基礎上的醫(yī)療保險，醫(yī)療保險人數(shù)預計將在2010財年增加10.5個百分點。</p><p>　　當你在這個州和聯(lián)邦收入都有顯著下降，就有短缺來滿足財政義務。毫不奇怪，醫(yī)療費用

57、控制正在到位。三十二個國家計劃以減少或凍結2010財年的供應商付款，在2011年48個州將采取這樣的措施（全國州長協(xié)會2010年）。</p><p>　　隨著醫(yī)療改革的，2010年3月23日病人保護和支付得起的醫(yī)療保障法案通過并成為法律，同時開始大規(guī)模擴建，以支付定于2014年1月1日的地方投保。雖然這會為無醫(yī)療保險，保險不足，與不良債務帶來清晰的長期財務規(guī)劃，支付改革意味著將有有所權衡。在未來數(shù)年的預期削減意味

58、著供應商在2014年的收入將不會激增。困難的經濟時期創(chuàng)造了一個使廣大利益相關者的很好理解的環(huán)境。因此，病人和醫(yī)院的員工知道他們面臨的財政挑戰(zhàn)。</p><p>　　該法律的其中一個結果是對成本控制和成本管理戰(zhàn)略的濃厚興趣。這種關注多半是需要實現(xiàn)一個組織的金融目標，在要求和計劃支出超過可用資金時縮小差距。然而，成本管理已經成長遠遠超出職權范圍內的金融，作為支付改革措施深深影響質量和進程的提高，現(xiàn)在也會帶來財政獎勵或

59、處罰。相關的例子包括通過對某些早期診斷入院后30天出院，并拒絕支付獎金的電子健康記錄（美國國會2010年，2009年）</p><p>　　除了內部的性能比較預算，收縮資源以滿足不斷變化病人數(shù)量和要求，并比較自己的組織機構和現(xiàn)有同類數(shù)據(jù)庫，一個管理成本如何？這一切都始于基準，如勞動力資源的控制和管理跨度分析工具和方案。</p><p>　　在實踐中，標桿是一個非標準化的術語。對于大多數(shù)，標

60、桿基準等手段本身作為一個最佳實踐組織組織的一些比較，類型：</p><p>　　1標桿是在我們的研究結果相比，同類院校數(shù)據(jù)庫的過程。</p><p>　　2標桿管理是我們的跟蹤和比較組織本身。</p><p>　　3標桿管理是我們的組織相比，性能標準由外部機構設置。</p><p>　　成本管理取決于人事管理決策，這是最好的基準進程排名第三的

61、支持。通常情況下，60醫(yī)院的費用百分之勞動，一組在護理費用占多數(shù)。在這個過程中許多組織是由業(yè)務或者財務管理是一個持續(xù)的和復雜的儀表板的重點部分?；鶞蕼y試中排名第三的描述不應該是一次性的過程，而是應該由一個外部機構持續(xù)進行。</p><p>　　許多醫(yī)院似乎已經臃腫的管理隊伍的基礎上題分析，薪酬等級，或者誰參加經理會議。雖然這是在金融共同或它來尋找誰被稱為經理或主管，誰個人管理等部門管理人員應直接報告，獲得這個稱號

62、方案，而不是工作人員。</p><p>　　斯潘的控制研究得出結論認為，根據(jù)醫(yī)院的組織結構圖與職稱，有太多的經理人往往沒有足夠的工作人員向他們匯報。這一發(fā)現(xiàn)是基于嚴格的職稱和組織結構圖。這一發(fā)現(xiàn)是基于嚴格的職稱和組織結構圖。當實際的工作是審查和確定，標桿專家經常發(fā)現(xiàn)這是不是管理水平位置，如果是重新歸類醫(yī)院的控制范圍內正確的范圍內。由于工作人員留用策略，職稱有夸大隨著時間的推移證明這樣做的主要工作支付正常工資的等級

