Chap 16

A nurse is educating a coworker on the intrinsic factors and cost of health care. The nurse knows that the teaching has been effective when the coworker lists the following intrinsic factor as the major cause of increased cost: a. Almost 10% of Americans over 65 years old are considered at or below the poverty level. b. The new medical technology available has increased the cost of health care. c. There are increasing labor costs in the total hospital spending budget. d. The staff nurse does not understand the responsibility of economics and money management.

ANS: A A major intrinsic factor contributing to the high cost of health care is that an increasing number of Americans are over 65 years old, and a significant portion of this age group does not have the funds to obtain medical care. The US Census Bureau's 2011 Supplemental Poverty Measure reports an even higher percentage, 15.1%. The other options listed are extrinsic factors—new medical technology, increasing labor costs, and lack of staff nurse understanding of fiscal responsibilities of the organization.

Which statement by the nurse indicates understanding of the major factors influencing the increase in health care costs? a. "Health care expenditures are exceeding the cost of the gross domestic product (GDP) in excess of 14%." b. "Older adult patients consume more of the health care product than they can afford to finance." c. "The cost of prescription drugs is soaring so rapidly that the majority of people cannot afford them." d. "Because of the limited payment of Medicare, institutions are not being reimbursed at the same level of expenditures."

ANS: A Health care expenditures consume more than 16% of the GDP—the amount of money being spent exceeds the amount of money recompensed. The older adult population contributes to this situation because they require more health care as a result of chronic conditions. The cost of prescription drugs and the level of Medicare reimbursements also contribute to this problem.

Which statement by the nurse shows understanding of the Rand Health Insurance Experiment? a. "When consumers were required to pay 25% co-payment, there was a considerable decline in the use of health care services." b. "There was an increase in the use of health care services when consumers were required to make a co-payment." c. "If the health care cost is being paid by insurance companies, the consumer is not concerned about the cost." d. "The implementation of the Oregon Health Policy for reimbursement of the cost of health care services led to the Rand Health Insurance Experiment."

ANS: A Participants in the Rand study either received free care or paid co-payments of 25%, 50%, or 95%. Economic theory would predict that as price increases, the purchase of goods or services would decline. That is exactly what happened. With a co-payment of 25%, there was a decline in utilization of health care of 19% compared with a free plan. There were even greater declines in utilization of health care services at the higher rates of co-payments.

What is the most important way that a nurse can be fiscally responsible to the employing institution? a. By providing quality, safe nursing care b. By considering patient needs and prioritizing appropriately c. By accurately documenting the patient's condition d. By maintaining accurate charges for supplies used in patient care

ANS: A Quality nursing care includes using fiscal resources wisely, but most important is the provision of quality nursing care—preventing falls, controlling the spread of infection, providing care to prevent complications, for example. All of these situations increase the length of stay for a patient and ultimately the costs of the institution. The other options are ways to be fiscally responsible but not the most important.

Which of the following statements indicates the nurse's understanding of fiscal responsibility? a. "Fiscal responsibility should be a concern for all nurses." b. "Fiscal responsibility is only a concern for the department manager." c. "Fiscal responsibility is only a concern for the hospital administrators." d. "Fiscal responsibility is not a concern for the nursing staff."

ANS: A The nurse has an adequate understanding of fiscal responsibility when stating: "Fiscal responsibility should be a concern for all nurses." Fiscal responsibility affects everyone in the health care system. The nurse, as well as the entire hospital staff and administration, needs to have an understanding of the costs of care.

The nurse has an adequate understanding of productive time when stating: a. "Productive time is the amount of time the nurse is available to give care to patients." b. "Productive time is the amount of time the nurse is attending a continuing education activity." c. "Productive time is counted when the nurse is not directly giving bedside care, such as going to lunch and taking a break." d. "Productive time is counted when the physician is at the patient's bedside."

ANS: A The nurse has an adequate understanding of productive time when stating that "productive time is the amount of time the nurse is available to give care to patients." One work day (8 hours) is usually considered to be 7.5 productive hours. Nonproductive time reflects the amount of time that is not available for direct care, such as vacations, days off, holidays, continuing education, committee work, breaks, and lunch.

A nurse is educating a group of students about health care economics. Which statement would the students make if the teaching were effective? a. "Extrinsic factors include the cost of prescription drugs." b. "Extrinsic factors include the age of the population." c. "Extrinsic factors include the demand for health care." d. Extrinsic factors include employer-paid health insurance."

ANS: A The nurse would know that the teaching was effective when the students states: "Extrinsic factors include the cost of prescription drugs." The other statements about health care economics are false.

The nurse manager receives the budget variance report for the assigned nursing unit. What other critical information must the nurse manager consider to evaluate this report? a. Projection of costs in the operating budget b. The amount of money allocated to meet expected costs c. Figures on which a zero-based budget were determined d. Planning needs for unit staffing based on patient acuity

ANS: A The operating or budget costs are guidelines by which the nurse manager determines whether the unit has operated within allowable expenses. This is often called an expense or operating budget. The other options are not considered critical information that the nurse manager would need to consider when evaluating the report. The operating budget also includes all of the items necessary for care on the unit. These are called line items in a budget and include such things as supplies, telephones, small equipment (e.g., wheelchairs, nurse pagers, fax machines), postage, and copying costs. Some of these are variable costs—that is, costs that change with the volume of patients cared for in a year. Zero-based budgeting is the efficient allocation of resources because it is based on needs and benefits where all expenditures have to be approved.

