Title: Section 444.21 - Other operating expenses description

444.21 Other operating expenses description. (3280)

(a) Research Expenses (3281)

(1) 8010 RESEARCH. (i) Function. This cost center administers, manages, and carries on research projects funded by outside donations, grants and/or the hospital. Additional activities include: Maintenance of animal house and administration of specific research projects.

(ii) Description. This cost center contains the direct expenses incurred in overseeing all research and in carrying on research in the hospital. Separate cost centers should be maintained for each research activity for which separate accounting is required, either by a grant agreement, contract, or because of restrictions made upon donations. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(b) Education Expense (3282)

(1) 8220 NURSING EDUCATION

8221 Registered Nurses

8222 Licensed Vocational (Practical) Nurses

(i) Function. Hospitals may either operate a School of Nursing or provide the clinical training activities for student nurses when the degree is issued by a college or university. Nursing Education is a school for educating Registered Nurses and/or Licensed Vocational (Practical) Nurses. Additional activities include, but are not limited to, the following:

Selecting qualified nursing students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems; selecting faculty personnel; assigning and supervising students in giving nursing care to selected patients; and administering aptitude and other tests for counseling and selection purposes.

(ii) Description. This cost center shall be used to record the direct expenses incurred in, or providing clinical facilities for, the education of Registered Nurses and/or Licensed Vocational (Practical) Nurses. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: number of FTE nursing students. The number of FTE nursing students in the Nursing Education cost center is defined as the sum of the percentage of time each student nurse is enrolled in the school during the year divided by 100.

(iv) Data source. The number of FTE nursing students in this educational program shall be the actual count maintained by the Nursing Education cost center.

(2) 8240 POSTGRADUATE MEDICAL EDUCATION--APPROVED

PRIMARY TEACHING PROGRAM--INTERNAL MEDICINE

8250 POSTGRADUATE MEDICAL EDUCATION--APPROVED

PRIMARY TEACHING PROGRAM--FAMILY PRACTICE

8260 POSTGRADUATE MEDICAL EDUCATION--APPROVED

PRIMARY TEACHING PROGRAM--PEDIATRICS

8270 POSTGRADUATE MEDICAL EDUCATION--OTHER

APPROVED TEACHING PROGRAMS

(i) Function. A Postgraduate Medical Education Teaching Program provides an organized program of postgraduate medical clinical education to interns and residents. To be approved, a medical internship or residency training program must be approved by the Council on Medical Education of the American Medical Association or, in the case of an osteopathic hospital, approved by the Committee on Hospitals of the Bureau of Professional Education of the American Osteopathic Association. Intern or residency programs in the field of dentistry in a hospital or osteopathic hospital must have the approval of the Council on Dental Education of the American Dental Association. Additional activities include, but are not limited to, the following:

Selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems; and assigning and supervising students.

(ii) Description. This cost center shall be used to record the direct expenses incurred in providing an approved organized program of postgraduate medical clinical education. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers. All salaries and stipends paid to interns and residents in approved teaching programs must be reflected in this cost center, in the "Salaries and Wages" natural expense classification (.07).

(iii) Standard Unit of Measure: number of FTE students. The number of FTE students in Postgraduate Medical Education Approved programs is defined as the sum of the percentage of time each student is enrolled in such programs during the year divided by 100. (iv) Data source. The number of FTE students in these educational programs shall be the actual count maintained in each such program.

(v) Effective dates. For the reporting of accounts 8240 through 8270, relative to approved teaching programs, cost reporting periods beginning on or after January 1, 1981. The Standard Unit of Measure (FTE students) for accounts 8240 through 8260 must be collected beginning July 1, 1981. For cost reporting periods beginning in 1980, report all Approved Postgraduate Medical Education programs (including the Standard Unit of Measure) under account 8270.

(8) 8280 POSTGRADUATE MEDICAL EDUCATION--NON-APPROVED TEACHING PROGRAM (i) Function. A Postgraduate Medical Education program provides an organized program of postgraduate medical clinical education to interns and residents. To be non-approved means that a medical internship or residency training program is not approved by the Council on Medical Education of the American Medical Association or, in the case of an osteopathic hospital, is not approved by the Committee on Hospitals of the Bureau of Professional Education of the American Osteopathic Association. Intern or residency programs in the field of dentistry in a hospital or osteopathic hospital are non-approved unless the approval of the Council on Dental Education of the American Dental Association has been received. Additional activities include, but are not limited to, the following: Selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems, and assigning and supervising students.

