Question

Elmo Clinic has identified three activities for daily maternity care: occupancy and feeding, nursing, and nursing supervision. The nursing supervision oversees 150 nurses, 25 of whom are maternity nurses (the other nurses are located in other care areas such as emergency room and intensive care). The nursing supervisor has three assistants, a secretary, several offices, computers, phones, and furniture. The three assistants spend 75% of their time on the supervising activity and 25% of their time as surgical nurses. They each receive a salary of $60,000. The nursing supervisor has a salary of $80,000. She spends 100% of her time supervising. The secretary receives the salary of $35,000 per year. Other costs directly traceable to the supervisory activity (depreciation, utilities, phone, etc.) average $170,000 per year.

Daily care output is measured as “patient days.” The clinic has traditionally assigned the cost of daily care by using a daily rate (a rate per patient day). Daily rates can differ between units, but within units the daily rates are the same for all patients. Under the traditional approach, the daily rate is computed by dividing the annual costs of occupancy and feeding, nursing, and a share of supervision by the unit’s capacity expressed in patient days. The cost of supervision is assigned to each care area based on the number of nurses. A single driver (patient days) is used to assign the costs of daily care to each patient.

A pilot study has revealed that the demands for nursing care vary within the maternity unit, depending on the severity of a patient’s case. Assume that the maternity unit has three levels of increasing severity: normal patients, cesarean patients, and patients with complications. The pilot study provided the following activity and cost information:

Activity                                            Annual Cost                     Activity Driver                                Annual Quantity

Occupancy and Feeding               $1,500,000                       Patient days                                    10,000

Nursing Care (maternity)             $1,200,000                       Hours of nursing care                  50,000

Nursing Supervision                                        ?                       Number of nurses                                  150

The pilot study also revealed the following information concerning the three types of patients and their annual demands:

Patient Type                                                 Patient Days Demanded                           Nursing Hours

Demanded

Normal                                                           7,000                                                              17,500

Cesarean                                                       2,000                                                              12,500

Complications                                              1,000                                                              20,000

Total                                                               10,000                                                           50,000

Required:

1. Calculate the maternity cost per patient day by using a functional-based approach. This is a traditional approach that costs maternity cases by patient day as a whole based on the total cost of maternity care.
2. Calculate the cost per patient day by using an activity-based approach. (Round rates and unit cost to two decimal places.) Assume two cost pools: occupancy and feeding and nursing care. Determine the cost per patient day by type of patient.
3. The hospital processes 1,250,000 pounds of laundry per year. The cost of laundering activity is $600,000 per year. In a functional-based cost system, the cost of the laundry department is assigned to each user department in proportion to the pounds of laundry produced. Typically, maternity produces 240,000 pounds per year. How much would this change the cost per patient day calculated in Requirement 1? Now, describe what information you would need to modify the calculation made in Requirement 2. Under what conditions would this activity calculation provide a more accurate cost assignment?

Answer 1

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