Gotham City Hospital is unionized. In 20X6, nurses received an average annual salary of $45,000.

The
hospital administrator is considering changes in the contract with nurses for 20X7. In turn, the
hospital may also change the way it charges nursing costs to each department. The hospital holds
each department accountable for its financial performance, and it allocates revenues and expenses to
departments. Consider the expenses of the obstetrics department in 20X6. Variable expenses (based
on 20X6 patient-days) are Meals $ 610,000 Laundry 260,000 Laboratory 900,000 Pharmacy 850,000
Maintenance 150,000 Other 530,000 Total $3,300,000 Fixed expenses (based on number of beds) are
Rent $3,000,000 General administrative services 2,200,000 Janitorial 200,000 Maintenance 150,000
Other 350,000 Total $5,900,000 Management assigns nurses to departments on the basis of annual
patient-days as follows: Volume Level in Patient-Days Number of Nurses 10,00012,000 30 12,001
16,000 35 Total patient-days are the number of patients multiplied by the number of days they are
hospitalized. The hospital charges each department for the salaries of the nurses assigned to it. During
20X6, the obstetrics department had a capacity of 60 beds, billed each patient an average of $810 per
day, and had revenues of $12.15 million.

Compute the 20X6 volume of activity in patient-days.

12150000/810= 15000
2. Compute the 20X6 patient-days that would have been necessary for the obstetrics department to
recoup all fixed expenses except nursing expenses.
12150000-3300000 =8850000
C.M ratio = 72.84

BEP = 5900000/.7284 =$8099945

BEP in patient days = 10000

3. Compute the 20X6 patient-days that would have been necessary for the obstetrics department to
break even including nurses salaries as a fixed cost.
5900000 + 35 x 45000 = 7475000
74750000/.7284 =10262219/810 = 12669 patient days

4. Suppose obstetrics must pay $200 per patient-day for nursing services. This plan would replace
the two-level, fixed-cost system employed in 20X6. Compute what the break-even point in patientdays would have been in 20X6 under this plan.
12150000-3300000-200 x 15000 =5850000
C>M ratio = 5850000/12150000 = .4815
BEP = 5900000/.4815 =12253374 /810 = 15128 patient days