HOSPITAL CLIENT: Mr. Scott Lovelace
PROJECT COORDINATOR: Mr. John Gialanella
PROJECT DIRECTOR: Dr. Richard Coffey
Executive Summary
The University of Michigan Hospital operating rooms currently use two fixed hourly/half hourly charge rates for two overall categories of surgery. In addition, flat fees are used for procedures being done in the endoscopy rooms. These charges evolved over a long period of time, but within the past two years were linked to reimbursements because of the evolution of payments based on diagnosis related groups. Questions, therefore, remained concerning the cost and related profit margins for individual surgeries as well as for categories of surgery.
During the winter semester of 1989, a team of three industrial and operations engineering students, including one who is already an RN, developed a LOTUS spreadsheet. This spreadsheet uses cost accounting principles to calculate a cost per procedure. This tool was then used to calculate costs for six procedures previously identified by Scott Lovelace and Leo Rutledge.
A breakdown of the costs and comparison with current charges yields the following basic conclusions:
A. Large profit margins on long, complicated procedures
B. Slim profit margins for endoscopy procedures mostly due to a large indirect overhead burden and potential incomplete reimbursement realities.
An analysis of the accounting steps used and further explanation of our findings is provided in the following report.
Julie Hemmen Kathleen Koester Eric Meyer, BSN, RN
April 1989
INTRODUCTION AND BACKGROUND
This report summarizes the creation of a cost analysis model for the University of Michigan Hospital main operating rooms and endoscopy rooms. Currently, the hospital is charging for surgical procedures using a fixed room rate for the first hour of surgery plus a rate for each additional half hour of surgery. Chargeable items are also billed separately from the room rates. This structure is based on covering total expenses and revenues. An actual breakdown on how the expenses are used in the operating rooms has not been analyzed.
Historically, hospitals have been fortunate to obtain 100% reimbursement for their outpatient procedures. Presently, though, this has not been the case, third party reimbursement groups have been paying only a percentage of the total charges. This reduction in reimbursements and an increase in competition among hospitals has created the need for a cost analysis of the operating rooms.
The main objective of this project was to provide Scott Lovelace with a cost analysis model to assess the actual costs of performing a particular surgical procedure. The model was to be easy to use and yet as accurate
(j as possible. We have created two parallel models in the form of a LOTUS spreadsheet One model represents the main operating rooms while the other is used for the endoscopy rooms. We feel that the overhead costs of the two vary greatly and should not be allocated equally.
APPROACH AND METHODOLOGY
In developing the model to calculate the costs of all surgery cases we followed the procedure outlined in the proposal.
1. Determine, with the client, what specific operating room direct and indirect costs affect all surgery cases. To determine the specific costs we initially met with Project Coordinator, John Gialanella, and outlined all the possible operating room costs. We then met with Project Client, Scott Lovelace, and Administrative Associate, Leo Rutledge, to verify the determined costs and their categorization.
2. Develop a summation equation for determining total cost per procedure. In the initial meeting with John Gialanella the costs determined to affect all surgery cases were put into a summation equation. This equation was then edited and verified by Scott Lovelace and Leo Rutledge. The finalized equation follows:
Total Operating Room Cost per Procedure =
Direct Expenses + Indirect Expenses
Direct Expenses:
Variable Labor
Variable Commodities
Overhead Labor
Overhead Commodities
Indirect Expenses:
Institutional Overhead
3. Classify determined costs into well defined variables which will be used in the equation. Through contact with John Gialanella, Scott Lovelace, and Leo Rutledge, we determined the costs that would be included in each of the terms of the equation.
4. Quantify through investigation all these current costs. Through contact with several departments we collected the necessary data to quantify the costs affecting all cases. Several interviews were held with the nursing staff to aid in determining variable labor cost, variable commodities cost, and overhead commodities cost. Leo Rutledge supplied the projected operating rooms budget for the 1988 - 1989 fiscal year, data regarding the labor overhead of the operating rooms department, and the breakdown of surgery cases and hours for the previous year. The Capital Programs department supplied the list
2
of all depreciable items present in the operating rooms and their values. The Finance Department supplied data regarding the institutional overhead allocated to the operating rooms from other non-revenue centers of the hospital. The collected data was analyzed and, in coordination with Scott Lovelace, John Gialanella, and Leo Rutledge, a method of allocating each cost to the cases was determined.
