Health Care Financial Management for Nurse Managers : Merging the Heart with the Dollar

by Dunham-Taylor, Janne; Pinczuk, Joseph Z.

• ISBN13: 9780763731496
• ISBN10: 0763731498
• Format: Paperback
• Copyright: 2005-06-01
• Publisher: Jones & Bartlett

Summary

In practice, every management decision has financial implications, and every financial decision has management implications. Bottom-line thinking, if made top priority, loses money. The best financial outcome is achieved when listening To The patient is first priority followed by giving service(s) the patient values. This is achieved through effective leadership and organizational processes, all discussed in this book. Chapters are devoted to staffing, budgeting, identifying and analyzing variance, measuring productivity, costing, accounting, strategic planning and other effective financial strategies. Financial Management for Nurse Managers, written by a nurse administrator and a chief financial officer, prepares nurse managers for successful interfacing between the financial departments and nursing administration, and advocates for decisions based upon both perspectives . PowerPoint Slides and Test Bank now available for instructors!

Table of Contents

Dedications	iii
Contributors	iv
Preface	xxiii
Acknowledgments	xxiv
Introduction Every Management Decision Has Financial Implications---Every Financial Decision Has Management Implications	1	(10)
Part I Necessary Essentials for Financial Viability--or If Not Fixed It Will Cost More Money	11	(262)
An Open Letter to Nurse Leaders: If We Do What Is Right for the Patients, Financial Well-Being Will Follow	17	(8)
Catherine B. Leary
Mission	18	(1)
Staffing Model	19	(2)
The Budgeting Process	21	(1)
The Nursing Team	21	(1)
Group Think	22	(1)
Other Relationships	22	(1)
Keep Your Promises	23	(2)
Providing Value-Based Services while Achieving Quality and Financial Accountability	25	(84)
Janne Dunham-Taylor
Dru Malcolm
Sandy K. Calhoun
Introduction	25	(2)
We Have a L-O-N-G Way to Go to Fix our Health Care System	27	(9)
Patient Safety Issues	27	(1)
Sub-Standard Care	28	(2)
Bottom-Line Orientation Loses---Both Quality and Money	30	(1)
Poor Administrative Leadership	30	(1)
Regulatory Issues	31	(1)
Technology Costs	31	(1)
Is It Possible to Achieve Quality when We Are Having to Cut Costs?	32	(1)
Reframing the Cost-Quality Dilemma to Value-Based Care	32	(4)
So Where Do We Start?	36	(1)
The Patient Value Perspective---Our First Priority	37	(19)
What Do We Mean by What the Patient Values?	39	(1)
Reframing from the Health Perspective	40	(3)
The Healing Relationship	43	(4)
Cultural Diversity	47	(5)
Replace Patient Compliance with What the Patient Values	52	(4)
What Do We Mean by Quality Care?	56	(21)
Reframing/Our View of the World	57	(1)
Recognition of Value and Quality	58	(2)
Evidence-Based Practice	60	(5)
Providing Patient Safety	65	(1)
Remove Blame---Replace with ``What Could We Have Done to Prevent the Error from Occuring??''	66	(1)
Encourage Error Reporting	66	(2)
Identify Trends Causing Errors	68	(5)
Set up Systems to Prevent Mistakes	73	(1)
What Does It Mean to Be in the Information Age?	73	(2)
Get Everyone in on the Act!	75	(1)
Change Organizational Processes	75	(1)
Communicate, Communicate, Communicate!	76	(1)
Employee Issues	77	(1)
OSHA Standards for Employee Safety	77	(1)
Promoting a Healthy Workplace	77	(1)
Bioterrorism	77	(1)
Performance Improvement	78	(18)
Performance Measurement	80	(6)
Using a Balanced Scorecard System	86	(10)
Getting Further Out of the Box!	96	(13)
Quantum Physics	96	(2)
