METHOD OF ACTIVITY BASED COSTING
BACKGROUND OF THE INVENTION
The present invention relates to activity based costing of a business process.
Activity based costing (ABC) is a cost accounting methodology which
seeks to distribute costs to individual business units (product, customer, service,
business line, etc.) based on the activities needed to produce the service, product
or desired output. ABC begins by identifying the activities that are required to
produce products, services, and service customers. Costs are then determined for
each activity. Total costs for a product, service, or customer are calculated by
summing the costs of all activities necessary to produce that product or service,
or to service the customer.
ABC is different from traditional cost accounting methods in three
significant respects. Firstly, ABC focuses on providing costs for individual
products, services or customers, where traditional cost accounting provides cost information about organizational business units such as divisions, plants or
departments. Second, ABC allocates costs based on the work activities and
resources consumed to produce products, services or to service customers. This
is in contrast to cost accounting which allocates costs based on an arbitrary metric
(an example would be allocating costs for four different business lines based on
the percentage of revenue brought in by each business ). Finally, ABC allows the
measurement of the cost of not doing the work in such cases as machine
downtime, waiting for required materials or tools, where traditional cost
accounting only allows us to measure realized department or machine costs.
ABC information has both a strategic use and an operational use. At the strategic level, ABC information allows organizations to understand the true cost
of producing products, services, and servicing customers. Knowing this allows
organizations to shed products, services, and customers whose consumed
resources are greater than the revenue they generate, or re-price these products,
customers or services to generate a profit. An ABC system also allows businesses to determine the cost of "Not Doing" or hidden liability that stems from
incomplete work. At the operational level, ABC information allows managers to
focus in on processes and activities that consume large amounts of resources and
re-engineer those processes to reduce costs and cycle time. Using ABC
information, organizations can drastically change their cost structure to become
more competitive.
Though ABC is widely used in manufacturing, it has been almost
impossible to practice in service industries. Manufacturing accounting systems
typically allow plant or division costs to be broken down to department costs, and
then to machine costs, work group labor costs, machine materials cost, etc.
Accountants can assign these small units of cost to specific activities, and then
assign activities to products or customers. This process allow the creation of an
ABC system. In service industries, accounting systems also track division or
department costs. However, a large percentage of service business' department
costs are labor costs. No system has been found for breaking down these costs
and assigning them to activities in order to create an ABC model when workers
switch between tasks and customers minute by minute. Typically service
companies would use an arbitrary metric such as percentage of revenue to allocate costs, as discussed above. Another way would be to determine the amount of time
out of total time spent on each business line or customer. There are two ways to
accomplish this: asking an expert to render an opinion, and time sampling. Time
sampling results are both inaccurate and un-duplicatable because time sampling
is dependent on the process, skill of the operator, and the statistics of sampling.
A time sampling subject also performs differently in a test environment than
under normal conditions. An educated guess is less accurate because experts do
not often recall accurately all of the activities or time required to perform a task.
A solution to this problem has been required for many years. In Peter Drucker's article 'The Information Executives Truly Need" (Harvard Business Review, Jan-
Feb 1995, pages p. 54-62) it is stated on page 56 that "for most knowledge-based
and service work, we should, within 10 to 15 years, have developed reliable tools
to measure and manage costs and to relate those costs to results". It is accordingly
clear that a solution to this problem has been required for some considerable time.
Several operator independent methods of task time measurement are
presently in existence. An operator independent method of task time
measurement is a method which analyzes any manual operation or method into
the basic motions required to perform it, and assigns each motion a pre¬
determined time standard which is determined by the nature of the motion and the
conditions under which it is made. These measurements are calculated in such a
way that they are independent of any particular operator, and instead represent the
time taken to carry out an activity or task as performed by a standardized person.
Predetermined-Motion Time Systems (PMTS) is such a methodology, and
is based on the Methods Time Measurement (MTM) concept developed in 1948
by H. B. Maynard, G. J. Stegemerten and J. L. Schwab. MTM is defined as a "procedure which analyzes any manual operation or method into the basic
motions required to perform it, and assigns to each motion a pre-determined time
standard which is determined by the nature of the motion and the conditions
under which it is made. The data is often the result of frame by frame analysis of
motion-picture films involving diverse areas of work, as in the case of the MTM-
1 methodology. MTM and PMTS are well known technologies available in the
public domain. Details of the techniques used therein can be found in "R. M.
Motion and Time Study: Design and Measurement of Work"; Barnes, 7th edition; 1980.