5. Apply this cost model to the chosen six surgery cases. After the model was complete, it was applied to the six surgery cases chosen by Scott Lovelace and Leo Rutledge, shown below:
Colonoscopy Gastroscopy Hysterectomy Liver Transplant Right Heart Catheter Coronary Artery Bypass - Graft (CABG)
The necessary data specific to the six surgeries was obtained through interviews with the nursing staff and patient charge sheets
6. Provide the client with a computerized model to determine costs for all future surgery cases. The model was then put on a Lotus •spreadsheet. A separate spreadsheet was developed for the main operating rooms and the endoscopy rooms. With the input of at most seven values corresponding to a particular surgery, the spreadsheet contains all the necessary information to calculate the cost of any surgery. The spreadsheet also contains the yearly input data, which when updated is automatically calculated into the surgery cost
3
ANALYSIS OF MODEL
The following is a detailed qualitative explanation of the terms in the total cost per procedure equation. The derivations of the terms and the methods of allocation are given. A quantitative explanation is provided in Appendix I.
Variable Labor Cost
The variable labor cost is the cost of the nursing staff in the operating room during the surgery plus the fixed cost of one person from the nursing staff setting up the room. The 1987 - 88 average nursing and technician salaries paid, their projected raises, and a benefits percentage were used to calculate the projected 1988 - 89 nursing and tech hourly salary. For one year the nursing staff productive hours of 1579 was used. A weighted average hourly salary was calculated based on the amount of presently employed nurses and technicians. The computed variable labor cost for the main OR is
$45.73t+$11.43
$23.16t+ $3.86
where t represents the length of the case in hours.
Variable Commodities
The variable commodities cost is the cost of the non-chargeable medical/surgical supplies and the bedding/linen/laundry used during the case. The operating rooms projection of expenses for the fiscal year 1988 - 89 was used as the basis in calculating the cost. The 1987 - 88 percentage of chargeable med/surg supplies to total med/surg supplies, 53.4%, was used to calculate the patient non-chargeable med/surg supplies. The chargeable supplies will be input into the model directly from the patient charge sheets. A percentage of the variable commodities was separated for allocation to the endoscopy rooms based on the ratio of the supplies ordered for the endoscopy rooms to the total med/surg supplies.
4
For the main OR the cost was allocated to each surgery based on a combination of per case and per hour. A fixed cost was allocated to each first hour of surgery and a variable cost for each additional half hour of surgery. The reason for this being that a fixed amount of supplies are used for the opening and closing of the patient regardless of length or type of surgery, and then additional supplies are used as the length of the surgery increases. This percentage of the remaining half hour cost to the first hour cost of 18.75% was determined from the current hospital operating room charges based on reimbursement. The computed variable commodities cost for main OR surgeries is
$152.39 + $28.57(2t-2)
where t is the length of the case in hours. The value for t input into the above equation must be greater than or equal to 1.
For the endoscopy cases the variable commodities cost was allocated evenly to all cases based on the projected number of cases for the 1988 -
89 year. The length of the endoscopy cases were not long enough and did not have enough variation to justify allocating the cost based on time. The computed variable commodities cost for endoscopy cases is $18.35.
Overhead Labor
The overhead labor cost is the cost associated with the operating rooms department personnel. The calculations were based on the January 31, 1989 Staffing Summary Report, the special salary percentages obtained from Leo Rutledge, and a benefits percentage. The overhead labor includes the Professional and Administrative Staff, the Office Staff, AFSCME, and the Nursing Professional and Administrative Staff. For all cases the salaries of the AFSCME Fixture and Wall Cleaner and the Custodian II were not used the calculations because these positions will soon be eliminated. For cases in the main OR, the salaries of the remaining three AFSCME employees were included. For cases in the endoscopy rooms, the salaries of the Stockkeeper II and the Operating Room Aides were t included in the àalculation because their work does not pertain to the endoscopy rooms, but the salary of the Instrument/Ster. Processor was included. The cost of the overhead labor was calculated to be $98.65 for cases in the main OR and $62.36 for cases in the endoscopy rooms.
5
Overhead Commodities
The overhead commodities cost is the cost of the non-variable supplies used by the operating rooms department plus the cost of the depreciation of the general equipment used during the case. The amount of general equipment depreciation includes only the equipment used in all cases and all equipment costing under $10,000. The projected 1988 - 89 total equipment depreciation for the operating rooms was used as the basis for the depreciation calculations. Specialty equipment costing more than $10,000 and endoscopy equipment were separated from the general main OR depreciation. The equipment included in the endoscopy rooms depreciation is listed in Appendix Ill. All depreciation values were calculated based on the four Master Equipment Lists pertaining to the four operating rooms accounts, which were obtained from the Capital Programs Department.