Chaos Theory	98	(11)
Quantum Leadership: Love One Another	109	(76)
Janne Dunham-Taylor
So What Is Good Leadership Anyway?	110	(12)
Leadership Fallacies	115	(7)
Quantum Leadership Excellence	122	(63)
Developmental Levels of Leadership	127	(1)
The Only Constant Is Change	128	(4)
Personal Mastery	132	(21)
Relationship Effectiveness	153	(27)
So What Is Effective Leadership Anyway?	180	(5)
Organizational Strategies	185	(60)
Janne Dunham-Taylor
Tammy Samples
Core Ideology	188	(53)
Core Values	189	(2)
Purpose	191	(1)
The Power of Meaningful Work	192	(2)
Organizational Assessment	194	(33)
Designing the Organization	227	(14)
Conclusion	241	(4)
Ethics in Nursing Administration	245	(28)
Jo-Ann Summitt Marrs
Introduction	245	(1)
Ethics	245	(2)
Morality	247	(2)
Ethical Principles	249	(20)
Ethical Principles of Nurse Administrators	251	(1)
Ethical Systems	252	(7)
Role of Administrators in Ethical Decision Making	259	(1)
Steps in Ethical Leadership	260	(1)
Retention, Excellence, and Ethical Leadership	261	(1)
Types of Ethical Issues Experienced by Nurse Administrators	261	(2)
Guidelines for Decision Making in Complex Ethical Situations	263	(1)
Ethics Committee	264	(1)
Ethical Inquiry in the Economic Evaluation of Nursing Practice	264	(1)
Ethical Conflict between Nurse Managers and their Organizations	265	(4)
Summary	269	(4)
Part II Health Care and the Economy	273	(96)
Everything You Wanted to Know about Health Care and More!	275	(72)
Janne Dunham-Taylor
Economic Theory versus Quantum Physics	275	(2)
How Did We Get into this Mess?	277	(20)
Colonial Period to 1900	277	(1)
1900s	278	(7)
1980s	285	(4)
1990s	289	(2)
2000s	291	(6)
Health Care Expenditures Predominantly Spent for Illness Care	297	(2)
Providers	298	(1)
Consumers and Third-Party Payers	298	(1)
Health Care Dilemma	299	(2)
Five Players: Consumers, Providers, Payers, Suppliers, and Regulators	301	(39)
Consumers	302	(4)
Providers	306	(7)
Payers	313	(27)
Public Policy	340	(1)
Personal Changes	341	(6)
Is there Life after Capitation? The Economics of the U.S. Health Care System after the Managed Care Revolution	347	(22)
J.D. Kleinke
Competing Tensions	348	(1)
DRGs---The Beginning of Managed Care	348	(1)
Global Capitation	349	(1)
Why We Need (Ugh) Managed Care	350	(2)
Why Managed Care Doesn't Work	352	(4)
Micro-Managing Payments	352	(2)
HMOs in Conflict with their Mission	354	(1)
Not Everyone Can Afford It!	355	(1)
Surviving Managed Care---Consolidation, Branding, and Niche Marketing	356	(11)
The Overall Strategy	356	(1)
Consolidation	357	(2)
Branding and Niche Marketing	359	(2)
Consumerism and Patient Power	361	(6)
Conclusions	367	(2)
Part III Information Systems	369	(54)
Knowledge Is Power: Here's How to Plug In	371	(40)
Rick Wallace
Martha Whaley
Information and Patient Care	371	(2)
Information and Money	373	(2)
Consumer/Patient Health Information	375	(25)
Web Sites with Selection Policies Based on Evaluation Criteria	376	(4)
Evidence-Based Practice	380	(5)
A Crash Course in Searching the Nursing Literature	385	(8)
Information Products and Salespeople (Vendors)	393	(2)
You and the Information Technology Guy (or Gal)	395	(3)
Information and PDAs	398	(2)
Information Retrieval on the Web	400	(4)
Web Searching Resources	400	(1)
How to Evaluate Web Sites	401	(1)
Information Need and Nursing	401	(2)
Information and Ethics	403	(1)
Information and Libraries/Librarians	404	(4)
Hospital Librarians	404	(1)
Outreach Librarians	405	(1)
Librarianship in the Clinic	405	(1)
Specialized Information Resources for Nurse Administrators	406	(2)
Summary	408	(3)
