Managing Resources Responsibly Chapter 3. Factors Affecting Costs of Health Care.
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Transcript of Managing Resources Responsibly Chapter 3. Factors Affecting Costs of Health Care.
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Managing Resources Responsibly
Chapter 3
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Factors Affecting Costs of Health Care
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Factors Affecting Costs of Health Care
Increased demand for health care services
Technological advances
Increased pharmacologic, medical equipment, and supply costs
Increase in health care personnel salaries
Increase in hospital costs
Increase in litigation
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Revenue Sources for Health Care
Health care insurance– Fee for service
– Third party payer
Governmental programs– Medicare
– Medicaid
– SCHIP
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Question The State Children’s Health Insurance Plan (SCHIP)
was designed for families who did not qualify for Medicaid yet could not afford health insurance. How is this plan funded?
A. By the federal government
B. By the state government
C. By the federal and state governments jointly
D. By the state government and private endowment
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Answer
C. By the federal and state governments jointly
Rationale: this plan is jointly funded by the federal government and the individual state and is administered by the state.
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Access to Health Care Economic access
Geographic access-
– rural versus city
Cultural access
– Education, language, literacy
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Cost Containment
Using reimbursement to control costs
Prospective payment systems
– Tax Equity and Fiscal Responsibility Act
– Medicare and Medicaid payment policies
– Diagnostic related groups (DRGs)
– Private insurance companies and managed care plans
– Balanced Budget Act
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Definition of managed care
– Any health plan system in which care is actively managed by the third-party payer who sets the ground rules for care and determines where, how, and by whom care will be provided
Managed Care and Preferred Providers
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Definition of preferred provider
– Preferred providers are physicians, hospitals, and other health care providers who have contracted for a specific, usually lower, payment for their services and thus have an incentive to decrease the costs
Managed Care and Preferred Providers (cont'd)
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Capitation – Plan contracts with a provider organization – Provider organization is paid a flat amount for every
individual enrolled – Provider assumes the risk that an individual
consumer might need very high-cost care – Incentive for the provider organization to work at
health promotion and disease prevention strategies
Managed Care and Preferred Providers (cont'd)
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Restructuring of organizations providing health care
Cost awareness for nurses
Contributors to individual patient costs of care
– Acuity level of the patient
– Length of stay
– Complications
Managed Care and Preferred Providers (cont'd)
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Cost of personnel– Accounts for 50% to 60% of the total hospital
operating budget – Traditionally included on the patient’s bill – Direct nursing costs and total nursing costs – Essential to enhance accountability for efficient
and cost-effective care – How many hours of work are needed – Fluctuation in acuity and census
Managed Care and Preferred Providers (cont'd)
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Question
What is included in direct nursing costs?
A. Supervising other staff
B. Planning and implementing patient care
C. Evaluating the work of other staff
D. Acuity of patients on unit
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AnswerB. Planning and implementing patient care
Rationale: direct nursing costs reflect the intensity of nursing care that can be measured in time required to provide the care. They include assessing, planning, implementing, and evaluating nursing care.
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Non-salary costs of care
Cost-containment strategies for nurses
Examining procedures and processes
Participating in prevention services
Effective assessment and management of care
Cost Awareness for NursesCost Awareness for Nurses
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Decrease staff turnover
Managing supplies
Legal and ethical aspects of cost containment
Future of cost containment
Cost Awareness for Nurses (cont’d)
Cost Awareness for Nurses (cont’d)
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Question
Is the following statement true or false?
Legal and ethical standards of care are defined by the profession.
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AnswerTrue.
Rationale: legal and ethical standards for nursing care require adherence to standards of care defined by the profession.
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Using Budgets to Manage Finances
Capital versus operating budgets
Budgets and organizational evaluation
Budget processes
– Planning the budget
– Value analysis
– Approval of the budget
Monitoring the budget
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Operating Budget
concerned with items that can’t be reused and that are needed for the daily operation of the facility.
Examples-– Salaries– Supples– Costs to run the institution
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Capital Budget Include major equipment or changes in
the building such as construction, renovation
High expense items…ie anything over $1000.00
Examples of items that fall under the Capital budget include:– Remodeling– Cath lab equipment– Mechanical lift devices
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Managing Time
Strategies for effective time management
– Time assessment
– Writing things down
– Prioritizing activities- (Display 3.3 p. 112)
– Learning to do tasks more quickly
– Organizing tasks
– Multitasking
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Question Multitasking on a nursing unit presents its
own dangers. What is a danger created when a nurse multitasks?
A. All tasks may not be finished on time.
B. You must re-orient and re-focus.
C. Delegating of tasks is not accomplished.
D. You may feel scattered and forget part of the task.
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Answer
D. You may feel scattered and forget part of the task.
Rationale: if you have too many tasks going, you may feel scattered and may forget some aspect.
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Strategies continued
– Delegating
– Organizing with the team
– Eliminating unnecessary tasks
– Creating effective meetings
Managing Time (cont'd)
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Barriers to Effective Time Management
Time wasters- p.119
– Controlled
– Uncontrolled
Personal approaches to time
– Procrastination