Complete case study from chapter 11 page 242-244. Budgeting and Financial Management for Nonprofit Organizations by Lynne A. Weikart, Greg G. Chen, and Ed Sermier, CQ Press a division of SAGE, Washington, D.C. ISBN: 978-1-6087-1693-7

CASE STUDY: COST-BENEFIT ANALYSIS FOR A NONPROFIT HOSPITAL CONSIDERING ADOPTING NEW TECHNOLOGY

As a part of proposed health care reform, the federal government is encouraging hospitals to use new health information technology as a means to reduce health care costs and increase quality of services. You are the CFO of a nonprofit hospital and need to conduct a cost-benefit analysis of the idea to present to the board. Being well trained in economic evaluation, especially cost-benefit analysis, you have happily accepted the challenge of this task. You have collected some relevant information. You know that the new system will enable the hospital staff to make more timely diagnoses and interventions, will reduce medical errors, and will improve communication within the care team. The initial start-up cost for your hospital is estimated to be $10 million, which includes planning, purchasing of information systems. (hardware and software), and staff training, among other things. You also estimate that the operating and maintenance cost of the new system will be about $1 million. After the system is implemented, the hospital is expected to benefit financially from cost savings and revenue enhancement. It is estimated that cash inflow will increase by $2.4 million. The information system will be obsolete in about ten years, and no residual value is expected. The improved quality of diagnosis and appropriate treatment will also have broader social and human consequences. Studies show that for hospitals similar in size to yours, the system has saved an average of two lives because of reduction of errors, plus a likely decrease in injuries and long-term disabilities to patients. Based on the information collected, and following the steps outlined above, you decide to study the matter from the perspectives of both the hospital financials and the larger social impact. In consultation with the CEO and other key personnel, you specify the current hospital status quo as the basis for comparison, which dictates that all costs and benefits are incremental from that of current practice of the organization. Working with your evaluation team, you identify key impacts, such as cost savings and increased revenue, to be included in the benefit accounting when studied from the hospital perspective. From the societal perspective, the benefit includes the lives saved. You search the literature and decide to use $7 million as the statistical value for a human life. You could borrow money, through municipal bond with the help of the local government, at the 4 percent real interest rate. You decide to use this as the discount rate in the analysis. You also decide to conduct a sensitivity analysis, in which you change the discount rate to 8 percent, in case you need to borrow from the financial markets directly. If the net present value of the analysis is positive at either discount rate, you will have more confidence of the robustness of the results. What do you find in your base case cost-benefit analysisthat is, from the hospital perspective and using 4 percent as the discount rate? Changing the discount rate to 8 percent, what is your conclusion in your sensitivity analysis? And what is the result if you conduct the cost-benefit analysis from the societal perspective under the 4 percent and the 8 percent discount scenarios? What is your recommendation to the CEO with regard to the adoption of the new system? It should be noted that this case is a simplified analysis of the very complex issue of hospital investment in adopting advanced health care information technology. For instance, there are many other costs and benefits that are not included in this study. We present this case here to give you practice in the step-by-step application of cost-benefit analysis in nonprofit organizations. The case is educational and illustrative in nature, and you are advised to delve deeper into other impacts of such a project on the hospital, the locality, and the society at large in the real application of this economic evaluation technique.

DISCUSSION QUESTIONS

1.Why is the concept of the time value of money important to a nonprofits fiscal health?

2.If you were an executive director of a social service agency offering several different programs to many disadvantaged groups, when would you use the concept of the time value of money?

3.Give examples of an annuity from your own experience. 4.If you were an executive director of a small nonprofit offering programmatic technical assistance to other nonprofits, when would you use cost-benefit analysis?