Premire!certification!des!tablissements!publics!de!sant!:!nouvelle!mission!pour!le!commissaire!aux!comptes!
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#$%%&'() "Sommaire !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !1 !
Liste !des !abrviations !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !5 !
Table !des !figures !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !7 !
Note !de !synthse !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !8 !
Introduction ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !11 !
Partie ! ! ! 1 ! ! ! ! LA ! PREMIRE ! CERTIFICATION ! DES ! TABLISSEMENTS !
PUBLICS ! DE ! SANT ! : ! PRISE ! DE ! CONNAISSANCE ! DE ! LENTIT ! ET ! DE !
SON !ENVIRONNEMENT !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !16 !
Chapitre!1!La!prsentation!dun!tablissement!public!de!sant!(EPS)!et!de!lvolution!de!
son!environnement!rglementaire!...................................................................................!18!
Section!1! Les!EPS!:!dfinition!et!rles!.......................................................................................!18!
1.1.! Prsentation!des!diffrentes!catgories!dEPS!..............................................................!18!
1.2! La!place!des!EPS!dans!le!paysage!hospitalier!en!France!................................................!20!
1.3! Personne!morale!de!droit!public!...................................................................................!21!
1.4! Le!centre!hospitalier!universitaire!(CHU)!:!lacteur!le!plus!reprsentatif!des!EPS!.........!21!
Section!!2! Lvolution!de!lenvironnement!rglementaire!des!EPS!:!du!plan!hpital!2007!au!
plan!hpital!2012!..............................................................................................................................!23!
2.1.! Pacte!de!modernit!pour!lhospitalisation!:!le!plan!hpital!2007!.................................!23!
2.2.! La!continuit!du!volet!investissement!du!plan!hpital!2007!:!le!plan!hpital!2012!......!24!
Section!3! La!rforme!des!hpitaux!:!la!loi!hpital,!patients,!sant!et!territoire!(HPST)!...........!26!
3.1.! Lorganisation!territoriale!du!systme!de!sant!............................................................!26!
3.2.! Lamlioration! de! laccs! ! des! soins! de! qualit! et! ! la! prvention! de! la! sant!
publique.27!
3.3.! La!modernisation!des!tablissements!de!sant.............................................................!28!
3.4.! Le!principe!de!la!certification!des!comptes!des!EPS!......................................................!29!
Chapitre!2!La!premire!certification!des!EPS!et!ses!enjeux!...............................................!30!
Section!1! Un!nouveau!march!pour!la!profession!...................................................................!30!
Premire!certification!des!tablissements!publics!de!sant!:!nouvelle!mission!pour!le!commissaire!aux!comptes!
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1.1.! Les!champs!dintervention!respectifs!de!la!Cour!des!comptes!et!des!commissaires!aux!
comptes.!......................................................................................................................................!30!
1.2.! Les!EPS!concerns!par!la!certification!...........................................................................!31!
1.3.! Les!conditions!de!certification!des!tats!financiers!des!EPS!.........................................!32!
Section!2! Les!enjeux!pour!les!EPS!.............................................................................................!33!
2.1.! Un!puissant! levier!de!progrs!dans! la! rnovation!des!processus!et!des!organisations!
pour!les!EPS!..................................................................................................................................!33!
2.2.! La! certification! des! tats! financiers! facteur! damlioration! de! la! performance! des!
EPS..35!
Chapitre!3!Les!particularits!comptables!et!financires!des!EPS!.......................................!36!
Section!1! Une!sparation!des!fonctions!efficientes!.................................................................!36!
1.1.! Rles!et!responsabilits!de!lordonnateur!.....................................................................!36!
1.2.! Rles!et!responsabilits!du!comptable!..........................................................................!37!
Section!2! Les!particularits!induites!par!le!contexte!rglementaire!........................................!38!
2.1.! Le!rfrentiel!comptable!de!rigueur!:!linstruction!M21!...............................................!38!
2.2.! Prsentation!des!tats!financiers!..................................................................................!39!
2.3.! Les!contraintes!induites!par!le!secret!mdical!..............................................................!40!
Section!3! Zoom!sur!la!spcificit!du!systme!de!facturation!...................................................!41!
3.1.! Volume!de!facturation!!traiter!lev!...........................................................................!41!
3.2.! Complexit!des!rgles!de!facturation!............................................................................!42!
Chapitre!4!Aspects!comptables,!financiers!et!budgtaires!:!tat!des!lieux!et!plan!daction
!........................................................................................................................................!43!