The data is generally used to establish fair labor standards by employers
and unions, in terms of the number of times the motion can be reasonably
expected to be achieved in a given unit of time, and also to measure productivity of employees. The information is also used to determine the number of
production workers needed for a process, manufacturing production schedules
and the amount and delivery times of materials.
A problem with both MTM and PMTS is that there are many body
movement/distance combinations. For example, fundamental motions evaluated
by PMTS systems include reaching, leg motions, moving, side stepping, turning,
turning the body, applying pressure, bending, stooping or kneeling on one knee,
grasping, kneeling on both knees, positioning, sitting, disengaging, standing from
sitting, releasing, eye travel, walking, eye use, foot motions, and cranking. MTM
and PMTS are accordingly unwieldy measurement systems.
PMTS was refined by K. B. Zandin and the H. B. Maynard and Company,
Inc. in 1974 to produce a new proprietary product, the Maynard Operation
Sequence Technique (MOST ®). The development of MOST was the result of an extensive review of MTM data. The MOST system is based on the concept
that work is the movement of objects, work being defined as force applied over
distance. The human body moves in very specific patterns, each of which have
an amount of work associated therewith. For example, the hands and fingers only
work in certain ways, and the legs and arms only bend in certain ways. Through
millions of lab observations, MOST has defined these patterns of human body
movement as work is performed and assigned time values to each pattern and
distance combination. MOST® has two unique characteristics which provide advantages over previous time management systems: 1) MOST is a scientific
method that can be duplicated with an expectation that the generated time values
will be the same for the same work process, as the results are independent of the
operator. 2) The time values assigned to discrete tasks are accurate
representations of the time in which it could be expected that the task be
performed, within a 95% confidence that the value is within a 5% range either
side of the "true" time required to perform a task at 100% effort and 100% skill
and performing the task in the manner instructed. This is because the time
generated is based on millions of lab observations. Clearly the time taken by an
operator could be greater than this due to inefficiency in execution of the task or
lower than this due to the operator not needing to perform certain parts of the
tasks (particularly mental steps) or having particular dexterity due to years of
practice. The measure does not try to establish a mean value, but essentially that of an ideal person performing the task exactly as instructed.
Details of the operation of the MOST technique can be found in Work
Measurement, Kjell B. Zandin, 2nd edition 1993. There are two commonly used
MOST methods as described in the above publication, referred to as basic MOST® and mini-MOST®. Mini-MOST is used for high frequency, low duration activities where accuracy is very important.
SUMMARY OF THE INVENTION
The invention provides a way of creating a costing model of a business
that allows the underlying cost of carrying out a business process to be
established, independently of the actual human operators involved in the
operation of the process.
Removing factors dependant on the efficiency of the operators from the
costs allows more accurate analysis to be achieved, as particularly skilled or
unskilled operators working on a particular process could otherwise influence the
perspective on the efficiency of an operation which could rapidly change along with a business' s personnel.
The results of the process of the invention are used to establish financial
profit, risk profile and quality of life in the business organization. The invention
also allows businesses to measure the cost of "not doing" work in terms of hidden
liabilities that exist when work is not completed. A financial model can be
created which allows a service business to measure the utilization rate of
resources, and by so doing allows the work tasks to be re-distributed to maximize
the results or yield of every resource. Utilization ratios can be used to determine the quality of life of employees within a business. Risk profile of a business can
be calculated by comparing the statutory or industry standards for a particular
process with the measured business' s process. The invention also allows
businesses to conduct business scenario analyses, conduct calculations on return
on investment (ROI), return on invested capital (ROIC) and internal rate of return
(IRR). Furthermore, the invention allows the benefits of process improvements
to be predicted and task time improvement requirements to be defined in order
to meet specific goals.
The invention is particularly applicable to service industries. There are
two types of benefits to creating an ABC model of a service business, strategic
and operational. At the strategic level, if the revenue of different services or
customers is known and the true costs of activities necessary to provide the
service or service a customer are also known, then the true profitability of that service or customer can be ascertained. Service lines that are unprofitable can be terminated and customers who do not meet profitability goals can be re-priced or
terminated. There are four additional strategic benefits that the invention
provides.
Firstly, the invention allows the capacity of all resources to be compared
with the sum of all activities using the resource. This allows the utilization ratio
of the resource to be determined. The utilization ratio allows activities to be
redirected to underutilized resources, and provides information regarding where
additional capacity needs to be added to resources that are acting as bottlenecks to the flow of work through the process. By cross leveling capacity and adding
resources, utilization ratios below 100% can be ensured. This improves quality
of life and thereby reduces employee turnover. The risk associated with non-
compliance with statutory or industry mandates is also reduced by ensuring the
work processes and time meet specified requirements.
