NA281 Managing Costs and Budgets
Terms in this set (26)
What are some of the factors that are increasing health care cost?
- increasing age and complexity of patients
- more elective surgeries
-supplies of health care providers, nursing shortage
- patient want to be cared for right away
-outpatient and noninvasive procedures
What are examples of Government healthcare?
Medicare and Medicaid
Government finances majority of the healthcare field
What are examples of private insurance?
Blue Cross Blue Shield
Private insurance has deductibles, co payments, and sometimes co insurance, normally have second opinion for surgeries
the second major source of financing
Who is covered by medicare?
65 years and older, ALS, and end stage renal disease, and some other disabilities that have paid into social security
What is covered under medicare A ?
hospital stay, hospice, skilled nursing care
What is coved under medicare B?
outpatient care, physician services, medical equipment, diagnostic tests
people have to pay a deductible to have this, voluntary thing they do not have to have it
What is medicare D?
covers medications and prescriptions
What is medicaid?
a state-level program financed by federal and state funds, pays for services provided to persons who are medically indigent, blind, disabled and to children with diabilities
What does hospice have to do with medicare?
hospice- terminal illness with less than 6 months left to live, and must have a 24 hour care providers is at home
cost based system
consists of the cost of providing a service plus a markup for profit, retrospective
flat rate (prospective)
method in which the third party payer decides in advance what will be paid for a service or episode of care
- we know ahead of time what we are going to get pain
- DRG 1983
-400-500 diagnosis and with comorbitities with them
Preferred provider organization
Health maintenance organization
PPO and HMO, both are called managed care or flat rate
Not as rigid as an HMO, as long as within the network no referral is needed
pay up front if you used the service or not, POS has to make a referral to see another doctor
- pay per month per capita or per year (HMOs)
Also called a discount, difference between what is charged and what is actually paid
Medicare and Medicaid, insurance companies
- office will bill and will never get the full amount of the bill back from the companies
- managers have to look at ways to use it efficiently
offering rewards and incentives to high performing organizations (outcomes, hospital acquired conditions, and patient satisfaction scores)
* if you do really well you can get extra payments and also better scores are published (which is millions)
What are cost conscious nursing practices?
- understand what is required to remain financially sound
- knowing the cost and reimbursement practices
- capturing all charges in a timely fashion
- using time efficiently
- discussing the cost of care with patients
- meeting patients rather than provider needs
- evaluation cost effectiveness of new technologies
- prediciting and using nursing resources effectively
- using research to evaluate standard nursing practice (EBP)
a formal plan of managing financial recourse,
a tool for planing, monitoring, and controlling cost; a plan for meeting expenses
prepared based on previous records and educated predictions of future needs
serves as a guide for nursing performance and location of personnel, supplies, support services, and facilities
what are different kinds of budgets?
what is operating budget?
a financial plan for day to day activities of operation, used by manager for day to day needs
What is capital budget?
a plan for purchasing major capital items, such as equipment or a physical plant, with a useful life greater than 1 year and exceeding a minimum cost set by the organization
What is a cash budget?
a plan for an organization' cash receipts and disbursements, used to pay bills, consists of operating plus capital budget together
When is the fiscal year
dependent on the organization's time line, can start at the beginning of the year or in the middle of the year
What is FTE?
full time equivalents, a position not a person ( 3 part time could make up on FTE), paid for 40 hours per week for 52 weeks per year (2080 hours)
What is revenue?
money earned by an organization for providing goods or services
What is variance analysis?
budget-control process to determine differences between income and expenses, projected and actual costs