Multispecialty hospitals · Healthcare
Package-level cost for multispecialty hospitals, before the next payer rate is signed
A multispecialty hospital agrees package rates with insurers, government schemes and corporates long before it knows what those cases cost to treat. We cost the packages that drive volume from bed days, theatre time, consumables and doctor fees. Each payer rate can then be tested before it is signed.
In one paragraph
Multispecialty hospitals of 100–500 beds, usually at ₹50–600 crore turnover, treat a mix of cash, insured, corporate and government-scheme patients. The same procedure can be billed at several rates depending on who pays. Its cost, meanwhile, is set by length of stay and what was used on the ward and in theatre. Promoters, chief executives and finance heads, often with the medical superintendent, have to manage both sides.
Promoter or chief executive, often with the finance head and medical superintendent
The economics
How the money moves in this trade
A multispecialty hospital bills cash patients item by item and most insured, corporate and scheme patients by package. A package fixes the price of a procedure, including a set length of stay. Every extra day, complication or high-value consumable comes out of the hospital's margin. Ayushman Bharat PM-JAY and CGHS publish their own package rates, and ECHS pays its empanelled private hospitals at CGHS rates. Insurers negotiate tariffs that differ by hospital and by policy.
Costs are largely fixed and shared. Beds, nursing, theatres, imaging and support services serve every specialty at once, so occupancy and case mix decide profitability more than any single price. Average revenue per occupied bed and average length of stay are watched closely. They are rarely linked to what each payer actually pays for the cases it sends.
The problem
Where the numbers usually break down
Packages are priced without a cost
Package rates are agreed by comparing with other hospitals or the payer's schedule, not with what the hospital's own cases cost, so some high-volume packages lose money on every admission.
Length of stay overruns are not costed
Package cases that stay beyond the included days are tracked clinically, not financially, so the cost of overruns by procedure and consultant is unknown.
Scheme and corporate dues are mixed together
Government-scheme, public-sector and corporate receivables sit in one ledger, each with different submission rules and settlement timelines, so ageing tells nobody which payer to chase.
Consumables are charged inconsistently
High-value consumables used in package cases are issued from stores but not always captured against the patient, so they disappear into ward cost.
New blocks and equipment are approved on gross revenue
Capital spending on a new wing, a cath lab or an MRI is justified on projected revenue without the occupancy, payer mix and package rates that will apply to it.
What we do
The work, and the result each part produces
Package costing for high-volume procedures
Bed days, theatre minutes, consumables, investigations, drugs and doctor fees costed for the packages that drive most admissions.
Each package shows its margin by payer.
Payer-rate testing
Proposed insurer, corporate and scheme rates compared with package cost and recent case mix before agreement.
Tariff negotiations start from the hospital's own numbers.
Length-of-stay variance
Actual against included days reported by package, consultant and payer, valued at the cost of each extra day.
Stay overruns become a cost someone can manage.
Receivables by payer class
Scheme, corporate, public-sector and insurance dues aged separately, with submission status, queries and deductions tracked by case.
Collection effort goes to the payer and the case that need it.
Consumable capture in package cases
Store issues reconciled with patient charges and package inclusions, with uncaptured items reported by ward.
High-value consumables are charged or knowingly absorbed.
Capital project appraisal
New blocks and major equipment appraised on expected occupancy, payer mix and package rates, with a ramp-up period.
Capital decisions rest on the revenue the hospital will actually receive.
Where we start
The first steps of an engagement
HIS billing and payer files
We ask for HIS billing data by admission, the package master with each payer's rates and inclusions, TPA and scheme claim ledgers, store issues to wards and theatres, and doctor fee schedules.
Cost of the highest-volume packages
We cost the packages that make up most admissions from bed days, theatre minutes, consumables, investigations and doctor fees. Each is set against what every payer pays for it.
Receivables split by payer class
Scheme, corporate, public-sector and insurance dues are split into separate ledgers. Each is aged, with submission status, queries and deductions tracked by case.
Package margin by payer report
The first report shows margin on the high-volume packages by payer, stays beyond the included days valued at cost, and receivables by payer class and age.
How it is measured
The reports the work is judged on
Each is recorded as a baseline before the work starts, so later reports have an honest comparison.
- Package margin by payer and procedure
- Average revenue per occupied bed, by payer class
- Length of stay against package inclusions
- Receivables by payer class and age
- Consumables issued against consumables charged
- Occupancy and contribution by specialty
Who it suits
Written for, and not the right fit for
- You need help with clinical establishment registration, NABH accreditation or scheme empanelment; those are your responsibility with the relevant authorities.
- You need the hospital's statutory audit or tax-audit report signed — that is the work of an independently engaged CA.
- Multispecialty hospitals with a significant share of insured and scheme patients.
- Promoter-run hospitals adding a block, a specialty or a second facility.
- Hospitals preparing for investment, a bank renewal or a payer-rate renegotiation.
Services
Services this work draws on
Costing and profitability
What each product, line and customer really contributes.
Explore service ↗MIS and financial planning
Reporting built around the questions you actually need answered.
Explore service ↗Internal controls and risk
Controls sized to your business, documented and actually tested.
Explore service ↗Fractional CFO services
Senior financial leadership on the days you need it, not a full-time hire.
Explore service ↗Every other service, also available in this trade
Common questions
Questions owners in this trade ask
Does every hospital package need to be costed?
Not all at once, and not all of them. The twenty or thirty packages that make up most admissions are where the money is, and costing those first gives you most of the answer.
Will doctors accept a length-of-stay report?
It works best when it's presented as a cost of the package, not a judgement on clinical decisions. Clinical judgement stays with the doctors; the report simply shows what each extra day costs.
Do you help with NABH or scheme empanelment?
No. Accreditation, registration and empanelment are your responsibility with the relevant bodies. We handle the finance side — costing, receivables, controls and reporting.
5th Quadrant performs costing, receivables, reconciliation, control and reporting work. Clinical decisions, clinical establishment registration, NABH accreditation and scheme empanelment are the hospital's own responsibility with the relevant authorities and bodies. Statutory audit and tax-audit reports are performed by independently engaged licensed professionals. Full detail is on our Professional Scope page.
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