This overhead commodities cost is allocated evenly to all cases performed in the main OR and in the endoscopy rooms based on the projected number of cases for the 1988 - 89 year. The calculations are based on the operating rooms projection of expenses of the fiscal year 1988 - 89. The yearly maintenance costs of the lithotrypter and the heart lung machine are subtracted out of the total overhead commodities to be inserted later for the specific procedure. There is also a component for the depreciation of specialty equipment to be input for the particularcase (see Appendix II for the specialty equipment list). The overhead commodities cost of each main OR and endoscopy procedure, without including specialty equipment, was determined to be $55.18 and $21.29 respectively.
Institutional Overhead (f’— I
The Institutional Overhead report was obtained by Fred Kegarise in the finance department. Only 75% of these numbers were used in our model since this report includes Mott and Kellog hospitals along with the main hospital. We obtained 75% by dividing the cases performed in the main hospital by the total number of cases performed in the University of Michigan Hospital, which these numbers in the report represent.
Each item was allocated either by case or by time according to the nature of the item. For example, billing was allocated by case since the time of
6
the procedure was independent of the time spent on billing for the case. Employee benefits, however, were allocated according to time since staffing is based on surgical hours and employee benefits is directly related to staffing. An itemized listing can be found in the Appendix
Besides allocating by time and case, some items were also multiplied by the square footage ratio of main operating rooms to endoscopy rooms. These items include housekeeping/building and exchange cart supplies. A second intermediate step was also performed for admitting and 0/P registration. These were allocated over inpatient and outpatient cases.
Even though the institutional overhead is an indirect cost, there still exists variance between cases due to time of case and if the procedure was performed in the main OR or endoscopy rooms. This breakdown and calculations can be found in the Appendix I.
FINDINGS / CONCLUSIONS
The findings for the use of the model on the six specific surgeries are as follows:
1) The operating rooms appear to be making money in all areas of the surgical spectrum, i.e., from endoscopies to liver transplants. See Figure 1.
2) Profit margins are large with the longer, more complicated types of surgery. However, profit margins are less for both the gastroscopy and colonoscopy due to the reality of incomplete third party reimbursement.
3) A huge percentage of the costs associated with the endoscopy procedures is from the indirect institutional overhead. See Figure 2.
4) The special equipment component of the endoscopy procedures is very small at $2.54 per case. At the same time a patient flow bottleneck seems to develop on occassion with colonoscopies related to equipment breakdown. For example, only 4 colonoscopes were functional on 4/7/89. The quantity of functional gastroscopes was felt adequate at 8.
7
R%%
. F,,
- 1.0%
10.2%
p
‘——F,——
Procedure
RECOMMENDATIONS
1. Purchase 3-4 additional colonoscopes a Cost component small over 10 years and 3000
cases/yr b. Would alleviate patient flow bottleneck c. Should increase lifetime of existing scopes
2. Raise flat fees for endoscopy procedures? a. Must remain competitive b. These procedures generate revenue from subsequent
therapeutic/surgical procedures
3. Move endoscopy rooms to an off site? a. Would decrease institutional overhead? b. Would avoid parking structure/complex building layout c. Would still need to retain one room to service inpatients
4. Use our cost based model a. Spreadsheet quick and easy to use b. Will maintain cost accounting basis for future monitoring
1. Can follow trend as surgical time increases/decreases 2. Can follow trends for procedures involving specialty
equipment3 Can follow trend as pharmacy or materials management move a satellite into OR
5. Enhance model in future a. Price initial non-chargeable supplies from preference cards b. Make use of counts of lap sponges, sutures, gloves, etc. for
cost accounting purposes c. Include scope maintenance costs in endoscopy specialty
equipment (currently not included)
Nursing (1 .05)($30,000)/1\productive hours = $19.95 per hour Technician (1 .0l)($23,600 roductive hours = $15.10 per hour
Weighted Average Salary 1’
Main OR [.75($1 9.95) + .25($1 5.10)] = $18.74 per hour Endoscopy [.80($1 9.95) + .20($1 5.1 0)] = $18.98 per hour
Benefits Percentage = 22%
Surgery
Main OR 2 nurses for case Endoscopy I nurse for case
Set Up
Main OR 1 nurse for 1/2 hour Endoscopy 1 nurse for 1/6 hour
Final Equation
$45.73t + $11.43
$23.16t + $3.86
where t represents the length of the case in hours.