Nursing Information Systems: Guide for Nursing Management	411	(12)
Sharron Rutledge Grindstaff
Nursing Informatics	412	(1)
Identification of Department Goals and Objectives	412	(1)
Selection of the Information System	413	(5)
Information Systems Committee and Implementation Team	413	(1)
Types of Information Systems	414	(2)
Hardware and Software	416	(1)
Confidentiality and Security	417	(1)
Other Important Factors	418	(1)
Determining the Information System Cost	418	(1)
Staff Education	418	(1)
System Support	419	(1)
Information System Implementation Phase	419	(4)
Policies and Procedures	420	(3)
Part IV Budget Principles	423	(132)
Budgeting	425	(32)
R. Penny Marquette
Janne Dunham-Taylor
Joseph Z. Pinczuk
Introduction	425	(3)
Budgets and Patient Care	426	(1)
Data Systems	426	(1)
Nursing---A Big Budget Item	426	(1)
Integrity	427	(1)
Interfacing with the Finance Department	427	(1)
The Budget Process	428	(5)
Basic Cost Concepts---How Costs Are Defined	433	(1)
Basic Cost Concepts---How Costs Behave	434	(7)
Break Even Analysis	437	(3)
Alternate Ways to Organize the Budget	440	(1)
Capital Budgeting versus Operational Budgeting	441	(4)
Budgeting Revenues	445	(7)
Revenues versus Cash Flows	445	(2)
Predicting (Budgeting) Revenues	447	(1)
Pricing to Cover Your Costs	447	(4)
What Did We Forget?	451	(1)
Appendix A Charts of Accounts	452	(5)
Budget Development and Evaluation	457	(36)
Janne Dunham-Taylor
R. Penny Marquette
Introduction	457	(2)
Budget Terminology	459	(6)
Full-Time Equivalent (FTE)	459	(1)
Unit of Service	460	(1)
Nursing Workload	460	(3)
Overhead	463	(1)
Product Lines	464	(1)
Lost Leaders	464	(1)
Vertical Integration	465	(1)
Financial Person for the Nursing Department	465	(1)
Annual Evaluation of the Cost Center Budget: Building a Nursing Expense Budget	465	(23)
Historical Data Sources of Services Rendered	467	(1)
Calculating Direct Care FTEs	468	(4)
Determine the Staff Mix	472	(1)
Indirect Nursing Staff	473	(2)
Total Cost Center FTEs	475	(1)
Dividing FTEs into Shifts	475	(1)
Determine Part-Time versus Full-Time Ratio	476	(2)
Calculate Nursing Care Hours Needed per Day	478	(1)
Figure Actual Personnel Costs	479	(1)
Information Systems Technology	480	(1)
Minimum Staffing	481	(3)
Equipment and Supply Costs	484	(2)
Measuring and Adjusting for Inflation	486	(2)
Determining Variance between Historical and Newly Figured Budgets	488	(1)
Other Ways Actual Cost Data Can Be Used	489	(4)
Budget Variances	493	(28)
Norma Tomlinson
Introduction	493	(1)
Types of Variance	494	(15)
Expense Budget	494	(1)
Revenue Budget	495	(2)
Man-Hours Budget	497	(4)
Salary Budget	501	(2)
Benefit Expense	503	(1)
Non-Salary Expenses	503	(6)
Variance Analysis	509	(5)
Variance Report	514	(6)
Statistics	514	(1)
Revenue	515	(1)
Man-Hours	515	(1)
Salary Expense	515	(2)
Benefit Expense	517	(1)
Non-Salary Expense Analysis	517	(3)
Summary	520	(1)
Comparing Reimbursements with Cost of Services Provided	521	(34)
Patricia M. Vanhook
Introduction	521	(1)
Reimbursement	521	(6)
Historical Perspective	521	(1)
Payors	522	(1)
Reimbursement Sources	523	(2)
Costs	525	(2)
Clarifying the Cost Issue	527	(9)
Defining Costs, Charges, Payment	527	(1)
Cost of Service versus Reimbursement	527	(1)
Cost Determination Methods	528	(6)
Nurse Manager's Role in Cost Control	534	(2)
Managing Expenses with a Cost Accounting System	536	(1)
Departmental Operations Report	537	(15)
DRG Costing Example	539	(3)
Other Factors Contributing to Reimbursement	542	(4)
Revenue Budget	546	(4)
Predicting Financial Success	550	(1)
Nursing Management Decisions Impact Financial Outcomes	551	(1)
