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Introduction Despite cost-standardization efforts, significant variations in hospital costs persist in insurance claims. We sought to identify and quantify factors driving cost variability at hospital and cost center levels following a complex gastrointestinal surgical procedure. Methods Individuals who underwent pancreatectomy (PA), colectomy (CO), and proctectomy (PR) were identified from the Surveillance, Epidemiology, and End Results database. Index surgery costs across 1,262 hospitals were compared, adjusting for clinical, demographic, and geographic factors. Multilevel regression modeling identified factors associated with variability in charges. Results Among 35,908 individuals (PA: 8.2%; CO: 79.4%; PR: 12.4%), the median age was 78 years (interquartile range [IQR] 72–84), with 56.1% male. Median Medicare payments varied significantly by cancer type (CO: $21,704, PA: $26,709, PR: $21,228; p < 0.001). Operating room ($6,891, 23.82%), hospital stay ($5,931, 20.9%), and professional fees ($4,352, 15.35%) were the top cost centers, comprising 60% of total costs. Surgeons had the highest charges (PA: $2,037; CO: $2,131; PR: $2,243), followed by anesthesiologists (PA: $622; CO: $431; PR: $480). Charges for critical care specialists and pathologists were relatively low. Multilevel modeling demonstrated total charge variability was primarily influenced by patient factors (83%), followed by surgeon factors (9%) and hospital factors (8%). Conclusions There was marked variation in spending at the cost center level in the surgical treatment of gastrointestinal cancers. Patient factors demonstrated the greatest variability, followed by hospital and surgeon-level factors. Implementing value-based healthcare and standardized surgical protocols may improve both care quality and cost-effectiveness.

CMS Hospital Quality Star ratings reflect the quality of care given to patients. It is hypothesized that increased Star-rating is associated with higher cost and that the value proposition is diminished. This study used the Florida AHCA inpatient dataset, CY2019. Partial colectomy was selected as a representative inpatient surgical procedure. Analysis was performed on this data to compare high and low Star-rated hospitals. Total costs were equivalent among all Star levels on initial analysis. In a propensity matched comparison with 1 Star, 5 Star hospitals had significantly lower length-of-stay and ICU, anesthesia, radiology and lab costs, and conversely, had higher total (+2%), operating room and med-surg supply costs. These results demonstrate that total colectomy costs are functionally equivalent among the CMS 1- and 5- Star categories. The results indicate that higher CMS Star ratings fulfill the value proposition and indeed offer higher quality without significantly increased cost. •The Centers for Medicare and Medicaid Services “Star” rating, typically seen as a proxy for quality, is also indicative of value of care delivered.

The highest costs were in three cost centers: medications (total hospital costs, median (interquartile range): intervention-$977 ($406-$2506); comparison-$913 ($354-$2489)); laboratory (intervention-$793 ($512-$1310); comparison-$770 ($477-$1279)),; and diagnostic radiology (intervention-$434 ($165-$821); comparison-$466 ($225-$826)). Implementation of sedation and delirium screening was not associated with changes in costs for these three main cost centers; implementation of the early mobilization was associated with reduction in ICU, but not hospital, medication costs.

How does the adoption of cloud computing by a firm affect the organizational structure of its information technology (IT) department? To analyze this question, we consider an IT department that procures IT services from a cloud computing vendor and enhances these services for consuming units within the firm. Our model incorporates the competitive environment faced by the cloud vendor, which affects the price of the cloud vendor. We find that when the cloud vendor faces intense competition, the cost-center organizational model is preferred over the profit-center model. Infrastructure services such as basic storage, e-mail, and raw computing face intense competition, and our results suggest that such services be offered as a free corporate resource under the cost-center organizational structure. When the cloud vendor has pricing power, a profit-center organizational structure is likely to be preferred. Our results suggest that highly differentiated services such as cloud-based enterprise-wide enterprise resource planning or business intelligence be offered under the profit-center structure. Finally, the profit-center structure provides greater internal quality enhancement to cloud-based IT services than the cost center.

PurposeBuilding information modelling (BIM) claims to be spearheading the modern technological revolution in the global construction industry. While scholars have emphasised the cruciality of BIM, associated costs have been identified as one of the major barriers to successful BIM implementation, as is the case in Sri Lanka. Besides, lean principles (LPs) are known for increasing efficiency, quality and eliminating waste, thereby reducing overall costs. Hence, this research aims at addressing the BIM implementation barrier associated with costs by applying suitable LP, enhancing overall value by minimising value-insignificant activities.Design/methodology/approachThe study adopted a qualitative research approach. 10 experts with expertise in both BIM and LP were targeted for the primary data collection through semi-structured interviews. The collected data were analysed using manual content analysis.FindingsResearch findings discovered the cost centres that can be applied to the LPs and the effective LPs that can be applied with the cost centres of BIM implementation. The theoretical implication of the study is to provide insights into a potential application of LP for BIM cost centres, whereas practical consequences include the identification of LP's potential to minimise BIM cost centres, ergo, achieving a successful BIM implementation.Originality/valueThis study will be the first of its kind in the Sri Lankan construction industry, intending to apply LP with BIM implementation cost centres to achieve a successful implementation. This research also has paved the way forward for further research on the application of both the BIM and LP concepts for similar construction industries in developing countries across the world and in addressing other BIM implementation barriers.

