Better Accounting Transforms Health Care Delivery

Robert S. Kaplan; Mary L. Witkowski

Article | Accounting Horizons

Better Accounting Transforms Health Care Delivery

by Robert S. Kaplan and Mary L. Witkowski

Abstract

The paper describes the theory and preliminary results for an action research program that explores the implications from better measurements of health care outcomes and costs. After summarizing Porter's outcome taxonomy (Porter 2010), we illustrate how to use process mapping and time-driven activity-based costing to measure the costs of treating patients over a complete cycle of care for a specific medical condition. With valid outcome and cost information, managers and clinicians can standardize clinical and administrative processes, eliminate non-value added and redundant steps, improve resource utilization, and redesign care so that appropriate medical resources perform each process step. These actions enable costs to be reduced while maintaining or improving medical outcomes. Better measurements also allow payers to offer bundled payments, based on the costs of using efficient processes and contingent on achieving superior outcomes. The end result will be a more effective and more productive health care sector. The paper concludes with suggestions for accounting research opportunities in the sector.

Keywords: Activity Based Costing and Management; Research; Health Care and Treatment; Health Industry;

Format: Print

DOI: 10.2308/acch-50658

Find at Harvard Purchase

Citation:

Kaplan, Robert S., and Mary L. Witkowski. "Better Accounting Transforms Health Care Delivery." Accounting Horizons 28, no. 2 (June 2014): 365–383.

Kurt Meyer, chief risk officer of Swissgrid, the Swiss national electricity transmission system operator, reflects on the risk management system he installed after the deregulation and liberalization of the European energy market. With 41 connections to other European networks, a failure in Swissgrid’s network could interrupt the supply of electricity in Switzerland and much of Europe. Meyer describes the periodic interactive risk workshops conducted at each business unit to identify, assess, and mitigate risks. Executive Risk Workshops of the CEO and the company’s leadership team discuss the business units’ risk profiles and risks that cut across the units, such as safety, weather, and regulatory changes. New and emerging risks are discussed at Extraordinary Risk Workshops. Meyer recently deployed an app on employees’ smartphones for them to easily report anomalies or concerns. Reports from the app are embedded in a new real-time crisis management platform used by several Swiss companies, federal authorities, and the Swiss Army. Despite a full array of risk management tools and processes, Meyer remains concerned about risks yet to be identified.

Working Paper | HBS Working Paper Series | 2018

Reverse the Curse of the Top-5

Robert S. Kaplan

The past 40 years has seen a large increase in the number of articles submitted to journals ranked in the top-5 of their discipline. This increase is the rational response, by faculty, to the overweighting of publications in these journals by university promotions and tenure committees. The ranking factors for academic journals, however, arose for a completely different purpose, to guide the journal acquisition decisions by budget-constrained university librarians. Using journal impact factors to infer the quality of an faculty members’ publications incurs a high incidence of both Type 1 errors, when we conclude incorrectly that a paper published in a top-5 journal is a high-impact paper, and Type 2 errors, when we conclude that papers (and books) not published in top-5 journals have low impact. In addition, a third type of error gets introduced as faculty pursue the research they perceive is favored by editors of top-5 journals, at the potential expense of more innovative and relevant research, perceived to be unpublishable in a top-tier journal. Accounting scholarship, in particular, has underinvested in research about innovative practices or the emerging accounting issues faced by contemporary organizations (Kaplan, 2011), likely because such research is viewed as unpublishable in top-5 journals. This gap persists despite recent scholarship that has documented how important, fundamental ideas can emerge from “use-inspired” research (see Pasteur’s Quadrant (Stokes, 1997)). The paper concludes by suggesting reforms to overcome the dysfunctional fixation on publication in top-5 journals.

Keywords: Information Publishing; Journals and Magazines; Power and Influence; Research;

Citation:

Kaplan, Robert S. "Reverse the Curse of the Top-5." Harvard Business School Working Paper, No. 19-052, October 2018. View Details

Cite View Details SSRN Read Now

This note was written to provide students with fundamental concepts and methods for the analysis of cost variances. It focuses on the decomposition of cost variances into price, quantity, and mix variance components, an approach that allows students to identify the root causes of differences between expected and actual costs.

Faculty & Research

Better Accounting Transforms Health Care Delivery

Abstract

Citation:

About the Author

More from the Author