Secondly, the invention allows financial models to be created that predict
the economic result of the addition of service lines, resources or process changes.
This allows a service business to know in advance the economic result of business decisions.
Thirdly, the invention allows a service company to calculate the ROI, ROIC and IRR on any capital investment decision.
Finally, the invention allows service businesses to measure the unrealized
cost of unperformed work which occurs when work is being performed in
practice in less time than it theoretically should according to the model. For example, if a person sees a doctor and is given a plan of treatment, prescription
and follow on appointment it might be thought that the service is complete. This
is not the case. The physician must take several more actions before the service
is complete. The doctor must identify the billing codes to be billed, dictate a note,
transcribe a note, file the chart, bill a visit, etc. If any of these activities are not
completed, the activity remains outstanding work that represents a hidden
liability. In a service business, these liabilities can total millions of dollars. In a
manufacturing industry, it is immediately evident that there is unperformed work,
because the manufactured product will be incomplete.
At the operational level, the invention allows managers to determine
which activities are consuming the most resources or time. With this knowledge,
managers can implement re-engineering, Total Quality Management (TQM) or
Statistical Process Control (SPC) processes to reduce costs and cycle time. The
invention allows the operations manager to describe a new activity or technique and know the benefits immediately. Conversely, the invention can tell an operations manager how much of a resource or activity time must be reduced to
meet a certain target benefit.
Furthermore, using this approach has the advantage of allowing operator
performance to also be monitored relative to the non-operator dependant
standards used, and allows the impact of an employee's efficiency on the
profitability of the operation to be established, so that an employee can be
appropriately compensated based on their performance.
The invention provides a method of performing costing of a work process
including human activity and overhead costs. A list of tasks is established for said
work process including tasks executed by a human operator. The expected
duration of execution of the tasks is established using an operator independent
method of task time measurement. A cost component of each task as a function
of the expected time of execution of said task and the cost per unit time for said
human operator is established along with a second cost component of each task
dependent on overhead costs of the process. Portions of the overhead costs are
apportioned to each task as a function of the time of execution of the task by the
human operator, machine operating time or other relative consumption of
resources. Finally, the cost components are summed for all the tasks to establish
a process cost, and from the cost and revenue generated by the process, the
profitability of the work process is determined, independently of the efficiency of the human operator.
In one embodiment of the invention, task times are developed using the
MOST® system.
In a further aspect of the invention, activity based costing is performed to
calculate costs of serving clients or customers in a service industry.
In a specific embodiment of the invention, activity based costing is
performed to calculate costs of serving patients in a healthcare practice.
The invention provides a system for calculating the discrete time and cost
for each work activity within a work process. Individual activity costs are then
used to create financial models. These financial models can be created for an
overall business, business lines, operation staffs and support staffs. A library of
activity costs can then be used in any business analysis or projection.
BRIEF DESCRIPTION OF THE DRAWINGS
A specific embodiment of the invention will hereinafter be described with reference to the drawings in which:
FIGURES 1 and 2 show an overview of the method employed according
to the preferred embodiment of the invention.
FIGURE 3 shows a simplified example of flow-charted task activities
performed by a medical practice in an example of the preferred embodiment of
the invention.
FIGURE 4 shows analyses which can be performed using the data acquired by the process shown in FIGURES 1 and 2.
FIGURE 5 shows examples of charges for particular activities performed
by a medical practice in an example of the preferred embodiment of the
invention.
FIGURES 6 and 7 respectively show the drivers in the example of the
preferred embodiment and the income generated thereby.
FIGURE 8 shows how the sessions can be apportioned to each business
practice in the example of the preferred embodiment..
FIGURE 9 shows the fixed costs apportioned to each practice unit as a percentage of the total fixed costs in the example of the preferred embodiment.
FIGURE 10 shows the total fixed costs apportioned to each practice based
on the values shown in FIGURE 9.
FIGURE 11 shows the frequencies of certain events in the example of the
preferred embodiment of the invention.
FIGURE 12 shows the salaries of practitioners in the example of the
preferred embodiment.
FIGURE 13 shows unused provider hours in the specific example of the
preferred embodiment.
FIGURE 14 shows the practitioner cost per minute of the practitioners in
the specific example of the preferred embodiment.