Variable Commodities /
Patient Non-Chargeables
Med/Surg Supplies $3,058,687 $2,963,265 $95,422 Bedding/Linen/Laundry $473, 147 $458,386 $14,761 Total Non-Chargeables $3,531,834 $3,421,651 $110,183
Main OR
Average length of case = 2.77 hours Projected 1988 - 89 cases = 13,496 cases 2.77 hours/case X 13,496 cases = 37,384 hours 37,384 hours - 13,496 first hours = 23,888 remaining hours
= 47,776 remaining half hours $3,421,651 = 13,496x + 47,776(.1875x)
Variable Commodities Cost =
$152.39 + $28.57(2t-2)
where t is the length of the surgery in hours (t must be greater than or equal to 1).
Endoscopy
V
P & A Office Nurs. P & A AFSCME Total Main OR $13.18 $20.76 $14.90 $49.81 $98.65/case Endoscopy $13.18 $20.76 $14.90 $13.52 $62.36/case
Overhead Commodities
$377,018
Projected 1988 -89 equipment depreciation $834,022 Less specialty equipment depreciation -$350.31 3 General depreciation $483,709
Main OR $483,709/i 3,496 cases = $35.84 Endoscopy $1 1,794*/6004 cases = $1.96
Total Overhead Commodities/case Main OR $19.33 + $35.84 = $55.18 Endoscopy $19.33 + $1.96 = $21.29
* see Appendix Ill for the items included in the Endoscopy depreciation
Institutional Overhead Allocation
Description by case by hour
Employee benefits HIS Purchasing Admitting Billing General Admin. $45.45 Hous/BIg. (main) $58.02 Hous/BIg. (endo) $47.37 Lin. & Laundry Cafeteria $1.38 Nurs. Admin. $12.23 Surg. Supplies Serv. Unit Mgmt. 0/P Registration Ex. Cart Sup. (main) $18.70 Ex. Cart Sup. (endo) $15.27 Medical Records Nursing School $ 3.16
Inpatient case percentage = 58% Outpatient case percentage = 42%
$4.95
$9.06
fi I’s
- ‘-
:
Equipment
Cardiac Bypass Surgery Bypass Unit \ Circulatory Assist iø Heart Lung Machine 1
Intraaortic Balloon 4
Gynecology Laser Surgical )
Orthopedics Bone Cutter ‘.
3 Tektronix Physio Monitors (EKG’s) 3 Olympus Lecturescopes q7c-
3 Oxi Meters -øo Io
6 Cambridge Stretchers i’e. 57/ 3 Airshields BP Monitors ‘W7.7,
3 Valleylab Electrosurgery Units y 1605%
3 Craftsman Supply Carts —,
1 Acmi Heater Probe Unit 0
(‘S..
NAME OF CASE COLONOSCOPY
input Data For Each Particular Case
Length of case (hours) 0.50 Chargeable supplies (Cost) Specialty instruments Pharmacy / other Specialty equipment dep./maint. 2.54 Inpatient service (0 or 1) 0.00 UMH charge 509.00
I I I I
I
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vg. nursing labor cost per hour 19.95 (avg. technician labor cost per hour 15.10 Senefits percentage 0.22
I I
Overhead Commodities I I I I
Total endoscopy depreciation per year 11794.00 Total general overhead commodities : 377018.00 Total cases (main + endo) per year 19500 Total endoscopy cases per year 6004
Overhead Labor
I I
Indirect Expenses
I I I
Inst. overhead allocated by case 51.13 Inst. overhead allocated by hour 1 138.87 dmitting cost by case 8.69 0/P registration cost by case 090 I
U.
