"Expense" is an accounting concept. The term means the outflow or other using up of an entity's assets, or incurrence of liabilities (or a combination of both), from delivering or producing goods, rendering services, or carrying out other activities that constitute the entity's ongoing major or central operations. Thus, it is our view that HCFA's study and rule-making methods about this fundamental accounting concept should be rooted firmly in basic accounting principles if those methods purport to provide decision makers with a proper basis for sound policy decisions.
The following information is provided about basic accounting principles we considered in developing our critique.
Cost Accounting
In his book, Essentials of Cost Accounting For Health Care Organizations, Steven A. Finkler, PhD, CPA, notes that cost accounting has become an essential part of health care management. Also, Dr. Finkler states that "from a narrow perspective, cost accounting is an element of financial management that generates information about the costs of an organization and its components. As such,cost accounting is a subset of accounting in general; accounting generates financial information for decision making."
The fundamental theory behind cost accounting is the identification of resources consumed in the production/provision of goods or services and the corresponding costs (e.g., direct and indirect expenses) of those resources. The allocation and reporting of these costs represents an entity's cost accounting system. Defining and appr opriately allocating and reporting these costs are essential factors for a successful system. In healthcare, the final "product" is the treatment provided to a patient; thus, the cost accounting system must be able to identify and allocate the actual costs of resources used at the procedural level in treating patients.
Essential Qualities of Accounting Information for Decision Makers
Statement of Financial Accounting Concepts No.2, Qualitative Characteristics of Accounting Information, promulgated by the Financial Accounting Standards Board (FASB) -- the principal accounting standard setting body in the United States -- states that "in the last analysis, each decision maker judges what accounting information is useful, and that judgment is influenced by factors such as the decisions to be made, the methods of decision making to be used, the information already possessed or obtainable from other sources and the decision maker's capacity (alone or with professional help) to process the information.
Relevance and reliability are described in the Statement as the two primary qualities that make a ccounting information useful fordecision making. Comparability, which includes consistency, is a secondary quality that interacts with relevance and reliability to contribute to the usefulness of the information. The Statement provides further clarification of these concepts:
- Relevant accounting information is capable of making a difference in a decision by helping users form predictions about the outcomes of past, present and future events [predictive value], or to confirm prior expectations [feedback value].
- Timeliness, that is, having information available to decision makers before it loses its capacity to influence decisions, is an ancillary aspect of relevance.
- Reliability rests upon the extent to which the accounting description or measurement is verifiable and representationally faithful. Neutrality of information also interacts with those two components of reliability to affect the usefulness of the information.
- Verifiability is a quality that may be demonstrated by securing a high degree of consensus among independent measurers using the same measurement methods.
- Representational faithfulness refers to the correspondence or agreement between accounting numbers and the resources or events those numbers purport to represent.
- Neutrality means that, in formulating or implementing standards, the primary concern should be the relevance and reliability of the information that results, not the effect that the new rule may have.
- Information about a particular enterprise gains greatly in usefulness if it can be compared with similar information about other enterprises and with similar information about the same enterprise for some other period or some other point in time. Comparability between enterprises and consistency in the application of methods over time increases the informational value of comparisons of relative economic opportunities or performance.
The Federal Government has also developed guidelines about cost accounting in its Cost Accounting Standards (CAS), the purpose of which are to establish rules for government contractors to use in accounting for and reporting of costs to the Federal Government.
The fundamental concepts of CAS require that an organization's cost accounting practices used in estimating costs for a proposal to the Govern ment must be consistent with the actual cost accounting practices regularly used by the organization in accumulating and reporting costs. Further, consistency in the application of cost accounting practices is necessary to enhance the likelihood that comparable transactions are treated alike. The CAS states that the consistent application of cost accounting practices will facilitate the preparation of reliable cost estimates.
As such, the Government's cost accounting standards explicitly adopt several of the fundamental accounting concepts for decision making as prescribed by the FASB.