FIGURE 15 shows the salaries of the support staff and the cost per minute
in the example of the preferred embodiment.
FIGURE 16 shows examples of the activity based costing performed in the example of the preferred embodiment.
FIGURE 17 is a table showing calculation of the time taken by a
department or provider to process one occasion of service.
FIGURE 18 is a table showing calculation of the number of patients
which can be treated per hour in the different practice .
FIGURE 19 is a table showing a way of calculating utilization ratios
based on restrictive and non-restrictive time.
FIGURE 20 shows the utilization ratios of the departments and
practitioners in the example of the embodiment based on the activity based
costing performed or based on the calculations of FIGURE 19.
FIGURE 21 shows risk profiles generated from the utilization ratios of
FIGURE 20.
FIGURE 22 shows a financial analysis of the data obtained in the example
of the preferred embodiment.
DETAILED DESCRIPTION OF THE INVENTION
An overview of the method of a specific embodiment of the invention is
shown in FIGURES 1 and 2. An overview of the method is shown as two
flowcharts, with solid lines showing the flow of operation, and dashed lines
showing information being generated at each stage and used at further stages in
the method. For clarity, FIGURE 2 shows a series of steps represented by a single
box 104 in FIGURE 1. As shown in FIGURE 1, firstly, a list of work activities
or tasks is generated (step 102). Ideally, each department in a company is asked to create an exhaustive list of all work tasks performed. The task period cost 134
is calculated for the first task (step 104). Establishing the list of tasks will usually
involve establishing different revenue generating work processes and breaking
them down into tasks. These tasks can be flowcharted, and a simplified example
of such a set of tasks is shown in FIGURE 3 for an office visit in a medical
practice. The tasks can be categorized by the operator performing the task, as in
FIGURE 3 to aid in costing, as will become clear. Some tasks might be common
to more than one work process. This step is repeated for each task to obtain all the
task costs for the process, as represented by looping decision box 108.
The steps required to calculate the task costs are shown in FIGURE 2. It
will be apparent that the steps shown in both FIGURES 1 and 2 could be
performed in different orders to achieve the same end results, and that there are
many equivalent combinations of calculations which could be performed based on the same values which would yield the same results. The sequence shown is in no way intended to be limiting, and other such sequences of calculations would
be within the scope of the invention.
The first step (Fig 2, 110) involves the calculation of task unit time
values. Ideally a library of activity time costs is established in order to make this
task simpler.
Each task is designated as a fixed or variable task. A fixed task is one whose time to complete has a low variance from a standard, doesn't occur very
often and whose time to perform is easy to accurately measure. A variable task
is a task not fitting these criteria. Each task is assigned a method of measurement.
The methods of measurement will vary depending on the task's importance
frequency and nature. The following four methods are utilized in this embodiment
of the invention:
1) Expert Opinion is used when the task has no or few sub-components, is
a task that requires analysis or thinking, is infrequent, not complex, and
variation in performance of different operators is minimal.
2) Time studv is often used when a task has multiple sub-components, has a low frequency and is not complex.
3) Industry Best Practice/Standards is often when a task is complex, has
multiple sub-components, or the client dictates the value to be used. This would include government billing codes, such as Medicare codes
presently used by the US government to standardize charges for performing certain activities in healthcare businesses.
4) A Pre-determined Motion Time System (PMTS) studv using the Maynard
Operation Sequence Technique (MOST®) is used when the task's sub¬
components can be identified, when the frequency of occurrence is high,
and when the financial impact is high.
The decision regarding which method to use to a generate a task's time
value is made on a task by task basis. The result of the implementation of these
tools is a time value standard for every task.
In the next stage (Fig 2, step 116) , the Task Unit Labor Cost 118 is
established by multiplying the task time 112 by the rate of pay 114 or Unit Salary Cost for each employee.
In the following stage (step 122), the Task Unit Overhead Cost 124 is
calculated by allocating Sales General & Administration (SG&A) and overhead
costs 120 to the task using the relative consumption of the resource. Such
techniques establish what portion of the overhead and administrative costs are
consumed by which activities and would normally include resource downtime in
the costing.
Likewise, in step 123, the Task Materials Cost 125 is calculated by
allocating the Materials Costs to the task using the relative consumption of the
materials by the task.
Then, in step 126, the Task Unit labor Cost 118 and Task Overhead Cost
124 and Task Materials Cost 125 are summed to give the Task Unit Cost 128.