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18 ‘..-._, I
I I ‘I cn I I I
I I I I I I 1 1
: 98.65 I I ,_ — — I
I I I I I I
I I I I
I I I I
—— I_ —
296.59
Total Variable Labor Costs
Total Variable Commodities
Total Overhead Commodities
Totaf Overhead Labor
Total Direct Expenses
I ‘IjI 1*1 * I I
INPUT DATA FOR ENDOSCOPY ROOMS
NAME OF CASE GASTRDSCOPY
Input Data For Each Particular Case
Length of case (hours) 0.50 Chargeable supplies (Cost) Specialty instruments Pharmacy / other specialty equipment dep/maint. 3.47 Inpatient service (0 or 1) ooo UMH charge 363.00
a I I I
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a I
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a 60fl4 • a a • I I a I I I I
• a I I
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I I a a
Variable Labor Costs
Avg. nursing labor cost per hour Avg. technician labor cost per hour Benefits percentage
Variable med/surg supplies
Total endoscopy depreciation per year Total general overhead commodities Total cases (main + endo) per year Total endoscopy cases per year
Overhead Labor
Indirect Expenses
Inst. overhead allocated by case 51.13 Inst. overhead allocated by hour 138.87 Admitting cost by case 8.69 0/P registration cost by case 0.90
Direct Expenses
a a a • I I
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‘:. cc : I I — — — a I I — — — I
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121.47 — —— — I —— I I
A II f,_I_J_ I I -,
0.50 1 a Ii 1I I I I• I.L•—t•• I I I
• —. I I a I I — I I
34.291. I I I I
Variable Labor Costs Surgical Time Setup Cost
Total Variable Labor Costs
Total Variable Commodities
Total Overhead Commodities
Total Overhead Labor
• a I I
a - 117 a • I I
19.33 1 I a I • I —— I
• I ‘I,l 77 Ia a .1-.!I a I I I • a I
• 9B • I .DJ I I
I I I
E_ Total Institutional Overhead
Total Indirect Expenses
Total Cost Per Procedure 1 297.52 1 a I- I a
UtIH charge I I : 363.00 1 I I * II I I I
Expected Profit Margin 1 65.48
/
NAME OF CASE Hysterectomy
Length o-f case (hours 1) Chargeable supplies (Cost) Specialty instruments
. Pharmacy / other Specialty equipment dep./maint. Inpatient service (0 or 1) UMH charge
Input Data For Each Year
Variable Labor Costs
Avg nursing labor cost per hour Avg. technician labor cost per hour Sene-f its percentage
Variable med/surg supplies
Overhead Commodities
Total main OR depreciation per year Total general overhead commodities Total cases (main + endo) per year Total main OR cases per year
Overhead Labor
Indirect Expenses
2467.00
a aa a • aa a I aa a I j9 r a I 7,J a
a 15.10 a Ia a a a I - a a aa a
a a a 9 Ia J.i.. a a 357Ia - a a aa a a a I I
a aa a
a a I I
a a a a I Ia a a aa I
Inst. overhead allocated by case 51..13 Inst. overhead allocated by hour 15295 Admitting cost by case 8.69 0/P registration cost by case 0.90 1
Direct Expenses
I 4C
I 4 Cr. I a ._J_ a
a iiI — I
a ‘7j7 17 I I I
I C’ -a a a I SaJ4 . I
78.46: O..00 0.00 :
748.10 I a a Ia — I — —— a I
748.10 a a aa a a
1 1549.93 a i -I I a I I I
• a 467CO • a I .s..
• a a a a a
a ‘ 917.07 aa a
a a
Non—chargeable Supplies Chargeable Supplies Specialty Instruments Pharmacy / other
Total Variable Commodities : 430.84 I I I a I a I I
I I a a
General Equipment Depreciation 35.84 * Specialty Equipment Depreciation 1 0.00 1
General Overhead Commodities 1 19.33 1 • I p a• I I I
Total Overhead Commodities : 1 55.18
I LC I Ia ica.c,.J a a a • — — a I a a
801.83 a a I I a a
I I a a a a
I a a a a a
a
Total Institutional Overhead
UMH charge
Input Data For Each Particular Case
Length of case (hours >= 1) Chargeable supplies (Cost) Specialty instruments Pharmacy / other Specialty equipment dep. /iriai nt -
Inpatient service (0 or 1) UMH charge
1 1 50 -
123.24 1 - 00
I
Variable Labor Casts
Avg. technician labor cost per hour 8enef its percentage
Variable rned/sLtrg supplies I
Initial hour charge 152.39 1 Additional half hour charge 28.57
V
a a — I I
