Healthcare costs: Nursing

Nurse Irving is the charge nurse on a 24-hour observation unit where the majority of clients are admitted for chest pain.

Then they go for a cardiac stress test, and are discharged if the test results are normal. During the unit huddle, Nurse Irving is informed that the hospital budget has become more limited due to price inflation, so every unit charge nurse is tasked with assessing ways to cut costs.

After the huddle ends, Nurse Jade approaches Nurse Irving and says, “We waste so much money on broken equipment here.” Nurse Irving asks Nurse Jade what she means and she continues, “Just last week another portable heart monitor broke because it accidentally got sent down in the hospital laundry.” Nurse Irving realizes that these portable heart monitors cost thousands of dollars and says, “You’re right, we need to address this.

Let's create a plan to preserve these heart monitors.” Nurse Jade agrees to help Nurse Irving and speaks to the rest of the staff about possible solutions.

Nurse Irving and Nurse Jade will use what they know about healthcare costs to provide quality client care in a cost-effective way.

Healthcare costs in the United States are increasing every day; in fact, Americans spend over 3 trillion dollars on healthcare per year!

But, increased spending of healthcare dollars hasn’t always translated into better health outcomes, such as average life expectancy.

Healthcare facilities are tasked with improving health outcomes and delivering quality care in the most cost-effective way.

Indicators of quality of care such as safety and client satisfaction scores directly influence how healthcare facilities are reimbursed.

For example, increased rates of hospital acquired infections or hospital readmissions after discharge can decrease reimbursement.

On the other hand, healthcare facilities that consistently demonstrate positive quality indicators are reimbursed accordingly.

Now, within the healthcare environment there are healthcare consumers and healthcare payers. Healthcare consumers are individuals who receive health services, and they can be insured or uninsured individuals who pay out of pocket for the care they recieve.

Then there are healthcare payers which are organizations that collect payments and process claims, and include private health insurance companies, Medicaid, and Medicare.

Private health insurance comes from private companies, and the premium for the insurance is often paid for in part by a person’s employer.

On the other hand, Medicaid and Medicare are two government-sponsored healthcare programs. Medicaid is an insurance program that serves clients of any age who are considered low-income, whereas Medicare is an insurance program that serves clients over 65-years-old, as well as those who are disabled or with end stage renal disease.

When a client has Medicare, their diagnoses are categorized into a diagnosis-related group, or DRG. Each DRG has a payment assigned to it based on the average costs of treating other clients with these same diagnoses.

Regardless of the amount a healthcare facility actually pays to care for a client, the DRG cost remains the same. One common DRG is for the treatment of chest pain; for example, if a client comes to Nurse Irving’s unit with chest pain and ends up needing additional care due to an infection, the hospital will only be reimbursed for the original DRG.Like most healthcare providers, nurses face the challenge of providing quality care while keeping costs in check.

Nurses play a key role in helping healthcare facilities to identify cost savings opportunities because of their perspective from the bedside.

For example, nurses can identify which supplies are unnecessary or underutilized when providing care. In addition, nurses can reduce costs by routinely performing hand hygiene or repositioning clients every two hours, since these actions can decrease healthcare costs associated with infection and pressure injuries.

Furthermore, nurses can help contain costs by capturing and documenting supplies used for client care. For example, some hospital units require nurses to scan the barcodes of serviceable items, such as urinary catheter kits and nasogastric tubes.

If the nurses don’t appropriately charge these items when they are used, their unit will be responsible for covering the costs.

Lastly, nurses can reduce costs by performing client care in an organized and efficient manner, like when a client is discharged by the healthcare provider, it’s the nurse’s responsibility to facilitate the discharge in a timely manner to make room for new clients.

When a client’s discharge is delayed, this can lead to additional costs for the healthcare facility as well as decreasing the potential revenue from new clients.

Okay, let’s check back in with Nurse Irving and Nurse Jade, who’ve worked together with the facilities manager to create a hanging basket in each client room to hold portable heart monitors when clients aren't wearing them due to bathing or being discharged.

Nurse Irving presents this change in practice at the monthly staff meeting and the unit nurses are enthusiastic and excited to use them.

Nurse Jade says, “We can save our unit thousands of dollars! As nurses we can recognize ways to reduce costs while providing the best client care!”All right, as a quick recap… Healthcare costs in the United States are increasing every day and healthcare facilities are tasked with improving health outcomes and delivering quality care, and to do so in the most cost-effective way.

Those involved in healthcare costs are healthcare consumers, like clients, and healthcare payers, like private insurance companies, Medicaid and Medicare.

Medicare categorizes medical diagnoses into a DRG which has a payment assigned to it based on the average costs of treating other clients with these diagnoses, which dictates how healthcare facilities will be reimbursed.

The quality of care delivered at a facility also plays a role in how they are reimbursed. If a healthcare facility consistently demonstrates low scores on quality indicators, they can be denied reimbursement or they may need to pay financial penalties.

Nurses play an integral role in reducing healthcare costs by eliminating waste, providing safe, quality care, charging items appropriately,