Section!1! Le!bilan!de!la!situation!comptable,!financire!et!budgtaire!actuelle!tabli!par!la!
Cour!des!comptes!et!par!les!chambres!rgionales!et!territoriales!des!comptes!..............................!43!
1.1.! Les!tudes!de!la!Cour!des!comptes!:!fiabilit!des!comptes!et!situation!financire!.......!43!
1.2.! Les!tudes!des!chambres!rgionales!et!territoriales!des!comptes!................................!46!
Section!2! La!prparation!!la!certification!des!tats!financiers!................................................!47!
2.1.! La!phase!prparatoire!:!mise!en!place!de!trois!groupes!de!travail!................................!47!
2.2.! La!prparation!des!EPS!!la!certification!.......................................................................!50!
2.3.! Quelques!exemples!de!mise!en!uvre!.........................................................................!52!
Partie ! 2 ! LA ! DMARCHE ! DU ! COMMISSAIRE ! AUX ! COMPTES ! : !
PROPOSITION !DOUTILS !DAIDE ! !LA !PREMIRE !CERTIFICATION !DES !
TATS ! FINANCIERS ! DES ! EPS ! ET ! COMPARATIF ! AVEC ! DAUTRES !
Premire!certification!des!tablissements!publics!de!sant!:!nouvelle!mission!pour!le!commissaire!aux!comptes!
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TABLISSEMENTS ! PUBLICS ! SOUMIS ! RCEMMENT ! ! LA !
CERTIFICATION !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !55 !
Chapitre!1!La!dmarche!du!commissaire!aux!comptes!lors!de!la!premire!certification!des!
tats!financiers!des!EPS!...................................................................................................!57!
Section!1! La!prparation!de!la!mission!:!dfinition!dune!cartographie!et!classification!des!
risques..!.................................................................................................................................!57!
1.1.! Lapproche!par!les!risques!de!lauditeur!.......................................................................!57!
1.2.! La!notion!de!contrle!interne!........................................................................................!59!
1.3.! Ralisation!de!la!cartographie!des!risques!au!sein!dun!EPS!.........................................!61!
1.4.! La!rponse!aux!risques!identifis!:!diligences!du!commissaire!aux!comptes!................!63!
Section!2! La!validation!du!bilan!douverture!:!un!objectif!!2013!............................................!64!
2.1.! La!norme!dexercice!professionnel!510!.........................................................................!64!
2.2.! Les!enjeux!de!la!validation!du!bilan!douverture!...........................................................!64!
2.3.! Proposition!dun!programme!de!travail!en!vue!de!la!validation!du!bilan!douverture!.!67!
Section!3! La!dfinition!dun!programme!de!travail!en!vue!de!la!premire!certification!des!
tats!financiers!des!EPS!....................................................................................................................!69!
3.1.! Rappel!des!!classiques!!en!audit!................................................................................!69!
3.2.! Les!points!spcifiques!au!secteur!tudi!.......................................................................!71!
3.3.! Proposition!dun!programme!de!travail!intgrant!les!spcificits!du!secteur!tudi!...!73!
Chapitre!2!Zoom!sur!les!cycles!spcifiques!du!secteur!tudi!...........................................!74!
Section!1! Les!moyens!humains!.................................................................................................!74!
1.1.! Le!cycle!personnel!riche!de!statuts!et!de!rgles!particulires!.......................................!74!
1.2.! valuation!des!dettes!diffres!.....................................................................................!76!
1.2.! Assertions!et!diligences!proposes!en!rponse!aux!risques!identifis!..........................!78!
Section!2! Les!moyens!actifs!......................................................................................................!79!
2.1.! Les!immobilisations!:!identification!et!dprciation!.....................................................!79!
2.2.! Les!stocks!.......................................................................................................................!83!
2.3.! Le!suivi!des!en"cours!clients!..........................................................................................!86!
Section!3! La!gestion!des!provisions!..........................................................................................!89!
3.1.! Les!provisions!:!un!outil!dajustement!pour!une!comptabilit!avant!tout!budgtaire!..!89!
3.2.! La!sparation!des!exercices!:!rattachement!au!bon!exercice!et!correcte!estimation!...!91!
3.3.! Les!provisions!pour!risques!et!charges!..........................................................................!92!
Chapitre!3!Du!dossier!de!travail!du!commissaire!aux!comptes!!lmission!de!son!opinion
!........................................................................................................................................!94!
Premire!certification!des!tablissements!publics!de!sant!:!nouvelle!mission!pour!le!commissaire!aux!comptes!