Summary	552	(3)
Part V Budget Strategies	555	(110)
Budget Strategies	557	(50)
Janne Dunham-Taylor
Linda Legg
Budget Cuts	558	(1)
What Is Our World View?	558	(1)
How Do We Choose a Strategy?	559	(13)
The Budget Process---Is It Flawed or Is It Effective?	560	(12)
Holding Down High Costs of Inpatient Care by the Employment of Advanced Practice Nurses and Hospitalists	572	(20)
Marketing	574	(7)
Staffing Expenses	581	(1)
Streamlined Documentation/Computerization/Enhanced Reimbursement	582	(5)
Cost Savings through Efficient Use of Supplies	587	(5)
Writing a Proposal	592	(4)
Appendix	596	(11)
Strategic Management: Facing the Future with Confidence	607	(40)
Sandy K. Calhoun
Strategic Management	607	(4)
Situation Analysis	611	(4)
External Environmental Analysis	612	(1)
Internal Environmental Analysis	613	(2)
Mission, Vision, Values, Goals	615	(1)
Strategy Formation	615	(8)
Directional Strategies	615	(3)
Adaptive Strategies	618	(2)
Market Entry Strategies	620	(2)
Development Strategies	622	(1)
Strategy Deployment	623	(4)
Culture	624	(1)
Structure	625	(1)
Resources	626	(1)
Strategic Management	627	(3)
Goals and Objectives	627	(1)
Measurement/Balanced Scorecard	627	(2)
Evaluation	629	(1)
Performance Improvement	629	(1)
Tools and Techniques	630	(12)
Quantitative Methods	630	(10)
Qualitative Methods	640	(2)
Role of the Nurse Manager	642	(5)
An Overview of Case Management	647	(18)
Patricia A. Hayes
Introduction	647	(1)
Models of Case Management in Nursing: Past and Present	648	(3)
Practicing Case Management: Role and Functions of a Case Manager	651	(3)
Case Management Certification	654	(2)
Trends and Issues in Case Management	656	(4)
Anticipating the Future of Case Management	660	(5)
Part VI Finance/Accounting Issues	665	(46)
Accounting for Health Care Entities	667	(24)
Paul Bayes
Introduction	667	(1)
Accounting Framework	668	(1)
Statement of Financial Position (Balance Sheet)	668	(14)
Assets	668	(3)
Liabilities	671	(1)
Stockholder's Equity	672	(2)
Income Statement	674	(3)
Cash Flow	677	(4)
Schedule of Changes in Equity	681	(1)
Internal Accounting Information	682	(4)
Cost/Managerial Accounting	682	(1)
Costs	682	(1)
Fixed versus Variable Costs	682	(1)
Direct versus Indirect Costs	683	(1)
Activity-Based Costing	683	(3)
Conclusion	686	(1)
Appendix	687	(4)
Financial Analysis: Improving Your Decision-Making	691	(20)
Paul Bayes
Common Size Balance Sheets	692	(3)
Common Size Income Statements	695	(2)
Financial Ratio Analysis	697	(1)
Liquidity Ratios	697	(1)
Activity Ratios	698	(1)
Leverage Ratios	699	(1)
Profitability Ratios	700	(1)
Trade or Cash Conversion Cycle Ratio	701	(1)
Not-for-Profit Comparisons	702	(5)
Current Ratios	707	(1)
Activity Ratios	707	(1)
Leverage Ratios	708	(1)
Profitability Ratios	708	(1)
Additional Financial Ratios	709	(1)
Conclusion	710	(1)
Part VII Determining and Evaluating Staffing	711	(150)
Patient Classification Systems	713	(48)
Kathy Malloch
Janelle Krueger
Introduction	713	(1)
Measuring Workload	714	(5)
Patient Classification Systems in Health Care	719	(3)
Patient Classification Systems in Nursing	722	(15)
Rationale for Patient Classification Systems	723	(2)
Factor, Prototype, Relative Value Unit, and Comprehensive Unit of Service	725	(3)
Other Units of Service/Systems	728	(1)
Essential Characteristics for a Valid and Reliable Patient Classification Systems	729	(1)
Validity, Reliability, and Sensitivity of Patient Classification Systems	729	(4)
Putting It All Together	733	(4)
Threats to Valid Patient Classification Systems	737	(3)
History of Misuse and Mistrust	737	(3)
