Nursing Leadership and Management-DAX-DL01 

Week 7 DQ

Discussion Topic

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Answer the following questions as they apply to the CS below. While some of these responses may be the same as other students, a unique perspective and response for each student is expected, and using someone else’s responses as your own work is quite simply plagiarism and will not be tolerated. Please make sure that your responses in the submission as your individual understanding of the questions and concepts and are not verbatim for what other students respond (it is best not to look at any other responses prior to posting this helps to take away any potential chance that your responses will reflect the very same answers in the very same format in the very same way as a fellow student. 

Please ensure your answer is your own.

END-OF-CASE RESOURCES (Answer the questions below; there is no need for peer responses this week) 

DISCUSSION QUESTIONS [6 questions] 

1. In a table, calculate the ADC and hours per patient day (HPPD) for the perioperative transition unit.

2. In a table, calculate the coverage factor for the perioperative transition unit.

3. Determine the total FTE requirements and skill mix to staff the perioperative transition unit.

4. Using bundle payment systems as a form of hospital reimbursement, explain the importance of benchmarking against national hospital-acquired conditions. (Hint: Use Table CCS7.2 to answer the question.)

5. Based on the projected patient volume and perioperative transition unit outcome targets, calculate the projected financial impact. Why is the focus on hospital-acquired conditions important for nurse leaders?

6. Calculate the total income, total variable costs, total fixed costs, contribution to margin, and net earnings for the perioperative transition unit.

Comprehensive Case Study 7: Main Hospital: Perioperative Transition Unit

Chapter supplementary

INTRODUCTION

Main Hospital is a for-profit hospital with a 585-bed capacity. The hospital chief executive officer (CEO) Bill McInroy has plans to expand hospital operations in the perioperative setting. A new 30-bed perioperative transition unit is being developed to care for patients in the postoperative setting and short-term stay. The perioperative transition unit is a redesigned approach to patient care innovations focusing on value-based healthcare delivery targeting high-quality care, cost effectiveness, and healthcare economics. The hospital CEO and chief nursing officer (CNO), Margaret Werrington, PhD, MBA, RN, collaborated with subspecialty surgeons performing a range of oncological surgeries. The perioperative transition unit is focused on incorporating techniques in enhanced recovery after surgery. Since enhanced recovery after surgery programs demonstrate significant quality enhancements, increase patient satisfaction, and reduce cost of care delivery, Mr. McInroy transitioned the hospital to a shared risk approach under the Centers for Medicare & Medicaid Services (CMS) value-based programs. Under the Medicare and Children’s Health Insurance Program (CHIP) Reauthorization (MACRA) Act, the hospital decided to follow the alternative payment model of bundled payment systems for each episode of care per oncological service line.

BACKGROUND AND CONTEXT

In partnership with the oncological surgeons, several outcome metrics were identified to benchmark against similar services nationally (Table CCS7.1). The hospital-acquired conditions identified with the oncological surgeons included hospital-acquired pressure injuries (HAPI), catheter-associated urinary tract infections (CAUTI), falls, postoperative nausea and vomiting (PONV), pain, postoperative ileus (POI), respiratory depression, surgical site infections (SSI), postoperative cognitive disorder (POCD), length of stay (LOS), and 30-day readmission rates.

Mr. McInroy tasked chief nursing officer (CNO) Werrington, PhD, MBA, RN, and her leadership team to develop a personnel salary budget with a staffing matrix, capital budget, and operating budget. The forecasting for the 30-bed unit includes 9,000 patient days, average daily census (ADC) at 25 cases, 82% occupancy rate, average acuity 3.3, and average workload indexed at 81.4. The staffing make-up includes a nurse manager, APRNs, RNs, LPNs, and patient care assistants (PCAs). The forecasted patient volume for the fiscal year is 6,395 patients. The perioperative transition unit operates 7 days per week due to each patient requiring a LOS beyond 1 day. The RNs, LPNs, and PCAs work 8-hour shifts. The provider-to-patient ratio is 1:3. The hours per patient day are 9.73. All staff, except APRNs and manager, receive shift differentials such as 10% for the 3 p.m. to 11 p.m., 20% for the 11 p.m. to 7 a.m., an additional 5% for weekends (any shift), and 50% for overtime. The nonproductive hours for each employee are based on 40 hours per week or 2,080 hours per year. Other nonproductive hours include 3 weeks’ vacation, 6 days sick leave, 8 holidays, and 3 personal days. Other benefits received from the hospital include 6.25% Federal Insurance Contributions Act (FICA), 1.25% Medicare, 6.7% health insurance, 1.5% life insurance, and 4.33% other. The hourly rate per employee is $62 per hour for the nurse manager, $65 per hour for the APRN, $36.50 for each staff RN, $23 per hour for each LPN, and $15 per hour for each PCA (Table CCS7.2).