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Section!1! Le!suivi!des!diligences!du!commissaire!aux!comptes!via!la!documentation!de!son!
dossier!de!travail!..............................................................................................................................!94!
1.1.! La!norme!dexercice!professionnel!315!.........................................................................!95!
1.2.! La!norme!dexercice!professionnel!230!.........................................................................!96!
1.3.! La!traabilit!des!travaux!de!lauditeur!lgal!.................................................................!97!
Section!2! La!finalisation!de!la!mission!de!lauditeur!lgal!........................................................!98!
2.1.! Exemple!de!plan!de!synthse!du!commissaire!aux!comptes!........................................!98!
2.2.! Les!vrifications!spcifiques!du!commissaire!aux!comptes!...........................................!99!
2.3.! Lmission! de! lopinion! du! commissaire! aux! comptes!:! rapport! sur! les! comptes!
annuels99!
Section!3! Les!retours!dexprience!dautres!tablissements!publics!soumis!rcemment!!la!
certification..!................................................................................................................................!101!
3.1.! Les!tablissements!publics!!caractre!scientifique,!culturel!et!professionnel!...........!101!
3.2.! Les!organismes!de!protection!sociale!..........................................................................!102!
Conclusion !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !105 !
Bibliographie !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !109 !
Annexes !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !121 !
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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
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1.2! La!place!des!EPS!dans!le!paysage!hospitalier!en!France!
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Figure!1!:!Les!tablissements!de!sant!en!France!
Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
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1.3! Personne!morale!de!droit!public!
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personnes! morales! de! droit! public! dotes! de! lautonomie! administrative! et!
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1.4! Le!centre!hospitalier!universitaire!(CHU)!:!lacteur!le!plus!reprsentatif!
des!EPS!
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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
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Figure!2!:!Panorama!des!centres!hospitaliers!en!France!!source!CHU.org!
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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
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Section!!2! Lvolution!de! lenvironnement! rglementaire!des!EPS!:!du!plan!
hpital!2007!au!plan!hpital!2012!
2.1.! Pacte!de!modernit!pour!lhospitalisation!:!le!plan!hpital!2007!
SX/"*gg-U" ?)"A?&5";LA'0&?"*gga"4'/)"B"1$55)("A?9/"1)" C&:'?'03/"&9G"A($C)//'$55)?/"
A$9(" ?&" (3&?'/&0'$5" 1)" ?)9(/" A($O)0/U" B" (3C$(%)(" ?)/" %$1)/" 1)" C'5&5:)%)50" 1)/"
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134)?$AA)%)50")0"5$0&%%)50"i""
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B"?&":&A&:'03"1)"13:'/'$5"1)"?)9(/"()/A$5/&2?)/"j!
c 1)//)(()(" ?)" :&(:&5" 1)/" (X>?)/" 1@&:;&0/" A92?':/" A$9(" &::3?3()(" ?)/"
'54)/0'//)%)50/")0"/'%A?'C')("?&">)/0'$5"j!
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c 1'/A$/)("1&4&50&>)"1@&90$5$%')")0"1)":&A&:'03"1@'5'0'&0'4)"1&5/"?@)G)(:':)"1)"
?)9(/"()/A$5/&2'?'03/"Q9$0'1')55)/h!
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?@)5/)%2?)"19"A)(/$55)?"/$'>5&50")0"&1%'5'/0(&0'Ch"
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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
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A$'50" ?)"A?9/"A$/'0'C"1)" ?&"(3C$(%)h".)/"A($C)//'$55)?/"/@&::$(1)50"A$9("%)00()")5"
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?@30&2?'//)%)50" )5" 13:$9?)h" =$9(0&50U" 1X/" $:0$2()" *ggaU" ?)" =(3/'1)50" 1)" ?&"
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"
2.2.! La! continuit! du! volet! investissement! du! plan! hpital! 2007!:! le! plan!
hpital!2012!
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;$/A'0&?')("i" &%3?'$(&0'$5" 1)/" 0):;5'Q9)/"%31':&?)/U" &9>%)50&0'$5" 1)/" A('/)/" )5"
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?@'5C$(%&0'/&0'$5"1)/"A($:)//9/"1)"/$'5/U":$5/0'09)"95"&G)"C$(0"19"A?&5h"
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1)" /&503U" :$%%)" ?)/" %'/)/" &9G" 5$(%)/" &50'/'/%'Q9)/" )0" ?)/" $A3(&0'$5/"
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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
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*W"
"
Section!3! La! rforme! des! hpitaux!:!la! loi! hpital,! patients,! sant! et!
territoire!(HPST)!