Total main OR depreciation per year 483709.00 Total general overhead commodities 377018.00 1 Total cases (main ÷ endo) per year 19500 1 Total main OR cases per year 13496
Overhead Labor V
Total overhead labor cost per case 98.65
Inst overhead allocated by case 51.13 Inst. overhead allocated by hour 15295 Admitting cost by case : 8.69 0/P registration cost by case 0.90 1
Direct Expenses
I ‘ 411.01 ‘
Li... —I1 I —I— f’ 4. I /11= 7) a av C(r 1 di..) L d LI OF OS . S - ..J * .‘ 4.. -
Surgical Time 1150 Setup Cost 11.43
Total Variable Labor Costs 1 537.20 1 , I
Non—chargeable Supplies 1 752.36 Chargeable Supplies 1 2025.64 Specialty Instruments I o.:o : Pharmacy / other 0.00 1
Total Variable Commodities 2776.00
C) General Equipment Depreciation 35.84 Specialty Equipment Depreciation 1224
* General Overhead Commodities I 19.33 a a a aa a a a
Total Overhead Commodities 178.42 1 I I I I I I I I
Total Overhead Labor I 98.65 .1 I I a I I I I a
Total Direct Expenses 1 3592.27
I I
Indirect Expenses
I I I I I a S I
I I 9 4 a, a a .1. .1. .1...) * I
I a — I I I I I I
: 1918.75 1 I a I I I I I
Total Indirect Expenses
INPUT DATA FOR MAIN OR
NAME OF CASE CABO
LenQth of case (hours >= Chargeable supplies (Cost> Specialty instruments Pharmacy / other Specialty equipment dep./maint. Inpatient service (C) or 1) UMH charge
Input Data For Each Year
Variable Labor Costs
6 . f)0 214731
123.24 1 — 00
I I
I I
Avg. nursing labor cost per hour 19.95 Avg. technician labor cost per hour 15.10 Benef its percentage 0.22
Variable med/surg supplies
Initial hour charge 1 152.39 Additional half hour charge 28.57
I I I - I
Overhead Commodities
Total main OR depreciation per year 483709.00 Total general overhead commodities 1 377018.00 Total cases (main + endo) per year 1 19500 Total main OR cases per year 13496
Overhead Labor
Indirect Expenses
98 ‘.o_
Inst. overhead allocated by case I 51.13 I Inst. overhead allocated by hour 1 152.95 I Admitting cost by case 8.69 1 0/P registration cost by case 0.90 1
TOTAL OPERATING ROOM COST IN MAIN PER PROCEDURE
Direct Expenses
Variable Labor Casts 45.72 Surgical Time : .oo Setup Cost I 11.43 1
I I I I I I I I
Total Variable Labor Costs I 285.75 1
Non—chargeable Supplies 438.09 1 Chargeable Supplies I 2147.31 Specialty Instruments I 0.00 Pharmacy / other 0.00 1 I
Total Variable Commodities 1 2585.40
I I I I I I I I
General Equipment Depreciation 35.84 Specialty Equipment Depreciation 123.24 1 General Overhead Commodities I 19.33
I I I Ia — a a
Total Overhead Commodities 178.42 I I I I I I $ I
1 98.65:Total Overhead Labor
I I I i I€ ‘)i Ia a ._j.-rc I
I I I I I I I I
I I I Ia i I I
I I I I I I a I
I I I I I I I I
a a I I I I I I I I cr-yr Ia I I I
I I a Ia I I — —— I
Total Indirect Expenses
Total Cast Per Procedure 4125.73 1 a a I I I
UMH charge I
(
NAME OF CASE Right Heart Caheter
Input Data For Each Particular Case
Length of case (hours >= 1) 1.00 Chargeable supplies (Cost) 158.00 1 Specialty instruments Pharmacy / other Specialty equipment dep./maint. Inpatient service (0 or 1) 1.00 UMH charge 1002.00
Input Data For Each Year
Variable Labor Costs
AVg. nursing labor cost per hour 19.95 Avg. technician labor cost per hour 15.10 Eenefits percentage 0. 22
I I I I
V I I
I I I
Total main OR depreciation per year 4837t:9.oo Total general overhead commodities : 377018.00 Total cases (main + endo) per year 19500 Total main OR cases per year : 13496
Overhead Labor
Total overhead labor cost per case 98.65 a Ia a
Inst. overhead allocated by case Inst. overhead allocated by hour Admitting cost by case 0/P registration cost by case
51. 13 152.95
Direct Expenses
i.oo : • ii 11’ I I
L.L-_. I I
I I
310.39 I I
I I I I I — I — —— 1
: 55.18 I I I I I - I I I
: 98.65 I I I I I I I I
521.36 I I I I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I •j) I I I £.L_l, I
• I I I I — I — I I
I I I ijb 77 I I I I -..L.L..!I
I I I I I I I I
73413
(....
(•
Total Variable Labor Costs
Total Variable Commodities
Total Overhead Commodities
Total Overhead Labor
Total Direct Expenses