(ii) Description. This cost center shall be used to record the direct expenses incurred in providing an organized program of postgraduate medical clinical education. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers. All salaries or stipends paid to interns and residents in non-approved teaching programs must be reflected in this cost center, in the "Salaries and Wages" natural expense classification (.07).

(iii) Standard Unit of Measure: number of FTE students. The number of FTE students in Postgraduate Medical Education Non-Approved programs is defined as the sum of the percentage of time each student is enrolled in such programs during the year divided by 100.

(iv) Data source. The number of FTE students in these educational programs shall be the actual count maintained by each such program.

(4) 8290 OTHER HEALTH PROFESSION EDUCATION

8291 School of Medical Technology

8292 School of X-Ray Technology

8293 School of Respiratory Therapy

8294 Administrative Intern Program

8295 Medical Records Librarian Program

(i) Function. Other Health Profession Education is the provision of organized programs of medical clinical education other than for nurses (RN and LVN) and doctors, and the provision of organized education programs for administrative interns and externs, Medical Records Librarians, and other health professionals. Additional activities include, but are not limited to, the following:

Selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems; selecting faculty personnel; assigning and supervising students in giving medical care to selected patients; and administering aptitude and other tests for counseling and selection purposes.

(ii) Description. These cost centers contain the direct expenses relative to operating health education programs other than nursing and postgraduate medical programs, such as a School of Medical Technology, School of X-Ray Technology, School of Respiratory Therapy, and other non-inservice education programs such as those listed above. A separate cost center should be established for each program. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: number of FTE students. The number of FTE students in Other Health Profession Education programs is defined as the sum of the percentage of time each student is enrolled in an Other Health Profession Education Program during the year divided by 100.

(iv) Data source. The number of FTE students in such programs shall be the actual count maintained by each such program. (c) General Services. (3283)

(1) 8310 DIETARY SERVICES (i) Function. Dietary Services includes the procurement, storage, processing and delivery of food and nourishments to patients in compliance with Public Health regulations and physicians' orders. Additional activities include, but are not limited to, the following:

Nutritional assessment;

Teaching patients and their families nutrition and modified diet requirements; determining patient food preferences as to type and method of preparation; preparing selective menus for various specific diet requirements; preparing or recommending a diet manual, approved by the medical staff, for use by physicians and nurses; and delivering food trays to, and collecting food trays from, patient service areas for meals and nourishments; and incidental activities such as cleaning up of spills in preparing food.

(ii) Description. This cost center contains the direct expenses incurred in preparing food for patients and delivering food to patient service areas. Infant formula must be reported in the using cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, and other direct expenses. Also included is Dietary Service's share of common costs of the Non-Patient Food Service and Dietary Services cost centers.

Examples of common costs include: salaries of cooks who prepare food for both cost centers, common food costs, common minor equipment costs, if expensed, common administrative costs, etc. These common costs shall be distributed to the Dietary and Non-Patient Food Service cost centers, based upon the ratio of number of meals served in each cost center. A detailed explanation of the method to be used in computing the number of non-patient meals served by the Non-Patient Food Service cost center is included in the explanation of the Non-Patient Food Service Standard Unit of Measure.

(iii) Standard Unit of Measure: number of patient meals. Count only regularly scheduled meals (3-meal schedules only) and exclude snacks and fruit juices served between regularly scheduled meals. Also excluded are tube feedings and infant formula.

(iv) Data source. The number of patient meals must be the actual count of patient meals maintained by the Dietary cost center.

(2) 8320 NON-PATIENT FOOD SERVICE (i) Function. Non-Patient Food Service includes the procurement, storage, processing and delivery of food to employees and other non-patients in compliance with Public Health regulations.