63、制度在人力資源工作人員不承認的水平。這種組織行為導致組織內部的管理層次太多。</p><p>　　在馬薩諸塞州諾伍德醫(yī)院，位于波士頓的市場競爭，是一個有病人護理服務以及現(xiàn)代化的急診室，它包括家庭分娩中心，最多最新的放射腫瘤科服務，豐富的內鏡服務，先進的腹腔鏡手術和神經系統(tǒng)全套264個床位的設施，以及心導管室。醫(yī)院提供特殊照顧的人超過30萬和16諾伍德周邊社區(qū)。</p><p>　　當在19

64、97年成為諾伍德醫(yī)院后，一個新的時代開始了。由明愛基督保健，在新英格蘭地區(qū)的第二大收購明愛醫(yī)療體系諾伍德醫(yī)院。，2009年，正式更名為諾伍德香港明愛家庭醫(yī)院。在最近公布的先例處理中，明愛基督保健購買了Cerberus資本管理私人股權公司。</p><p>　　通過經營利潤通常是位高于或低于盈虧平衡，每年的利潤，成本管理一直是一個優(yōu)先事項。諾伍德醫(yī)院側重于為政府部門，這些服務項目主要原則和經理：</p>

65、<p>　　?建立一個透明的環(huán)境下的信息共享，鼓勵提出意見和問題。</p><p>　　?創(chuàng)造一個經理人有望實現(xiàn)或超過他們的目標，如病人的臨床和卓越性能，并采取彈性工作人員和其他資源措施，以滿足不斷變化的環(huán)境容量的要求。</p><p>　　?提供及時的數(shù)據(jù)，包括定制開發(fā)的勞工標準，修訂和更新，現(xiàn)場咨詢外繼續(xù)進行定期審查，因此，生產力的目標和期望是明確。</p>

66、<p>　　經理人受益于得到國家的最先進生產力的信息和對數(shù)據(jù)進行比較的能力，并與香港明愛基督醫(yī)療體系醫(yī)院分享其他同行的經驗。這些比較特別有幫助，他們是在一個系統(tǒng)框架，特別是一對一系統(tǒng)的健康信息管理病人護理管理人員。這一分析導致經理擁有信息、工具和資源來管理其地區(qū)和執(zhí)行的期望。由于使用這些信息的結果：</p><p>　　?經理人員的目標希望實現(xiàn)目標和控制加班費、perdiems的使用、機構人員或確定這

67、些因素為什么不能得到控制，并制定一項行動計劃，尋求解決辦法。</p><p>　　?經理看到其他經理的結果，可以問為什么他們沒有達到他們的基準。一個通過電子郵件和其他交流熱烈的討論隨之而來。社區(qū)意識是管理造就的，但責任仍是重點，是一年來表現(xiàn)欠佳的后果。</p><p>　　以下是如何提高生產力諾伍德醫(yī)院擁有一些例子：</p><p>　　?早期的一個社區(qū)環(huán)境中啟用電

68、子病歷技術</p><p>　　?利用價值工程，更好的工作流程，重新設計的領域和系統(tǒng)流程，如急診科</p><p>　　?外部客戶生產力的基準來衡量和監(jiān)控勞動力資源</p><p>　　如果確定了超支的需要諾伍德醫(yī)院也會進行整體范圍的控制項目，確定為管理或裁減工作人員。為了實現(xiàn)持續(xù)的成功，這些評論必須建立基線基準。然后刷新為基準的新方案和技術實施。如果沒有這個令人耳

69、目一新，工作人員增加的FTE會有所變化，因為領導人不會拒絕不合理的FTE的請求。</p><p>　　諾伍德明愛醫(yī)院和基督醫(yī)療制度體系，期望能夠為病人提供最高質量的服務，隨著醫(yī)療保健的變化，這些預期將繼續(xù)成為一個金融挑戰(zhàn)。系統(tǒng)的功能，如財務、人力資源和IT位于市中心，而適當?shù)墓δ芡獍?，這不是一個放之四海而皆準的系統(tǒng)戰(zhàn)略，它認識到地方管理有關具體問題的投入和控制的需要。</p><p>