We surveyed 56 Ebola treatment centers (ETCs) in the United States and identified costs incurred since 2014 ($1.76 million/ETC) and sustainability strategies. ETCs reported heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.

According to modern management theory, the performance evaluation based entirely on objective indicators within an organization is not considered to be an effective tool. The research objective of this paper is to suggest a contemporary model for evaluation in the budgetary control process of the organization. The model is based on a modern evaluation approach and a complex toolkit of management science and mathematical theories of fuzzy sets and fuzzy logic. In this model, subjective evaluations of the responsibility centres’ achievement and performance in budgetary control are generated by fuzzy techniques based on a combination of quantitative and qualitative indicators. The model also allows for an immediate transformation of quantitative into qualitative evaluations and vice versa both in fuzzy and crisp types. The proposed model is an appropriate tool for the subjective performance evaluation of objective results from the organization’s budgetary control process under uncertainty. This model was tested in a Bulgarian enterprise for unique wood furniture manufacturing in July 2018 and was applied to five cost centres, with the results demonstrating its applicability. According to our study, the model provides a modern solution to a management problem that is unresolved in the scientific literature and is important to the budgetary management practice of organizations. We believe that the further improvement and implementation of the model will contribute to more effective management and thus to the enhancing competitiveness of the organization.

Introduction: For the Commonwealth Games 2010, Jai Prakash Narayan Apex Trauma Centre (JPNATC) of India had been directed by the Director General Health Services and Ministry of Health and Family Welfare, Government of India, to set up a specialized unit for the definitive management of the injured/unwell athletes, officials, and related personnel coming for the Commonwealth Games in October 2010. The facility included a 20-bedded fully equipped ward, six ICU beds with ventilator capacity, one very very important person observation area, one perioperative management cubicle, and one fully modular and integrated operating room. Objective: The objective of this study was to calculate the cost of disaster facility at JPNATC, All India Institute of Medical Sciences, New Delhi. Methodology: Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of these services by this facility. Results: The annual cost of providing services at disaster facility at JPNATC, New Delhi, was calculated to be INR 61,007,334.08 (US$ 983,989.258) while the per hour cost was calculated to be INR 7061.03 of the total cost toward the provisioning of services by disaster facility where 26% was the capital cost and 74% was the operating cost. Human resource caters to maximum chunk of the expenditures (47%). Conclusion: The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 62 in the year 2013).

This paper presents an analysis of energy use and sector coupling in a local energy community using a model based on energy cost centres (ECCs), functional units for decentralised responsibility and optimisation of energy use within defined system boundaries. The ECC model enables structured identification and optimisation of energy and material flows in complex industrial and urban settings. It was applied to a case study involving an energy-intensive steel plant and its integration with the surrounding community. The study assessed the potential for renewable electricity production (7914 MWh annually), green hydrogen generation, battery storage, and the reuse of 11,440 MWh of excess heat. These measures could offset 9598 MWh of grid electricity through local production and savings, reduce natural gas use by 4,116,850 Nm3, and lower CO2 emissions by 10,984 tonnes per year. The model supports strategic planning by linking sectoral actions to measurable sustainability indicators. It is adaptable to data availability and stakeholder engagement, allowing both high-level overviews and detailed analysis of selected ECCs. Limitations include heterogeneous data sources, uneven stakeholder participation, and the need for refinement of sub-models. Nonetheless, the approach offers a replicable framework for integrated energy planning and supports the transition to sustainable, decentralised energy systems.

The pipe production process is a complex dynamical system with a significant number of production operations and interconnected cost localization centres. Purpose. To develop a mathematical model of the process of handling analytical information of a pipe enterprise using graph theory for the needs of cost management at each production stage. Methodology. Technological flow charts of the production job, where the list of mandatory activities and routing of the operating process are indicated, were used to organize cost accounting by operational centres of their localization with the help of computer modelling elements, namely the graph theory. The work used a complex of research methods, including analysis and scientific synthesis of scientific and technical information; theoretical studies; methods of mathematical and computer modelling, engineering developments. Findings. The cost accounting process is represented by a directed hypergraph. Each production operation is associated with a graph vertex. Each vertex is assigned to a series of interrelated marks: type of technological operation; weight factor; the value of direct costs for the operation; the value of indirect costs for the operation; the expense factor. The initial state of the hypergraph is specified by means of its initial marking, which corresponds to the set cipher of the batch of pipes and its weight. Further execution of the marked hypergraph is performed by running the allowed vertices. Marking of the graph ends if all the information from the technological flow charts of pipe products has been used. Originality. A model of cost management by operational centres is proposed which will allow dividing the prime cost of pipes which differ according to the production technology. It is recommended to rank pipe products within each technologically similar group for an economically feasible allocation of costs between batches of pipes. The proposed process model of processing analytical information of the pipe enterprise using graph theory will allow providing data governance as for the prime cost of each individual batch of pipe products, will contribute to the improvement in the order generation procedure taking into account the acquired information, and will allow making the appropriate adjustments when making management decisions. Practical value. Calculation of expenses for production operations allows one to identify the most cost-intensive of them. Relying on the results of the calculation, the enterprise management has the opportunity to manage costs at any stage of the production process. Moreover, the model allows determining the amount of consumed metal for each production operation, which is relevant for pipe enterprises. It is appropriate to focus further scientific developments in this direction on the possibility of managing non-manufacturing cost with the help of mathematical models in economics to optimize the supply and sales activities of the enterprise.