(ii) Description. This cost center contains all directly identifiable expenses incurred in preparing and delivering food to employees and other non-patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, and other direct expenses. Also included is the Non-Patient Food Service's share of common costs of the Non-Patient Food Service and Dietary Services cost centers. The cost of edible supplies for vending machines serviced by the health facility must be included in this cost center. Vending machine revenue is to be included in other operating revenue account 5820 (Vending Machine Commissions).

(iii) Standard Unit of Measure: equivalent number of meals served. To obtain an equivalent meal in a pay cafeteria, divide total Non-Patient Food Service revenue by the average selling price of a full meal. The average full meal should include meat, potato, vegetable, salad, beverage and dessert. When there is a selection of entrees, desserts and so forth, that are available at different prices, use an average in calculating the selling price of a full meal. Count a free meal served as a full meal.

(iv) Data source. Non-Patient Food Service revenue must be taken from the general ledger.

(3) 8330 LAUNDRY AND LINEN (i) Function. Laundry and Linen activities include picking up, storing, issuing, mending, washing, distributing and processing of in-service linens. The services include uniforms, special linens and disposable linen substitutes.

(ii) Description. This cost center shall contain the direct expenses incurred in providing laundry and linen services for hospital use, including student, nonpaid worker, and employee quarters. Cost of disposable linen must be recorded in this cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: number of dry and clean pounds processed. Record the weight of linen processed (laundered and dried) plus the equivalent weight of disposable linen substitutes used. Linen is weighed after it has been cleaned and processed. Include uniforms and linen from personnel quarters and employee housing. If linen is not weighed, a conversion from pieces to pounds is allowed. If soiled linen is weighed, divide by 1.1. (iv) Data sour ce. The number of dry and clean pounds processed (laundered and dried) must be taken from actual counts maintained in the Laundry and Linen cost center. If the hospital uses an outside laundry service, the number of dry and clean pounds processed must be maintained and reported.

(4) 8350 SOCIAL SERVICES (i) Function. The Social Work Services cost center obtains, analyzes, and interprets psychosocial, environmental and economic information to assist in diagnosis, treatment and rehabilitation of patients. These services include: counseling of patients an families in individual and group units; collaboration with health care staff; mobilizing resources on behalf of patients both within a given hospital and in various agencies outside the hospital; and participation in the development of social and health programs in the community. Other tasks involve collecting and revising information on community health and welfare resources, departmental management and being accountable to responsible external organizations. Major activities include but are not limited to: screening, which is the process whereby a determination is made concerning the necessity for further professional assessment and services; assessment (including family members or significant others), which is the explication of a patient's problem or problems and the initial determination of a course of action for resolving the problem or problems; and the provision of problem-focused services (such as dealing with psychosocial problems as they relate to a patient's health and/or hospitalization, and arranging for post-discharge care of patients), which are directed toward the resolution of identified problems.

(ii) Description. This cost center contains the direct expenses incurred in providing social services to patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(5) 8360 HOUSING

8361 Employee Housing

8362 Nonpaid Worker Housing

8363 Student Housing

(i) Function. Housing is the provision of living quarters to hospital employees and nonpaid workers; and maintenance of residences for students, including interns and residents, participating in education programs carried on by the hospital.

(ii) Description. This cost center shall contain the direct expenses incurred in providing living quarters for hospital employees, nonpaid workers, and students involved in educational programs carried on by the hospital. Expenses of on-call rooms shall be included in this cost center only if they are not directly identifiable to another cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: average number of persons housed. Record the number of days each person is in the facility. Accumulate the monthly totals and divide by 12 to obtain the average number of persons housed.

(iv) Data source. The average number of persons housed shall be determined from the record of employees housed maintained in the Housing cost center.

(6) 8410 PLANT OPERATIONS AND MAINTENANCE

8410 Plant Operations

8412 Plant Maintenance

8413 Grounds

(i) Function. Plant Operations and Maintenance includes the maintenance and service of utility systems such as heat, light, water, air conditioning and air treatment; the maintenance and repair of buildings, parking facilities, and equipment; painting; elevator maintenance; vehicle maintenance; performance of minor renovation of buildings and equipment; and maintenance of grounds of the institution, such as landscaped and paved areas, streets on the property, sidewalks, fenced areas and fencing, external recreation areas, and parking facilities. Additional activities include, but are not restricted to, the following:

Trash disposal; boiler operation and maintenance; service and maintenance of water treatment facilities, drainage systems and utility transmission systems. Including all maintenance performed under contract; technical assistance on equipment purchases and installation; coordinating construction; establishing priorities for repairs and utility projects.