Once the steps 104 for each task have been performed for all the tasks,
and a library of task costs has been developed, various different analyses can be
performed on the data, as shown in FIGURE 4.
For certain analyses, it is beneficial to multiply the task unit cost 128 by
the period frequency of the task, which is generally established by interviewing
or studying the operation of the task operator while working. This gives the Total Task Period Cost 134, which is the total cost of performing a task over a given
period.
The task period costs 134 for a department can be summed, as shown in
step 152 in FIGURE 4 to give the department's total cost. These can in turn be summed to give business line and then total business operating costs. Task period
costs can also be summed to determine the cost of providing a particular service.
As shown in step 158, the utilization ratio for different employees can be
calculated for departments or staff and is defined as the time required to perform
work divided by the time allocated for work at 100% skill and effort.
As shown in steps 160 and 162, utilization ratios can be used to conduct
resource analysis which allows maximization of the yield of current resources and
identify and solve work process bottlenecks.
Using utilization figures and staff constraints, a quality of life index for
the business can be generated as shown in step 164. Performance rates can also
be ascertained for the employees, based on the utilization ratio.
As shown in step 146, risk profile can be ascertained by dividing statutory
or industry required hours to perform a given work load versus actual hours used
for that work load. Excessively high ratios are an indicator of incomplete work
or hurried activities and can be used to determine business liability and risk
profile. Such analysis is beyond the scope of this document.
Using service, business line and total operating costs from step 152, and
the revenue from step 153, the profitability of a service or business line can be
determined along with its correct price as shown in step 154.
Using total ask period costs, the hidden liability of unperformed work can
be calculated by determining the difference between required and scheduled hours
and multiplying the difference by the department pay rate per hour. This is shown
in step 148.
Using total task period costs, the activity costs are viewed from highest
to lowest to identify those activities that would yield the greatest benefit in a
reengineering, TQM, or SPC program. This is shown in step 150.
As shown in step 136, an electronic spreadsheet financial model of the
service business is created using task frequency drivers, billing codes, insurance
reimbursement schedules, reimbursement rules, and total task period costs. The
economic output of the business can then be computed using the formula Revenue-Costs=Profit.
Using the ABC financial model created in step 136 different resources and
staff members can be changed to determine the economic impact of business
decisions as shown in step 138. The financial model can further be used to predict
benefits of process environments as shown in step 140.
Using the ABC financial model created in step 136, activity times can be
substituted to determine the benefit of process improvements and the results used to conduct ROI, ROIC, and IRR calculations to determine the pay-back of capital
investment decisions. This is shown at step 142. Conversely, the activity time
improvements and capital investment necessary to produce specific financial
goals can be calculated as shown in step 140.
A specific example of activity based costing in accordance with the
invention will hereinafter be described with reference to FIGURES 5-18. These
figures mostly show tables of data which must be gathered from operational
databases, business records and activity sampling. The example relates to a
medical business which is funded in its capacity as a healthcare office, hospital,
skilled nursing facility (SNF), Care Plan Oversight (CPO) and Clinical Drug
Studies (DRGs).
The data in this specific example of the invention is stored in a computer
and calculations are performed to manipulate the data to create a service business activity based costing model. According to this embodiment, a spreadsheet
program such as Microsoft Excel is used to perform this task.
The data and the calculations shown in these figures are selected by way
of example from a complete simulated analysis of a healthcare business. Similar
models for other businesses will have different parameters, but the underlying
principles will be similar.
The income generated by different types of examination or other revenue
generating sessions in the practice are stored in the spreadsheet. Examples of
some of the types of sessions and the charges associated therewith are shown in
FIGURE 5. The charges shown are for healthcare office and hospital revenue
generating sessions. The Medicare code is shown in the first column, a
description of the session type in the second column, the number of appointment slots used up by the session is shown in the third column and the fee associated with each session is shown in the fourth column.
The number of actual sessions dealt with over a given period are also
stored, as shown in FIGURES 6 and 7. These events are broken down by the
practitioner or team of practitioners who deal with the sessions. For example,
DR1 and DR2 represent the two physicians, andNPl and NP2 represent the nurse
practitioners. Different combinations of physician and practitioner both involved
in a session make up the different teams. The sessions act as the drivers for the
profitability of the practice. FIGURE 6 shows the actual number of sessions in a
month handled by the practitioners in\he healthcare office. FIGURE 7 shows the
revenue generated by each session and the total revenue generated by each
practitioner or team per month.
The session totals thus generated provide a straightforward way to
apportion costs to the various types of practice in the business being analyzed.
