ECONOMICS & FIN. ASPECTS OF HEALTHCARE

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Online Lecture

This week we will review basic data analysis techniques to interpret financial data for effective financial stewardship and safe patient care.

The ability to transform data from a variety of sources into accurate information using visual representations, graphs, and tables is key when communicating the benefit of your proposed change.

Download the PowerPoint presentation below and use it to take notes on the assigned reading in the Waxman and Knighten 3rd Ed. text for Chapters 10 and 11:

Chapter 10_ Basic Data Analysis Techniques for Nurse Leaders.pptx

Chapter 11_ Role of Technology, Informatics, Artificial Intelligence, and Big Data in Healthcare Finance.pptx

Check out the link below!

· Florence Nightingale: Joy of Stats Links to an external site. – https://www.openculture.com/2016/03/florence-nightingale-created-revolutionary-visualizations-of-statistics-that-saved-lives-1855.html

Online Discussion Questions

As part of your business and financial plan due next week, you will include financial data to support the proposal.

Presenting the data clearly and concisely drawing the reader’s attention to the important facts for interpretation.

Graphs and tables are basic formats for communicating and displaying the data to inform.

For the initial discussion response, share a draft of data that you will use to inform your proposal.

PEER RESPONSES

Olivia Faig

Below is a financial plan of implementing a psychotropic medication class for CASAs (Court Appointed Special Advocates). Nurses are exposed to data daily in our profession, and it is important as nurse leaders we are able to provide an accurate analysis of this data which includes: interpretation of research, evaluation of research, consideration of empirical questions and planning research (Waxman & Knighten, 2023).

Since CASAs are volunteers, they come from many different career and educational backgrounds and are unfamiliar with psychotropic medications.   Foster children have higher rates of all mental disorders compared to non-foster children (Vanderwerker et al., 2014).  The Government Accountability Office (GAO) analyzed five states psychotropic prescription rates for foster children and non foster children. The five states were: Florida, Maryland, Massachusetts, Oregon, and Texas. Rates of foster children being prescribed psychotropic medications are much higher than non-foster children. For instance, foster children from 6 to 12 years old, 31.2% are prescribed psychotropic medication compared to non-foster children prescription rate of 12.3%. For 13–17 years old, the prescription rate of psychotropic medication was 36.8% for foster children and 11.9% for non-foster children (Government Accountability Office, 2020). When the five states were analyzed, three prescribing practices carry an increased level of risk for children: concomitant prescriptions of five or more psychotropic medications, medication doses which exceed the FDA approved drug labels, and prescriptions for infants (Government Accountability Office, 2020).  Because foster children are being prescribed psychotropic medications at an alarming rate compared to non-foster children, it is vital for CASAs to be aware of the side effects and safety parameters of these medications. Therefore, a financial analysis was conducted. The cost of implementing this project is approximately $325, and about 500 hours for research, designing, receiving feedback, and implementing the project. This table displays the necessary financial and hour cost breakdown. What are your thoughts regarding implementing this project? Am I missing any foreseeable costs?

References

Government Accountability Office. (2020).  Gao-12-201, foster children: Hhs guidance could help states improve oversight of               psychotropic prescriptions [PDF]. U.S. government accountability office.  https://www.gao.gov/assets/gao-12-201.pdfLinks to an external site.

Vanderwerker, L., Akincigil, A., Olfson, M., Gerhard, T., Neese-Todd, S., & Crystal, S. (2020). Foster care, externalizing               disorders, and antipsychotic use among medicaid-enrolled youths.  Psychiatric Services,  65(10), 1281–              1284.  https://doi.org/10.1176/appi.ps.201300455Links to an external site.

Waxman, K., DNP, & Knighten, M., DNP. (2023).  Financial and business management for the doctor of nursing practice (3rd ed.).              Springer Publishing Company.  https://doi.org/10.1891/9780826122094Links to an external site.

Allison Mayfield

Included financial plan for post fracture nurse navigation for patients within an outpatient setting. In the quality department we deal with data on a daily basis and not all of that data is useful and most of that data can be manipulated to tell different sides of the same story or to push an agenda. As a DNP prepared nurse, it is part of our duty to “transform data from various sources into usable information” (Waxman & Knighten, 2023, p. 510).  Having the usable information is beneficial as it helps to guide the decisions being made from a workflow and financial perspective.

The primary cost of the project is going to come from the salaries for the staff. Since fragility fractures cost the global healthcare system around $400 billion and account for 3% of healthcare costs (International Osteoporosis Foundation, 2022) the benefit of reducing these fractures is imperative not only for healthcare systems but for the patient’s quality of life. The salary rates are based on averages for the staff who will be doing the process both in the DNP project pilot and the long term. Even if only one navigator owned the process it would still have a monetary benefit for the system and the patient population. Knowing that it is also important to note both of the positions already exist in the organization and therefore no new FTEs are included. This process would be added to the capacity of workflow of the current population health support services staff. The nurse navigators also work from home and use the organizations equipment at their location. The data is included for those who might not have this centralized group with these resources within their organization. The plan is to expand to screening for osteoporosis and handle result management in the future.

