Personnel management, or HR, typically pertains to activities related to the management of those employed by the business. While much of this is covered through standard administrative practices by hospital (or group) HR organizations, we contend that for physician faculty, the responsibility of these functions often belongs to the practice leadership and members themselves. This is particularly accurate when the functions of HR are considered beyond the typical administration (e.g., payroll, credentialing) to include activities that promote faculty development to align with the strategy of the business (the delivery of high-quality pediatric critical care medicine) (5). Functions covered under this agenda include recruiting, hiring, maintaining credentials, evaluating performance, training, mentoring, guiding advancement, and retention. As mentioned earlier, many of these will be shared responsibilities between hospital or practice administrative parties, faculty leadership, and the individual faculty. However, as the balance of responsibility will be variably shifted among these parties based on practice location and type, it is increasingly important for all to understand the landscape of this administrative domain.

There is generally a compulsion to relieve the physicians and their leadership of the full burden of responsibility for these duties as they may have little to no training or experience to complete them. While appreciation of, and participation in, such activities is essential, we cannot stress enough the importance of working with personnel with background in areas such as business administration, accounting, and data analytics and management. Furthermore, much of the activities mentioned earlier will fall under the responsibility of group leadership rather than the physicians themselves. While traditional concepts of leadership are addressed in other chapters,
the functions addressed here may be considered to fall under the role of manager (2).

The overall cost of health care in the United States is higher than anywhere else in the world and has been the source of much national attention. This is no less true for critical care medicine, which contributes to a significant percentage of these healthcare costs (9,10,11). These critical care expenses continue to grow despite decreases in acute hospital expenditures overall (9). Since Medicare is the single largest payer to hospitals and reimbursement for intensive care in the population covered by Medicare is poor (12), cost containment in the ICU has received significant attention both by hospitals focused on their bottom line and from funding agencies (10). While pediatric critical care medicine is unlikely to garner the attention of our adult counterparts, we remain an expensive endeavor (13) and should similarly focus attention on evaluation of our cost and effectiveness. This need for providing cost containment along with valuable care is increasingly pressing as evolving models of reimbursement tie payment for services with quality and outcome (14). Now, more than ever, as described by Michael Porter and Lee (15), health care is being called upon to deliver value—high-quality care with proven outcomes at the lowest possible cost. While discussions of quality will be considered briefly below with regard to physician productivity as well as more comprehensively in other chapters, we will discuss the basics of financing critical care here.

As is true of any business, without profitability, medical care practices, hospital-based and otherwise, cannot continue; therefore, attention to the bottom line is paramount (1,3). In simple finance terms, a business’s profitability is a result of the revenues generated minus the expenses incurred (16). Plainly stated, profitability will increase by enhancing revenue, decreasing costs, or both. While a complete description of the details of this balance sheet for pediatric critical care services is complicated and beyond the scope of this chapter, we will briefly discuss some basic sources of expense and revenue at the practice level as well as give an overview of hospital costs and billing followed by a more in-depth tutorial on physician billing.

It is important to note that revenue and expenses for pediatric critical care services will differ based on hospital size and type. Sources of revenue generation primarily center on billing fees for provision of clinical services. It is important to distinguish professional charges and hospital charges. Physicians bill professional fees as Current Procedural Terminology (CPT) codes linked to diagnoses based on International Classification of Diseases (ICD) codes (17). Additional sources of revenue may come from the provision of clinical services outside of the ICU such as coverage of intermediate care and sedation services, direct hospital support, research and grant funding, remuneration for administrative and teaching roles, and philanthropic gifts. Expenses of the practice may include physician salaries, fringe benefits, insurance coverage, space and capital, salaries for intensivists in training, and administrative support (3).