Exam 2 budget

Question 1

What is budget?

Answer 1

financial activites
financial plan
an educated guess in order to help us plan appropriately

Question 1

Why budgeting is important?

Answer 1

Increased Hospital Costs
Older age population
Users of supplies & equipment
Nurses are the major element of personnel budget
✓ If we use our nursing team wisely we can be a great way to cut some of the costs

Question 2

Significance for patients

Answer 2

Patient outcomes
if nurse:patient ratio is high, chances are we will have POOR outcomes
HCAHPs
Results from these surveys affect REIMBURSEMENT to healthcare organizations

Question 3

a) What is cost
b) Price =
c) Utilization =

Answer 3

a) the expenses associated with the delivery of healthcare services(かかる費用）
b) Price= RATE ($) set for a service
c) Utilization = QUANTITY (#) of services provided

Question 4

Costs can include?

Answer 4

Supplies
Labor (Personnel): accounts for 50-60% of expenses
Equipment (Bed, linens, etc)
Utilities (light etc)

Question 5

Fixed cost?

Answer 5

Costs that DO NOT fluctuate with volume/census
➢ you need to pay regardless if you have 1 patient or 1,000 patients
buildings+equipment
Administrative salaries
Mortgage payments
Not utilities

Question 6

Variable cost
Fixed + Variable Costs =?

Answer 6

Costs that DO fluctuate in direct # of patients we have
Medical/surgical supplies
Laundry
Food

TOTAL Costs

Question 7

Revenue

Answer 7

income deriverd from roviding services to pt
Amount received BEFORE expenses are deducted
Reward for providing a service to a patient

Question 8

Reimbursement?

Answer 8

(MAIN SOURCE OF REVENUE)
✓ Government type payments: medicare, medicaid
✓ Private Insurance
✓ Individual Private Pay

Question 9

Types of reimbursement
Retrospective reimbursement

Answer 9

Paid AFTER service is rendered/give

“Cost-Based”
“Fee for Service”
No ceiling on amount charged
(cost just kept going up and up, and it became too much)

Question 10

Prospective Reimbursement?
example? 2

Answer 10

IN ADVANCE amount to be paid (regardless of actual cost)

DRG
Capitation

Question 11

Prospective Reimbursement
DRG

Answer 11

Diagnosis-Related Groups/medicare

Each DRG has a dollar amount allowed

They looked at the data and saw on average how long does this type of pt stay in the hospital (ex: average 3 days for CHF patient)
So, then they said we’re only going to pay you for 3 days, so by the 3rd day they should feel better and be ready for discharge… if you deviate from that
then they wont plan to pay for that

Question 12

Prospective Reimbursement
Capitation

Answer 12

HMO, PPO

A mode of payment in managed care systems based on a fixed dollar amount (not change) allocated PER MEMBER/PER MONTH (ex: $150/per adult/month)

Question 13

Medicare
Who is elagible?
What is ABCD?

Answer 13

Federal Health Insurance
>65 yr
A /arrive inpateint/hospital coverage
B/back outpatient/medical coverage
C/Choice HMO or PPO/ medicare advantage/by private companies approve
D/ outpatient prescription drug

Question 14

Medicaid
who is elageble?

Answer 14

Federal-State Health Insurance
low-income children and adults
disabilities and low-income seniors

Question 15

Reimbursement from government
From where?

Answer 15

Centers for Medicare and Medicaid Services (CMS)
CMS payments directly linked Joint Commission

CMS IS THE LARGEST PURCHASER OF MANAGED CARE IN THE U.S.

Question 16

a) what is Joint Commission?
b) Is accreditation or certification mandatory?

Answer 16

a) enable and empower health care organizations around the world to build a foundation for quality care and patient safety.
b) No, but usually most organizations WANT to so they can get paid by CMS

Question 17

Managed care is a system that try to integrate what care?

Answer 17

Efficiency of care
Access to care
Control cost of care

Question 18

One of the things they established was and what they focued on?

Answer 18

Primary care providers (PCP)
prevention, decrease inpatient care
use of clinical practice guidelines
selective contracting
Pharmacy formularies

If we want to see a spicialist, we need to get referral from PCP!

Question 19

Types of managed care
Health Maintenance Organization
HMO

Answer 19

Less expensive insurance
Fewer options
Need to select PCP
Must see a PCP first before see a specialist
If you’re young and healthy, this is a good option

Question 20

Types of managed care
Preferred Provider Organization
PPO

Answer 20

More expensive
More options
Greater access

Question 21

Bundled Payments

Answer 21

Ex
If a particular procedure is a certain amount, Obama care (affordable care act) will pay a certain amount of that. They will give you a sum of money.

Question 22

Accountable Care Organizations

Answer 22

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.

Question 22

Hospital Value-Based Purchasing

Answer 22

Reimbursement is based on QUALITY
Rewards acute care hospitals with incentive
payments for the quality of care provided in the inpatient hospital setting.