The totals generated are shown in the first table in FIGURE 8. These values are
shown as percentages of the total sessions for each type of practice in the second
table. The third table simply shows the breakdown of sessions by practice type,
and is based on the right-hand column of the first table.
The fixed costs of the operation are stored as shown in FIGURES 9 And
10. The actual costs per month are shown in the first column of FIGURE 9, and
the way the costs are apportioned to each of the practices is shown in the
subsequent columns. Some of these are apportioned according to the number of
sessions handled by the practices (eg. telephone, administrative salaries and
computer expenses) using the data of the last table in FIGURE 8, as they are more
dependent on the actual number of cases handled by each practice. Others are broken down according to the physical size of the practice, such as rent,
electricity and water. Others are broken down in other ways, such as office
supplies which are broken down by the actual use of supplies by each department.
This can also be monitored, or can be estimated statistically from studies of many
practices. Once the fixed costs have been apportioned, the actual fixed costs for
each practice can be calculated from the total fixed costs as shown in FIGURE
10.
The support staff are required to track the number of times they perform
certain operations over a certain period, and the results of this study are recorded in another table, shown in FIGURE 11. A description of the event is shown in the
first column. A numerical value of the frequency of the operation over the time
period in question is shown in the third column and the unit of measure of the
frequency is shown in the second column. The support department in question is shown in the fourth column.
The actual weekly hours are recorded, as shown in FIGURE 12 along with
the monthly salaries of the practitioners. Furthermore, the proportion of cases
handled by the physician and the proportion handled by the nurse practitioner
when they are acting as a team are stored for each different practice type. Finally,
the available time of the practitioners is recorded as shown in FIGURE 13, which
can be used in conjunction with the actual hours worked to calculate the unused
provider hours as also shown in FIGURE 13.
With the information in FIGURE 12, and knowing the number of work
days per month, it is straightforward to calculate the cost per minute of the
practitioners as shown in FIGURE 14. The cost of teams is calculated by
apportioning the cost per minute of the practitioners in the team according to the
proportion of cases handled by each practitioner shown in 12.
The salaries and cost per minute of support staff is calculated in a similar
manner, as shown in FIGURE 15.
FIGURE 16 shows a selected set of these activities performed by the
receptionist department for an office visit, averaged for the practice and for a
particular physician. Other activities involved in the visit by different
departments, including costs of the practitioners are not shown, but will be
included in the calculations. The second table in FIGURE 16 is a set of
calculations for a specific practitioner, in this case physician 1. Similar tables for
all the other physicians are established, and all the values therein are averaged to give an equivalent table for the average cost of a visit in the practice as a whole.
This table is the first table shown in FIGURE 16.
The frequencies per month of the operations associated with Physician 1
are shown in the first row of the second table, and are generally ascertained from
the drivers associated with that physician shown in FIGURE 6, or from the
frequencies of certain operations recorded by the support staff as shown in
FIGURE 11 multiplied by the percentage of sessions dealt with by each
practitioner, ascertained from the data shown in FIGURE 8.
The expected task time, in minutes, independent of the actual operator or
support staff member, is established using the MOST® software. A library of
such values would normally be created from which relevant activities are
selected. The following row in the second table shows the percentage of visits
in which the activity takes place, and the following rows show the time expended
on the activity per visit. These columns are cumulative columns, summing across
the row for each department and for the whole practice.
Finally, the monthly activity cost is calculated by multiplying the frequency of the activity, the task time and the cost per minute of the operator.
These are cumulated over the department and the practice in the last two rows.
Accordingly, average costs for a visit can be calculated when performed by each practitioner.
As mentioned above, all the values calculated for each practitioner in the
second table in FIGURE 16, and other equivalent tables for the other practitioners
are then averaged over all the practitioners and teams to obtain the equivalent
table for the whole practice, representing the average expected cost per visit at the
practice.
The income generated by the process is essentially the amount paid for the
service, in this case the cost of a visit to the practitioner. The profitability of a
process, independent of the efficiency of the different human operators, can
accordingly be calculated by subtracting the costs of the process from the revenue
generated by the service. Using this information, decisions can be made regarding
whether to continue providing certain services or products.
The table in FIGURE 17 represents the time it takes one department or
provider to process one occasion of service, including exceptions, in each of the
business lines, in minutes. These values are lifted directly from the results of the
calculations in FIGURE 16. For example, it takes billing 15.17 minutes to process
one hospital bill for an occasion of service. A doctor spends 23.52 minutes to see
one patient in a nursing home visit. This chart is used to establish how long each type of service lasts and therefore costs.