TABLE CCS7.1:

National Benchmark Outcomes and ERAS Economic Impact

CNO Werrington collaborated with CEO McInroy and the chief financial officer (CFO) to review the overall projected financials for the perioperative transition unit. Although the hospital is reimbursed under bundle payment systems, the team utilized Medicare Part A fee-for-service rates to determine the initial projected revenues for the unit. The average third-party payor reimbursement was projected at $2,080 per patient and Medicare was projected at $1,025 per patient. The payor mix is approximately 40% Medicare and 60% private insurers. The budgeted variable costs for medications and lab tests are projected at $351,725 and $30,000 for other variable costs. In addition to salaries and benefits, other fixed costs include building expenses at $416,244, office supplies at $2,400, transportation and travel at $67,236, advertising and branding the units to the community at $30,000, consultants such as legal and accounting at $25,200, liability insurance premiums at $104,400, and capital equipment depreciation at $373,428. The tax rate for the hospital is 15%. Also, hospital-acquired complications such as POI result in prolonged hospital LOS. In this case, a POI results in an additional 4-day LOS.

CHALLENGE AND OPPORTUNITY

A challenge confronting nurse leaders is understanding how to define and implement quality measures from a financial perspective. Also, an appreciation for reimbursement methodologies is essential for nurse leaders in generating personnel budgets, operational budgets, forecasting, and program innovations. Collaborative partnerships with the CEO, CFO, physicians, and other team members are opportunities that must be explored by every nurse leader.

KEY POINTS

• ■ Developing local financial benchmarks for patient care based on the evidence is crucial.
• ■ The importance of translating quality care and patient outcomes into financial outcomes enhances a nurse leader’s ability to better justify resources.
• ■ The nurse leader should be able to develop a staffing matrix outlining the full-time equivalent (FTE) requirements and related costs, as well as the operational benchmark drivers impacting FTE requirements.
• ■ The importance of understanding revenue sources, variable costs, fixed costs, and methods for controlling cost of care through enhanced patient care remain essential nurse leader competencies as healthcare increases in complexity.

SUMMARY

The Main Hospital perioperative transition unit demonstrates a range of important tasks in developing financial literacy in leadership. Collaboration with a range of stakeholders is an imperative for project success. With hospital stakeholders, a range of operational projections based on volume and cost is the initial step. Next, a staffing model and associated personnel costs to implement the service require a few basic financial principles specific to staffing models. The other important financial aspect of project development is revenue. Value-based healthcare delivery is a concept focused on quality of care. The professional and technical aspects of revenue generating are optimized through strict control of variable costs, fixed costs, and high-quality care. Finally, operational and clinical care benchmarks act as a gauge to the level of quality care with associated cost reduction and revenue optimization. Some examples discussed include skin breakdown, perioperative ileus, and POI. The nursing leader with strong financial acumen can assimilate and master each of these financial elements, resulting in a high-quality, value-based care delivery model.

Students you will answer the questions associated with this week’s Case but no peer replies are required.

Please remember for discussion posts: the initial post must be uploaded by the WEDNESDAY of the week and no replies to your peers by Saturday at 2359.

Please note the grading rubric for the discussion board. As a reminder, all discussion posts must be a minimum of 250 words, references must be cited in APA format 7thEdition and must include a minimum of 2 scholarly resources published within the past 5 years.