Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center Net Present Value (NPV) / MBA Resources

Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?

NPV solution for Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center case study is a Harvard Business School (HBR) case study written by Richard Bohmer, F. Warren McFarlan. The Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center (referred as “Beth Israel” from here on) case study provides evaluation & decision scenario in field of Technology & Operations. It also touches upon business topics such as - Value proposition, .

The net present value (NPV) of an investment proposal is the present value of the proposal’s net cash flows less the proposal’s initial cash outflow. If a project’s NPV is greater than or equal to zero, the project should be accepted.

NPV = Present Value of Future Cash Flows LESS Project’s Initial Investment

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Case Description of Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center Case Study

Describes the history of clinical computing at Boston's Beth Israel Hospital and the development, since the 1996 merger to form the Beth Israel Deaconess Medical Center, of an information system designed to support the delivery of patient care. The hospitals' CIO, John Halamka, MD, has overseen the development of an information system that places physicians at its center. Describes the design and function of five major components of the system: the On-Line Medical Record, ePrescribing, Physician Order Entry, the Emergency Department "dashboard," and the Performance Manager. Provides students with an opportunity to identify key design principles for health care information systems, and to discuss the unique implementation challenges that the health care delivery setting raises for CIOs and CEOs.

Case Authors : Richard Bohmer, F. Warren McFarlan

Topic : Technology & Operations

Related Areas :

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Calculating Net Present Value (NPV) at 6% for Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10005761)	-10005761	-	-
Year 1	3444609	-6561152	3444609	0.9434	3249631
Year 2	3965230	-2595922	7409839	0.89	3529041
Year 3	3965289	1369367	11375128	0.8396	3329333
Year 4	3239902	4609269	14615030	0.7921	2566306
TOTAL			14615030		12674311

The Net Present Value at 6% discount rate is 2668550

In isolation the NPV number doesn't mean much but put in right context then it is one of the best method to evaluate project returns. In this article we will cover -

Different methods of capital budgeting

What is NPV & Formula of NPV,
How it is calculated,
How to use NPV number for project evaluation, and
Scenario Planning given risks and management priorities.

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Capital Budgeting Approaches

Methods of Capital Budgeting

There are four types of capital budgeting techniques that are widely used in the corporate world –

1. Internal Rate of Return
2. Profitability Index
3. Payback Period
4. Net Present Value

Apart from the Payback period method which is an additive method, rest of the methods are based on Discounted Cash Flow technique. Even though cash flow can be calculated based on the nature of the project, for the simplicity of the article we are assuming that all the expected cash flows are realized at the end of the year.

Discounted Cash Flow approaches provide a more objective basis for evaluating and selecting investment projects. They take into consideration both –

1. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Beth Israel shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.
2. Timing of the expected cash flows – stockholders of Beth Israel have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.

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Formula and Steps to Calculate Net Present Value (NPV) of Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center

NPV = Net Cash In Flowt1 / (1+r)t1 + Net Cash In Flowt2 / (1+r)t2 + … Net Cash In Flowtn / (1+r)tn
Less Net Cash Out Flowt0 / (1+r)t0

Where t = time period, in this case year 1, year 2 and so on.
r = discount rate or return that could be earned using other safe proposition such as fixed deposit or treasury bond rate. Net Cash In Flow – What the firm will get each year.
Net Cash Out Flow – What the firm needs to invest initially in the project.

Step 1 – Understand the nature of the project and calculate cash flow for each year.
Step 2 – Discount those cash flow based on the discount rate.
Step 3 – Add all the discounted cash flow.
Step 4 – Selection of the project

Why Technology & Operations Managers need to know Financial Tools such as Net Present Value (NPV)?

In our daily workplace we often come across people and colleagues who are just focused on their core competency and targets they have to deliver. For example marketing managers at Beth Israel often design programs whose objective is to drive brand awareness and customer reach. But how that 30 point increase in brand awareness or 10 point increase in customer touch points will result into shareholders’ value is not specified.

To overcome such scenarios managers at Beth Israel needs to not only know the financial aspect of project management but also needs to have tools to integrate them into part of the project development and monitoring plan.

Calculating Net Present Value (NPV) at 15%

After working through various assumptions we reached a conclusion that risk is far higher than 6%. In a reasonably stable industry with weak competition - 15% discount rate can be a good benchmark.

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 15 %	Discounted Cash Flows
Year 0	(10005761)	-10005761	-	-
Year 1	3444609	-6561152	3444609	0.8696	2995312
Year 2	3965230	-2595922	7409839	0.7561	2998284
Year 3	3965289	1369367	11375128	0.6575	2607242
Year 4	3239902	4609269	14615030	0.5718	1852424
TOTAL					10453262

The Net NPV after 4 years is 447501

(10453262 - 10005761 )

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Calculating Net Present Value (NPV) at 20%

If the risk component is high in the industry then we should go for a higher hurdle rate / discount rate of 20%.

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 20 %	Discounted Cash Flows
Year 0	(10005761)	-10005761	-	-
Year 1	3444609	-6561152	3444609	0.8333	2870508
Year 2	3965230	-2595922	7409839	0.6944	2753632
Year 3	3965289	1369367	11375128	0.5787	2294727
Year 4	3239902	4609269	14615030	0.4823	1562453
TOTAL					9481320

The Net NPV after 4 years is -524441

At 20% discount rate the NPV is negative (9481320 - 10005761 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Beth Israel to discount cash flow at lower discount rates such as 15%.

Acceptance Criteria of a Project based on NPV

Simplest Approach – If the investment project of Beth Israel has a NPV value higher than Zero then finance managers at Beth Israel can ACCEPT the project, otherwise they can reject the project. This means that project will deliver higher returns over the period of time than any alternate investment strategy.

In theory if the required rate of return or discount rate is chosen correctly by finance managers at Beth Israel, then the stock price of the Beth Israel should change by same amount of the NPV. In real world we know that share price also reflects various other factors that can be related to both macro and micro environment.

In the same vein – accepting the project with zero NPV should result in stagnant share price. Finance managers use discount rates as a measure of risk components in the project execution process.

Sensitivity Analysis

Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Beth Israel should conduct a sensitivity analysis to better understand not only the inherent risk of the projects but also how those risks can be either factored in or mitigated during the project execution. Sensitivity analysis helps in –

What are the uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

Understanding of risks involved in the project.

What can impact the cash flow of the project.

What will be a multi year spillover effect of various taxation regulations.

What are the key aspects of the projects that need to be monitored, refined, and retuned for continuous delivery of projected cash flows.

Some of the assumptions while using the Discounted Cash Flow Methods –

Projects are assumed to be Mutually Exclusive – This is seldom the came in modern day giant organizations where projects are often inter-related and rejecting a project solely based on NPV can result in sunk cost from a related project.

Independent projects have independent cash flows – As explained in the marketing project – though the project may look independent but in reality it is not as the brand awareness project can be closely associated with the spending on sales promotions and product specific advertising.

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Negotiation Strategy of Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center

References & Further Readings

Richard Bohmer, F. Warren McFarlan (2018), "Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center Harvard Business Review Case Study. Published by HBR Publications.