FIGURE 18 Shows the calculation of the actual and maximum patients
per hour. First the average number of slots for an OOS for all types of patients,
i.e. new patients, established patients and consulting patients is established by
dividing the total number of slots used by the total number of OOS's, the data
being obtained from FIGURE 6.
From the schedule, the number of slots in the office are known, eg. 233
for the office per day. From the above calculation it is known that one patient OOS usually consumes 1.21 slots in the office. The number patient OOS's which
can be provided per day or hour can therefore be calculated based on the number
of slots per day or per hour. Enough time must be allocated for restrictive work
activities to cover maximum patients per hour.
The final column is the number of patients actually being seen based on the schedule. The difference lies in patient cancellations or no shows.
A department's utilization ratio (time required to complete work / time
allotted to accomplish work) can be calculated as shown in FIGURE 19. The
utilization ratio for a support department is not simply a straight calculation. It is
known that some activities must occur when the patient is interacting with a
support staff member. These tasks cannot be accomplished in the most efficient
manner because they are dependent on the patient. These are referred to as
restrictive activities. Other activities are independent of patients and can be accomplished in downtime. These activities are called non restrictive activities.
Activities that are restrictive are established and the time calculated in FIGURE 16 for each of the activities is summed (having been weighted by the proportion
of OOS's for which the activity is required). This gives the average restrcitive
time in minutes per OOS. Nonrestrictive time is calculated by summing the time
spent by the department or practitioner in each practice (obtained from the table
in FIGURE 17) per OOS, weighted by the proportion of OOS's actually occur in
each practice. The restrictive time per OOS is subtracted from this value to give
the non restrictive time per OOS. The number of man hours required to cover
restrictive activities by dividing the maximum patients that can be seen in one
hour by the number of restrictive hours it takes to process these patients is then
calculated. Based on the larger of the number of the actual or current patients per
hour calculated in FIGURE 18 and the restrictive time per OOS, the minium coverage in man hours per hour can be calculated. Depending on the number of
man hours available (eg there are 8 provider man hours for any hour in the office
practice) , the unutilized portion can be calculated by subtracting the available
time from the minimum coverage. The amount of time in one period that is not
being consumed by restrictive activities is then calculated (Unutilized Portion
Coverage). In the case of reception there is an Un-utilized portion of 80.77 hours
available to accomplish non restrictive tasks (calculated from the number of hours
per month available). Summing all non restrictive work for one period (by
multiplying the number of OOS's by the non-restrictive time per OOS)gives the
hours of non restrictive work that must be accomplished, in this case 490.6. The
difference between the available un-utilized portion of monthly hours and the
required time for non restrictive work gives us the amount of time per month (in
this case 409.89 hours) that must be added to the restrictive period hours to give the total period hours that are required to accomplish restrictive and non
restrictive tasks. Dividing the total available hours from the schedule by the total
of restrictive and non restrictive hours yields an accurate utilization ratio.
FIGURE 20 shows an alternative way of calculating of utilization ratios
of the departments and practitioners based on the activity based costing
performed. The first five columns of figures show the already calculated respective total hours which should have been required to carry out the activities
by each department or practitioner in each practice using the PMTS technique
used, and the totals across the whole business. The sixth column shows the actual
hours worked, calculated from the values already recorded in FIGURES 14 And
15, and from these a utilization ratio can be established. A very high ratio implies
that work is being hurried, or a backlog of follow-up work is building up, which
could imply that standards are low leading to a high risk value as shown. The
second ratio in this table is the ratio calculated using restrictive and non
restrictive hours discussed above.
As these numbers demonstrate, when the support staff member is
dependent on the patient or another input, tasks cannot be organized and
accomplished in the most efficient way possible. Since the method described is
attempting to get a true picture of the available capability of a department, this
must be taken into account or the model will give misleading conclusions.
The risk profile follows the basic formula of number of hours worked /
required time to service all the OOS's. This is relevant because by law, the doctor
must spend a certain amount of time with the patient, which corresponds to the
restrictive OOS time. Hence, the risk profile must be multiplied by an adjustment
factor to eliminate the non restrictive time associated with an OOS. The
adjustment factor simply eliminates non restrictive work from the calculation and is calculated from the ratio of non restrictive to restrictive hours.
Unutilized labor can be calculated where the utilization ratio is below 1
by multiplying a department or practitioner's salary per month by unutilized
portion of the time (1-utilization ratio).