See budget table below for reference.

When we consider the financials we also have to consider how the data can be interpreted and used because context can be everything. When we look at the 2022 data we see the denominator is less than the 2023 data. This can be explained by the opening up of the age criteria from starting at age 65 to age 50. When can also see that the benchmark that we are comparing ourselves to increased by 5% (Centers for Medicare and Medicaid Services, 2023).

What are some iterpretations of the data (knowing I have not provided all context)? Do you agree that without context the data is useless?

References

Centers for Medicare and Medicaid Services. (2023). 2023 Star Ratings Technical Notes. https://www.cms.gov/files/document/2023-star-ratings-technical-notes.pdf

International Osteoporosis Foundation. (2022). Policymakers. https://www.capturethefracture.org/policymakers

Waxman, K., DNP, & Knighten, M., DNP. (2023).  Financial and Business Management for the Doctor of Nursing Practice (3rd ed.). Springer Publishing Company.

Ashleigh Eversole

Table 1 outlines the basic preliminary budget and anticipated expenses for my project. As a review, I will be developing a palliative care screening tool for the electronic health record (EHR) which will alert providers to place the consult order when appropriate. Budgeting is essential to the success of projects, even those of scholarly origin (Pink & Song, 2020). Most costs for this particular project are related to office supplies and the salary for an information technology (IT) specialist to assist in the development of the EMR BPA. Fortunately, St. Elizabeth Healthcare already has a staff of IT specialists that have agreed to assist with this project and will not require any additional compensation. Therefore, this is not technically an additional expense but their salary will be included in the table for purposes of this budget proposal. Additionally, there are no extra operational or capital costs for this project beyond what are already provided by the organization. For example, use of Epic as the electronic health record, access to Microsoft office, and wifi are all expenses that have already been accounted for. The total budget for year one if this project were to continue is $34,420. Starting year two the cost for the IT specialist drops off leaving a remaining annual budget of $660 dollars. This $660 is based on the average hourly RN rate of $30 then calculated for the additional 5 minutes spent on palliative care screenings for at least 10 patients/day.

Table 1

Preliminary Budget

Table 2 attempts to quantify the potential revenue if this project is successful. Unfortunately, data is quite limited on prior studies related to savings from increased palliative care utilization in heart failure patients. Therefore, this table lacks high level quantitative reliability but is used to describe important factors that may potentially increase revenue through means of decreased costs and increased billing which leads to higher reimbursement. For example, the average cost of a heart failure hospitalization is around $12,000. If this project results in an average of 10 less CHF hospitalizations/year then the organization saves $120,000. The patient can also consider this a savings. Moreover, if increased use of advanced care billing codes such as 99497 are used, then the hospital with gain an additional $89,367.20 yearly for every 20 patients/week.

Table 2

Project Revenue

Table 3 demonstrates the potential program benefit year 1 compared to annually after year 1. For this table, only the direct revenue from reimbursement through billing code 99497 was used to simplify the benefit/loss. The savings from reduced length of stay and hospitalizations has numerous factors influencing the true benefit which is outside of the scope and purpose of this project.

Table 3

Program Benefit/Loss

References

George H. Pink, & Paula H. Song. (2020).  Gapenski’s Understanding Healthcare Financial Management, Eighth Edition: Vol. Eighth edition. AUPHA/HAP Book.

Raphaelle Molas

PICOT question:

Among newly hired APRN employees at the Cincinnati VA Medical Center (P), what is the effect of incorporating a formal APRN specific orientation program (I) on job satisfaction and retention (O) within the first 3 months of employment (T)?

Orientation is meant to relieve stress and promote a sense of confidence, competence and satisfaction for a new employee as they start a new position. Orientation provides a new employee a general overview or framework of the organization’s mission and should help new employees understand how their roles fit into the organization (Wallace, 2009).  Formal orientation programs are critical in employee retainment and motivation, reducing turnover, improving productivity and employee morale, facilitating learning and reducing anxiety among new employees (Ragsdale & Mueller, 2005). Additionally, a well designed and implemented orientation program has a wide range of benefits including improved commitment to the organization, which reduces turnover, thereby saving money and frustration. Other benefits include clear expectations and exchange of reliable information, shortened learning curves, and positive relationships among colleagues (Wallace, 2009).