.&" ?$'" E=#IW"&" 303" 3?&2$(3)" B" ?@'//9)" 1@95" ?$5>" A($:)//9/" 1)" :$5:)(0&0'$5" )0"
1@3:;&5>)/U"1)/"132&0/" '//9/"5$0&%%)50"1)" ?&":$%%'//'$5".&(:;)(U"1)/"3:;&5>)/"
1)/" 30&0/" >353(&9G" 1)" ?@$(>&5'/&0'$5" 1)/" /$'5/" )0" 1)/" :$5:?9/'$5/" 1)/" (&AA$(0/"
D'00)(a")0"8?&O$?)0e"i"95)"?$'"Q9'"A$/)"1)"5$94)&9G"A('5:'A)/h"
3.1.! Lorganisation!territoriale!du!systme!de!sant!
.)" A('5:'A&?" $2O)0" 1)" :)" 0'0()" )/0" ?&" :(3&0'$5" 1)/" 6D#fU" 5$94)??)/" &90$('03/"
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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
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3.2.! Lamlioration!de!laccs!!des!soins!de!qualit!et!!la!prvention!de!la!
sant!publique!
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c 1)" ?&" C$(%&0'$5" %31':&?)" :$50'59)" 1)4)5&50" 134)?$AA)%)50" A($C)//'$55)?"
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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!
"
*e"
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c ?&"?900)":$50()"?@$23/'03U""
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3.3.! La!modernisation!des!tablissements!de!sant!
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Partie!1,!chapitre!2!:!La!premire!certification!des!EPS!et!ses!enjeux!
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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Chapitre!2!La!premire!certification!des!EPS!et!ses!
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Section!1! Un!nouveau!march!pour!la!profession!
1.1.! Les! champs! dintervention! respectifs! de! la! Cour! des! comptes! et! des!
commissaires!aux!comptes!
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1.2.! Les!EPS!concerns!par!la!certification!
F)(0)/U" ?&" :)(0'C':&0'$5" 1)/" :$%A0)/" 1)/" H=#" )/0" 95" &G)" %&O)9(" 1)" 0(&4&'?"j"
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"
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Source!:!DGOS,!avancement!du!projet!fiabilisation!et!certification!des!comptes!des!tablissements!publics!de!
sant!
Figure!3!:!Objectifs!de!chaque!catgorie!dtablissement!
Tous!les!EPS!:!fiabilisation!des!comptes
X EPS!dfinis!par!dcret!certifis!par!un!CAC
8!CHU!certifis!par!la!Cour!des!comptes
Certification!des!comptes!de!2015!
au!!plus tard
Echance !dfinir
Partie!1,!chapitre!2!:!La!premire!certification!des!EPS!et!ses!enjeux!
!
"
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1.3.! Les!conditions!de!certification!des!tats!financiers!des!EPS!
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A('5:'A)"1)"2$55)" '5C$(%&0'$5h"I$9O$9(/" /)?$5" ?&"%^%)" /$9(:)U" 95)" '5C$(%&0'$5"
C'&2?)" 1$55)" 95)" '%&>)" C'1X?)" 1)" :)" Q9@)??)" )/0" :)5/3)" A(3/)50)(" )0" 1)" :)" Q9@$5"
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lannexe.!
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des! comptes!hospitaliers,!au! sens!de! la!norme! internationale! ISA,! il! existe!un!
rfrentiel!comptable!opposable,!linstruction!budgtaire!et!comptable!M21.!
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Partie!1,!chapitre!2!:!La!premire!certification!des!EPS!et!ses!enjeux!
!
"
++"
"
"
Source!:!DGOS,!avancement!du!projet!fiabilisation!et!certification!des!comptes!des!tablissements!publics!de!
sant!
Figure!4!:!Axes!des!travaux!!mener!en!mode!projet!
!
Section!2! Les!enjeux!pour!les!EPS!
2.1. Un!puissant!levier!de!progrs!dans!la!rnovation!des!processus!et!des!
organisations!pour!les!EPS!