With this information, a financial analysis as shown in FIGURE 22 can
be made to calculate the theoretical costs for a work process attributable to each
practitioner, team or the practice as a whole, for all its services, not taking into
account the skill of the support staff. As the support staff could change dramatically over a very short period of time, it is advantageous not to take their
skill into account when trying to establish the efficiency of the business and
operating techniques used. FIGURE 22 shows an analysis for one of the
physicians, but it will be appreciated that the same can be done for the other
practitioners and teams, and summed for each practice and the whole business.
The income of the practices is ascertained by summing the data in FIGURE 7 for
each practice. The utilized labor expense is simply the result of the calculations
shown in FIGURE 16. Note that this labor expense isn't the actual labor expense
(which is determined by the salaries of the staff) but is the theoretical labor
expense independent of the actual skill of the support staff. The unutilized labor
expenses are based on the values obtained form the analysis shown in FIGURE
20. Any additional income over and above the income from examination sessions
already taken into account is included at this stage, along with the fixed costs of
the business, calculated in FIGURE 10 which in this example are split evenly between the practitioners and teams.
This allows the overall theoretical profitability, independent of actual
staff, to be calculated as shown.
To summarize, using Pre-determined Motion Time Studies, it has been
shown that the capability is available to compute to + or -5%, with 95%
confidence, the true time of completing a task. Armed with that information, the
operator's pay rate can be used to compute the labor cost of a task, process, department, business line, product or service. Furthermore, a determination has
also been made of the allocation of Sales and Group Administrative costs by
applying those costs to the process tasks that consume them. In the process flow
diagraming, the tasks have been identified which require materials and at what
rate those materials are consumed. Summing the labor costs, S, G & A costs, and
material costs allow us to determine the total costs of a task, process, department, business line, product or service.
It is known that businesses create value by producing a goods or service that a consumer requires at a price that the consumer is willing to pay. This
process is called the value chain and represents a set of tasks that at their
conclusion result in the exchange of the service or product for money. One of the
first steps in the methodology is the identification of this value chain through
process mapping. This activity is conducted in order to determine the costs of the
value chain and also the revenue streams of products ad services generated by the value chain. Knowing revenue and costs allows us to implement the fundamental
business formula: Revenue-Costs = Profit, to determine the true profit of a
product, service, or business line. In the course of implementing the
methodology, we have recorded the business' available resources, the value chain
of activities required to produce a product or service, the consumption resources
for each task or process and its associated costs, and the revenue of each product
or service. Having completed all of the previous steps, we understand the
relationships and timing of how inputted resources (labor, S, G & A, materials)
become profit at the end of the value chain. These relationships are referred to
as a financial model of the business. These relationships are stored as sequenced mathematical formulas. Because activity costs have been used to determine these
relationships, the model is called an Activity Based Costing Financial Model. In
this methodology, an ABC financial model is created for each product, service,
business line, and for the total business. The ABC financial model is used to vary
a business' resources (human labor, S, G & A expenses, and material consumed) and to be able to predict the economic result of these decisions. Though there are
many applications of this information, 4 primary applications for this information are:
1. Reduced Risk - Business leaders can conduct "what if" scenarios to
analyze the results of a change in resources. This allows a business leader
to evaluate different courses of action to determine the best outcome.
Having this information allows a business leader to reduce the risk of
poor financial results, destruction of resources through overuse, or reduced regulatory compliance.
2. Financial Payback - From the above-mentioned use, the economic
outcome of the application of resources can be determined. If the cost is known of the implementation of these resources and the interest rate, the
return on investment (ROI) can be calculated. If the cost of borrowing
money to the organization is known, the return on invested capital
(ROIC) can be determined. The payback, or percentage return, of the
business decision can also be established by calculating the internal rate of return (IRR).
3. Process Benefits - Using the ABC financial model, the current cost
structure is known. If one or more processes is changed in the value
chain, using the same methodology, the change in the cost structure of the
product or service can be determined, and therefore the impact on profit,
risk and quality of life. The old process can then be compared to the new
process to determine the best method for accomplishing the necessary
tasks in the value chain.
4. Quantification of Goals - Conversely, from the above use, an
organization goal such as "reduce cost by 15%" or "improve net income
by 5%," can be taken and the reduction of resources (labor, S, G & A,
materials) necessary to achieve that goal can be determined.
Although the invention has been described by way of a preferred
embodiment, other variations and modifications could be implemented and would
still be within the scope of the invention.