Question 23

The Medical Home

Answer 23

Idea is that care is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety

Question 24

New CMS rules a) Effect on Patients? b) Effect on hospitals?

Answer 24

**Provide a list of atandardcharges to pt** Healthcare price transparency rules (2019) Hospitals must comply (obey) online in 2019 -required to provide clear, accessible pricing information online List of standard charges Value-based system a) Make cost and quality decisions b) Control rates and give best quality service

Question 25

Profit

Answer 25

The amount remaining from revenue after costs (expenses) and **obligations are met.** REVENUE – COST = PROFIT

Question 26

Budget variance

Answer 26

A **change** in expected revenue or expenses (costs) ✓ This basically messes up our budget Price: price of supplies will fluctuate Volume: unexpected increase or decrease Acuity: unexpected increase or decrease in the intensity of the patient’s needs for care Wage: wage may be adjusted for factors including inflation and promotion

Question 27

Budget capital

Answer 27

**Long-term investments** new equipment, replacement of equipment, new buildings or renovations ✓ Managers will be more involved in these type of decisions ✓ Includes construction budget

Question 28

Capital Justification (we have to justify the money that we are about to spend because remember these are BIG BUCKS)

Answer 28

Service provided Necessity and/or importance of the service Expected utilization Expected life Products Evaluated Cost of Equipment Estimated savings or profits Added value to the organization

Question 29

Budget/Operational

Answer 29

A plan for the **day-to-day** operating (**supplies**, minor equipment, and purchased services for each department) An operational budget focuses **on the total revenues and expenses of the organization for the year.**

Question 30

Budget/personnel

Answer 30

This budget is regarding labor and staffing ✓ THE LARGEST OF BUDGET EXPENDITURES

Question 31

Budgeting process model ADPEI describe the processes for developing, monitoring and controlling

Answer 31

**Assess** What need to be covered in the budget **Diagnosis** What needs to be accomplished/creaste a cost-effective budget **Plan** Most budget are for a 1 year period **Intervention** ongoing monitoring and analysis **Evaluation** reviewed periodically and modified as needed

Question 32

Nursing responsibilities for cost effective care Describe cost effective resource allocation nurseing practice

Answer 32

**SUPPLIES** -Properly charge patients **QUALITY** Reduce length of stay Prevent complications (because insurance wont pay for these!) **TIME UTILIZATION:** Delegate effectively

Question 33

Nursing Service is the LARGEST expense in HCO a) Strengths: b) Weakness:

Answer 33

a) nurses manage the organization and leverage with powerful/accurate real time data b) quick, short economic gains can be made by decreasing resources in nursing staff (first target)

Question 34

Solution for improvement

Answer 34

Supply Management Lean Five S (sort, set in order, shine, standardise, sustain) HCAHP scores (improvement) Decreasing Length of Stay (LOS)

Question 35

Operational budgets are financial plans for the entire organization day-to-day operations. This type of budget includes which of the following? a) Payroll, supplies, and expenses b) Supplies, expenses, and equipment purchases c) Expenses, equipment purchase, and payroll d) Payroll, monthly expenses, and large purchase items

Answer 35

a Rationale: Day-to-day operations include payroll, supplies, and expenses that change in response to the volume of service. The capital expenditure budget's purpose is for purchasing large capital items such as equipment. The cash budget is the operating financial plan for the month, that is, monthly accounts bills and employee salaries.

Question 36

Who is responsible for cost-containment? Nurses Doctors Hospitals All of the above

Answer 36

All of the above Rationale: Cost containment refers to the effective and efficient delivery of services while generating needed revenues for operations. Cost containment is the responsibility of every health-care provider, and the viability of most health-care organizations today depends on their ability to use their fiscal resources wisely.

Question 37

A nurse manager is **preparing the annual budget** for the coming fiscal year, and is considering what the goal is of using the allocated funds. What stage of the budgetary process is this? a) Evaluation b) Diagnosis c) Planning d) Assessment

Answer 37

b Rationale: The diagnosis phase of the budgetary process **considers what goal will be accomplished by using a cost-effective budget that maximizes available resources.** The assessment phase determines what needs to be covered in the budget. The planning phase maps out the **time frame in which the budget will be implemented.** The evaluation phase is the final step in the budgetary process, in which the budget is reviewed periodically and modified as needed throughout the fiscal year.

Question 38

A nurse manager is evaluating the current fiscal year budget. Which statement regarding the evaluation stage of the budgetary process is most accurate? a) Most units will have no variation from the projected budget. b) Large variations from the projected budget must be examined. c) The CEO is accountable for individual unit budgetary outcome. d) Budgets are usually created at the beginning and unchanged.

Answer 38

b Rationale: Usually, each unit will experience some variation from the projected budget. This must be monitored and the budget periodically adjusted. Large variations from the projected budget must be examined and corrective action taken. Individual unit managers are accountable for their unit's budgetary outcome.