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c 1)"2')5":$%A()51()"?@)54'($55)%)50"1&5/"?)Q9)?"$AX()"?)":?')50U"
Etats!fianciers!certifis
Dvelopper!le!contrle!interne!comptable!(CIC)
Sensibilisation!/!formation!au!CIC Audit!/!diagnostic
Elaboration!du!plan!d'actions!pluriannuel
Mise!en!oeuvre!et!suivi!du!plan!d'actions
Adapter!les!systmes!informatiques Ingtgration!CIC Piste!d'audit Hierarchie!/!habilitations
Piloter!le!projet Communication Gestion!des!risques Arbitrages Affectation!des!moyens
Amliorer!la!qualit!comptable
Formation!/!volutions!comptables Audit!/!diagnostic
Rvisions!des!critures!comptables
Prparation!du!bilan!d'ouverture
Faciliter!l'audit!NBon!droulement!du!1er!
auditMise!!jour!du!dossier!
permanent
Prise!en!comptes!des!ventuelles!rserves!de!certification!ds!N+1
Leve!des!ventuelles!rserves!de!certification!
au!plus!tard!en!N+3
Partie!1,!chapitre!2!:!La!premire!certification!des!EPS!et!ses!enjeux!
!
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Partie!1,!chapitre!2!:!La!premire!certification!des!EPS!et!ses!enjeux!
!
"
+-"
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2.2.! La! certification! des! tats! financiers! facteur! damlioration! de! la!
performance!des!EPS!
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Figure!5!:!En!quoi!la!certification!contribue"t"elle!!lamlioration!de!la!performance!?!
!!!!!!!!!!!!!!!!!!!!!!!!!Un!vritable!projet!d'entreprise
.!la!dmarche!n'est!pas!un!processus!!part!dans!l'entit
.!la!qualit!de!l'information!financire!et!comptable!ne!dpend!pas!
que!de!la!seule!matrise!des!processus!comptables!mais!aussi!des!
processus!en!amont
.!l'implication!des!mtiers!dans!la!dfinition!et!le!mise!en!oeuvre!de!
la!stratgie!de!contrle
!!!!!!!!!!!!!!!Elle!est!un!outil!essentiel!de!dialogue!et!de!pilotage
.!transparence!financire
.!non!opposabilit!des!donnes
.!un!outil!de!contractualisation
.!un!outil!de!pilotage!trs!performant!qui!permet!de!rorienter!
l'action,!de!connatre!les!marges!de!manoeuvre!et!d'objecter!la!
performance
!!!!!!!!!!!!!!!La!certification!fait!"bouger!les!lignes"
.!elle!induit!un!alignement!progressif!de!l'organisation!!la!startgie!
de!certification
.!il!s'agit!d'un!projet!qui!ne!peut!pas!se!faire!!organisation!constante
.!ce!projet!mobilise!tous!les!acteurs
.!elle!demande!de!repenser!les!processus,!les!pratiques!de!travail
.!elle!rime!avec!matrise!des!activits
.!se!concentre!sur!les!risques!majeurs
Certification/
Performance
Partie!1,!chapitre!3!:!Les!particularits!comptables!et!financires!des!EPS!
+W"
"
"
!!!!!!!!!!Chapitre!3!Les!particularits!comptables!et!financires!
des!EPS!
"
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Section!1! Une!sparation!des!fonctions!efficientes!
1.1. Rles!et!responsabilits!de!lordonnateur!
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Partie!1,!chapitre!3!:!Les!particularits!comptables!et!financires!des!EPS!
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1.2.! Rles!et!responsabilits!du!comptable!
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Partie!1,!chapitre!3!:!Les!particularits!comptables!et!financires!des!EPS!
"
+e"
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"
Section!2! Les!particularits!induites!par!le!contexte!rglementaire!
2.1.! Le!rfrentiel!comptable!de!rigueur!:!linstruction!M21!
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"
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Partie!1,!chapitre!3!:!Les!particularits!comptables!et!financires!des!EPS!
"
+f"
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2.2.! Prsentation!des!tats!financiers!
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2.3.! Les!contraintes!induites!par!le!secret!mdical!
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Section!3! Zoom!sur!la!spcificit!du!systme!de!facturation!
3.1.! Volume!de!facturation!!traiter!lev!
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Admissions
Hospitalisation
Bloc opratoireDIM
Facturation
Sortie
Partie!1,!chapitre!4!:!Aspects!comptables,!financiers!et!budgtaires!:!tats!des!lieux!et!plan!daction!!
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Chapitre!4!Aspects!comptables,!financiers!et!
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Section!1! Le! bilan! de! la! situation! comptable,! financire! et! budgtaire!
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territoriales!des!comptes!
1.1. Les! tudes!de! la!Cour!des! comptes!:! fiabilit!des! comptes! et! situation!
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Partie!1,!chapitre!4!:!Aspects!comptables,!financiers!et!budgtaires!:!tats!des!lieux!et!plan!daction!!
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