From a financial planning standpoint, most of the preparation of the APRN orientation curriculum will be accomplished by volunteer participants thereby incurring no additional cost for labor for overtime pay. For better and practical purposes, in class instruction of the APRN specific orientation curriculum will be provided by a voluntary nurse practitioner. The proposed formal orientation program will however require the volunteer nurse practitioner to be pulled away from clinical duties to present an in class didactic orientation for one eight-hour shift day, per new employee orientation session. The revenue lost from primary clinical and/or administrative duties must therefore be calculated. The VA nurse pay schedule is divided into three grades, then further subdivided into thirteen levels. Nurse grades are determined by education, years of experience, and the nurse’s contribution to the organization by means of projects such as program implementation, process improvement, quality initiatives, etc.  The subdivided levels steps from S1-S12 are awarded a step increase every two years. With this in mind, we would assume that the nurse practitioner mentors who are the most experienced, would be at a minimum grade 3, step 1, and those who have reached the peak of their VA careers as nurse practitioners at a grade 3, step 12 (See Appendix A). Assuming that volunteer nurse practitioner mentors, are paid at the highest grade level, (grade 3), using the VA’s current pay schedule for Cincinnati, the minimum daily rate for the nurse practitioner would cost approximately $487.77 [Grade 3, step 1 at $126,819 ÷ 52 (weeks) ÷ 40 (hours/week)  x 8 (hours/day)], and the maximum daily rate would cost approximately $648.70 [Grade 3, Step 12 at $168,663 ÷ 52 (weeks)  ÷ 40 (hours/week)  x 8 (hours/day)]. See Appendix B.

The electronic survey for both needs assessment and post implementation survey will be accomplished using Qualtrics, an online survey tool in which the VA currently holds a contract of $7500 payment for 3000 surveys. Total APRN count at the CVAMC is 78 employees. Goal for survey response is to reach 50% of all CVAMC APRNs, which would account for approximately 38 surveys. It will cost the VA approximately $95 to administer and analyze the needs assessment surveys ($7500 ÷ 3000 = 2.5  x 37 = 95). Post program implementation surveys may vary depending on how many APRNs will be hired ($2.5  x X).

The first 90 days of employment is a critical period to ensure the new employee is acclimated to the organization’s culture, develop positive relationships, and gain confidence and familiarity with their role. Low clinical productivity of the new provider is also expected during the initial orientation or onboarding process (Morgan, et al. ,2020).

To help determine the long-term projected cost of a formal implementation program, one must look at the potential revenue gained and lost the new hire will cost the facility. If it takes an average of 90 days for the new employee to feel independent enough to practice independently, let us examine the potential revenue gained and lost within that 90-day period. For instance, if the newly hired APRN is a Grade 2, step 2 employee (annual gross pay $109,851), it will cost the facility roughly $9,154.25 a month or $27,462.75 for 3 months, assuming that the APRN is not functioning at full capacity. In order to gain back this investment, it is critical that the new employee feel well prepared, and equipped with the necessary tools to function independently, gain confidence, and maintain job satisfaction and ensure job retention. If, however, the employee is dissatisfied with the position, and decides to leave, the facility would then have to re-hire and retrain another APRN at a loss of roughly $9,000 a month, depending on that employee’s designated pay scale.

Appendix A: Advanced Practice Nurse Pay Schedule (Cincinnati VA)

Source: U.S. Department of Veteran Affairs. Office of the Chief Human Capital Officer (OCHCO) Tile 38 Pay Schedules. Last updated: 07/22/2023

Appendix   B : Nurse III Pay Schedule (Cincinnati VA Medical Center) per day

X = Annual Gross Salary ÷ 52 (weeks) ÷ 40 hours/week x 8 (hours/day)

Source: Annual Gross Salary – Office of the Chief Human Capital Officer (OCHCO) Title 38 Pay Schedules

Appendix C: Qualtrics electronic survey cost

References:

Morgan, P., Sanchez, M., Anglin, L., Rana, R., Butterfield, R., & Everett, C.M. (2020). Emerging practices in onboarding programs for PAs and NPs.  Journal of the American Academy of Physician Assistants. 34(1). 32-38.  10.1097/01.JAA.0000723932.21395.74Links to an external site. 

Ragsdale, M.A., Mueller, J. (2005). Plan, do, study, act model to improve an orientation program.  Journal of Nursing Care Quality. 20(3), 268-272.  10.1097/00001786-200507000-00013Links to an external site. 

U.S. Department of Veteran Affairs. (2023). Office of the Chief Human Capital Officer (OCHCO).  Title 38 Pay Schedules. Retrieved on July 31, 2023.  https://www.va.gov/OHRM/Pay/Links to an external site.

Wallace, K. (2009). Creating an effective new employee orientation program.  Library Leadership & Management. 23(4) 168-176. file:///C:/Users/HOMEBASE/Downloads/SSRN-id1958214.pdf