Our organization uses cost accounting. All revenue is allocated to each department in a % of revenue received. It makes it impossible to balance your budget like you would balance your checkbook at home. I follow the trends and evaluate based on quarters and biannual. Insurance providers also do incentives and other bulk (not sure of term) payouts that make it even more challenging. You may want to just look at cost per DRG, charges per DRG and reimbursement per DRG for your top 5 revenue DRGs or your top 5 volume DRGs. I have found that if there is a high $$ amount attached then the organization finds a way to get you your information. They can evaluate how much they are making or loosing on a large scale.