The ambulatory care division of an integrated health system is evaluating its four departments, a multidisciplinary physician practice, a same day surgery center, an outpatient clinic, and a home health practice, to determine if it is maximizing the value of health care services it could provide under its $6,800,000 budget. All four departments are operating at their current level and each manager has been told to create budgets including revenues, expenses, and number of patients to be used to determine if their budget is increased and decreased. Substantial changes in patient volumes have been seen with a large increase in demand for same day surgery and a modest decline in the outpatient clinic. The output measure the departments will be evaluated and ranked on is revenue generated per dollar of expense. The health system recognizes that the outpatient clinic although generating less revenue than its expenses provides an outlet for the emergency room and has estimated that two of every five clinic patients would end up at the emergency room and generated substantial uncompensated costs. Avoided ER costs are included as a benefit (revenue) of the clinic to recognize its contribution to the health system.

Using the spreadsheet below (Problem 8.1),

-Calculate the revenue/expense ratios for all the decision packages and rank them from highest to lowest.

-Create a zero-base budget assuming a budget constraint of $6,800,000, should any departments be expanded or contracted?

-How many patients can be served under the ZBB versus the current budget?

Problem 8.1
	Minimal	Current	Expanded
Multispecialty Physician Practice	A1	A2	A3
Revenue	$1,574,400	$345,000	$380,000
Expense	$1,200,000	$300,000	$370,000
Patients	16,320	2,880	3,840
Same Day Surgery	B1	B2	B3
Revenue	$1,987,200	$468,000	$336,200
Expense	$1,280,000	$320,000	$320,000
Patients	4,416	1,104	828
O/P Clinic	C1	C2	C3
Revenue	$287,900	$60,580	$28,430
Avoided ER Cost	$676,800	$133,300	$62,540
Expense	$940,000	$208,000	$195,200
Patients	5,480	1,210	570
Home Health	D1	D2	D3
Revenue	$2,300,000	$492,000	$435,000
Expense	$2,000,000	$488,000	$530,200
Patients	48,000	10,000	8,700
Total Budget	$6,800,000