(ii) Description. This cost center shall contain the direct expenses incurred in the operation and maintenance of the hospital plant and equipment except the maintenance, repair and renovation of renal dialysis equipment used for Home Dialysis for which the hospital has been 100 percent reimbursed by Medicare. Such costs must be reported in the Home Program Dialysis Equipment--100 Percent cost center (account 6810). Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, utilities (except telephone and telegraph), other direct expenses and transfers. (iii) Standard Unit of Measure: number of gross square feet. Gross square feet is defined as the total interior floor area of the hospital facility, including common areas (hallways, stairways, elevators, lobbies, closets, etc.), measured to the center of interior walls.

(iv) Data source. The number of gross square feet shall be taken from current blueprints of the hospital facility, or from actual measurement in blueprints are not available.

(v) Expiration date. This cost center will be replaced by account 8400 (Plant Maintenance) and account 8410 (Plant Operation) effective with cost reporting periods beginning in 1982.

(7) 8400 PLANT MAINTENANCE

(i) Description. Maintenance and repair of buildings, grounds and fixed equipment; painting; vehicle operation (except operation of ambulances) and maintenance; care of grounds; and performance of minor renovations of buildings, fixed equipment, grounds, drainage systems and utility transmission systems, including all such maintenance performed under contract. Also included are expenses associated with technical assistance on equipment purchases and installations; coordinating construction; establishing priorities for repairs and utility projects; and operation, service and repair of parking lots. Exclude the costs of maintenance, repair and renovation of renal dialysis equipment used for Home Dialysis for which the hospital has been 100 percent reimbursed by Medicare. Such costs must be reported in the Home Program Dialysis Equipment--100 Percent cost center (account 6810). Examples of Job titles include chief engineer, stationary engineer, carpenter, plumber, electrician, painter, dispatcher, driver, groundskeeper, plasterer, parking lot attendant, guard, mechanic, electromedical equipment repairman, clerk and secretary.

(ii) Standard Unit of Measure: gross square feet. Gross square feet is defined as the total interior floor area of the hospital facility, including common areas.

(iii) Data source. Square feet shall be determined from the blueprints of the hospital facility, or actual measurement in blueprints are not available.

(iv) Effective date. Cost reporting periods beginning 1982 and thereafter.

(8) 8410 PLANT OPERATION

(i) Description. Maintenance and service of utilities, such as heat, light, water, air conditioning and air treatment; trash disposal; hourly operation and maintenance; service and maintenance of water treatment facilities and drainage systems. Examples of job titles include: director of plant operations, foreman, elevator operator, tool crib operator, incinerator and mechanic. This cost center also includes the direct expense of utilities such as: electricity, natural gas, liquid propane or butane gas, oil coal, purchased steam and hot water and water and sewage. Telephone and telegraph service are not considered utilities but are included in the Hospital Administration cost center (account 8610).

(ii) Standard Unit of Measure: gross square feet. Gross square feet is defined as the total interior floor area of the hospital facility, including common areas.

(iii) Data source. Square feet shall be determined from the blueprints of the hospital facility, or actual measurement if blueprints are not available.

(iv) Effective date. Cost reporting periods beginning in 1982 and thereafter.

(9) 8430 SECURITY (i) Function. The Security cost center maintains the safety and well-being of hospital patients, personnel and visitors, and protects the hospital's facilities.

(ii) Description. This cost center shall include the direct expenses incurred maintaining the safety and well-being of hospital patients, employees, visitors, and protection of the hospital facilities. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(10) 8440 PARKING (i) Function. Parking includes the provision of parking facilities to patients, physicians, employees and visitors.

(ii) Description. This cost center shall contain the direct expenses of parking facilities owned and/or operated by the hospital. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(11) 8450 HOUSEKEEPING (i) Function. This cost center is responsible for the care and cleaning of the interior physical plant, including