Limitations: What Patient Classification Systems Cannot Do	740	(6)
Patient Classification Systems Are Not Core Schedules	740	(1)
Patient Classification Systems Are Not Daily Staffing Guidelines	741	(1)
Patient Classification Systems Are Not Patient Care Delivery Systems	742	(1)
Patient Classification Systems Do Not Direct Nurse-Patient Assignments	742	(1)
Patient Classification Systems Do Not Direct the Budget; They Provide Information to Support the Process	743	(1)
The Patient Classification System Is Not a Recruitment or Retention Tool	744	(1)
The Patient Classification System Is Not a Caregiver Competency Tool	744	(1)
Admissions, Discharges, and Transfers Are Not a Part of a Patient Classification System	744	(2)
Legislative and Accrediting Agency Efforts	746	(8)
Collective Bargaining Units	751	(3)
The Future	754	(1)
Summary	755	(6)
Staff---Our Most Valuable Resource	761	(66)
Janne Dunham-Taylor
Introduction	761	(1)
Staff Effectiveness	762	(6)
Regulatory Requirements	766	(1)
Competency	767	(1)
Staffing/Scheduling Policies	768	(1)
Resource Management System	768	(4)
The Staffing Plan	768	(4)
Where to Find the Answers? An Ongoing Process	772	(5)
Staff Empowerment	773	(1)
Brainstorm Together	773	(1)
Experiment, Experiment	773	(1)
What Are We Thinking?	774	(1)
We Are All in this Together	774	(1)
And We Can Always Do It Better...and Better...and Better...	774	(1)
Evaluation or Development of the Staffing Plan	775	(2)
Nursing Staff Skill Mix	777	(4)
Nursing Care Delivery Models	781	(2)
Case Method	781	(1)
Functional Nursing	781	(1)
Team Nursing	782	(1)
Modular Nursing	782	(1)
Primary Nursing	782	(1)
Team Nursing and Case Management	783	(1)
Nursing Staff Resources	783	(7)
Advanced Practice Nurses	783	(1)
Registered Nurses	784	(2)
Nurses Are Professionals, Not Blue-Collar Workers	786	(3)
LPNs/LVNs	789	(1)
Unlicensed Assistive Personnel	789	(1)
Volunteers	790	(1)
Enhancing Staff Resources	790	(4)
Generational Differences	790	(2)
Coaching---Self Care	792	(1)
Reality Shock	792	(2)
Mentors	794	(1)
Clinical Ladders	794	(1)
Staff Learning and Development	794	(1)
Staff Recognition and Celebrations	794	(1)
Sources and Distribution of Staff	795	(4)
Full-Time/Part-Time Staff	795	(1)
Third Seasoners	796	(1)
Job Sharing	797	(1)
On Call	797	(1)
Floating Staff	797	(1)
Staffing Pools	797	(1)
Agency Staffing	798	(1)
Traveling Nurses/Foreign Nurses/Internet Nurses	798	(1)
Effective Staff Scheduling	799	(4)
Self Scheduling	800	(1)
Permanent Shifts	801	(1)
Flextime	801	(1)
Block or Cyclical Schedules	801	(1)
Shift Times	802	(1)
Organizational Issues	803	(3)
Daily Staffing Communication	803	(1)
Position Control	803	(1)
Job Analysis	804	(1)
Centralization versus Decentralization	804	(1)
Closed versus Open Unit Concept	805	(1)
Sister Units	805	(1)
Which to Use?	806	(1)
Retention	806	(5)
High Turnover---The Antithesis of Good Leadership	808	(2)
Absenteeism	810	(1)
Staff Recruitment and Hiring Practices	811	(2)
Mentoring New Employees	813	(1)
Staff Education	813	(1)
Monetary Incentives	814	(13)
Individual Incentive Plans	814	(2)
Group-Based Incentive Plans	816	(2)
Where Do the Extra Dollars Come from?	818	(9)
Productivity	827	(34)
Janne Dunham-Taylor
What Is Productivity?	827	(14)
The Open Systems Model	829	(8)
Components of Productivity Enhancement	837	(4)
Enhancing Productivity: Linking Efficiency with Effectiveness	841	(20)
Productivity Monitoring System	844	(9)
Productivity Evaluation Process	853	(3)
After the Initial Evaluation, What Comes Next?	856	(1)
Productivity Improvement	857	(4)
Index	861