A new graduate is preparing for a job interview. Which questions would be appropriate to ask the manager in regards to health care economics? (Select all that apply.) a. How is the acuity of patients factored into staffing? b. What is the turnover rate on this unit? c. How long are the breaks for staff on this unit? d. What is the overtime rate on this unit? e. What are the budgeted hours per patient day on this unit?

ANS: A, B, D, E The new graduate should consider asking how the acuity of patients is factored into staffing, what the turnover rate is, what the overtime rate is, and what the budgeted hours per patient day are for the unit.

Which action by the nurse shows fiscal responsibility to the employing organization? (Select all that apply.) a. Wash hands after each patient contact. b. Turn patients every 2 hours. c. Round on patients. d. Toilet patients frequently to prevent falls. e. Use resources of the institution wisely.

ANS: A, B, D, E The nurse can show fiscal responsibility to the employing organization by washing hands after each contact, turning patients every 2 hours to prevent bed sores, toileting patients frequently to prevent falls, and using resources of the institution wisely.

Which action by the nurse demonstrates fiscal responsibility to the employing organization? (Select all that apply.) a. Only bringing needed supplies into a patient's room b. Accurately documenting the patient's condition c. Minimally documenting in the patient's chart d. Taking breaks as scheduled e. Remaining healthy and able to function on the job

ANS: A, B, D, E The nurse shows fiscal responsibility to the employing organization by only bringing needed supplies into the patient's room, accurately documenting the patient's condition, taking breaks as scheduled, and remaining healthy and able to function on the job.

Which action by the nurse shows fiscal responsibility to the payer of care? (Select all that apply.) a. Understand Medicare and Medicaid insurance coverage. b. Efficiently and effectively use resources to provide patient care. c. Document minimally in the patient chart. d. Select interventions which are cost effective. e. Document the patient's plan of care.

ANS: A, B, D, E To show fiscal responsibility to the payer of care, the nurse should understand Medicare and Medicaid insurance coverage, efficiently and effectively use resources to provide patient care, select interventions that are cost effective, and document the patient's plan of care as well as condition.

It is important for the nurse to understand strategies that promote a fiscally responsible clinical practice. From the following listing, select those strategies that would achieve a fiscally responsible clinical practice. (Select all that apply.) a. Completes charge slips or scans bar code of nursing supplies used when changing a surgical dressing b. Participates in the annual hospital fund-raising activity c. Visits the Centers for Medicare & Medicaid Services to understand what services are provided during an inpatient visit d. Immediately reports any development of a patient medical complication to the health care provider e. Volunteers to participate in a hospital program initiative to reduce central line associated bloodstream infection (CLABSI) f. Completes a patient's discharge plan on the morning of discharge

ANS: A, C, D, E The following is a listing of strategies to promote a fiscally responsible clinical practice: • Provides quality nursing care that prevents complications and documents condition accurately • Makes conscious decisions about the allocation of professional nursing time • Understands Medicare and Medicaid insurance coverage • Engages in evidence-based practice and follows best practice guidelines • Shares information with patients and families about the costs of care and alternatives • Assigns assistive personnel (nurse aides, certified medical assistants) appropriately to help with care • Works with the members of other health care professions to promote fiscal responsibility for clinical practice • Begins discharge planning on admission; otherwise, if not available or prepared until the day of discharge, there may be confounding factors (lack of transportation) that require the patient to stay an additional hospital day • Completes charge slips for patient supplies if required (Answer A) • Avoids burnout by taking scheduled breaks, meal times, and vacations • Engages in safe clinical practice that will avoid personal injuries The participation in a fund-raising activity does not directly impact the clinical practice. It does build a sense of camaraderie among staff.

A nurse manager is preparing a presentation on health care economics for unit staff. How would the nurse manager explain the definition of economics as it relates to health care to the staff? a. Economics refers to how the health care system is going to care for the older segment of the population. b. Health care is a limited resource; economics refers to how this resource is going to be allocated. c. Health care economics refers to the budgeting and financial management of the institution providing the care. d. Economics is the balance of the utilization of health care services and the monies obtained for the services provided.

ANS: B Economics is the allocation of scarce resources. Health care economics is the distribution of the limited resource of health care. Economics includes not only the older adult segment but all age groups. Economics is not about using health care services and the monies obtained but instead how they will be distributed.

The nurse has an adequate understanding of capital budget when stating: a. "A capital budget is part of the expected expenses of the unit." b. "A capital budget is used to purchase or replace equipment costing more than $5000." c. "A capital budget is used to pay for nurses to work in the hospital." d. "A capital budget is used to purchase lunch for employees."

ANS: B The nurse has an adequate understanding of capital budget when the nurse states that the budget "is used to purchase or replace equipment costing more than $5000." The capital budget is the beginning point of the budget cycle. It is not used to pay for nurses to work in the hospital and is not used to purchase lunch for employees. The capital budget is not part of the expected expenses of the unit.

Which action by the nurse demonstrates fiscal responsibility to the patient? (Select all that apply.) a. Discharging a patient home with prescriptions and no health insurance to cover the cost b. Assessing the patient's resources and determining their ability to pay for prescriptions c. Setting the patient up for Meals on Wheels d. Giving the patient information on free support groups e. Calling local churches to see what services they can offer the patient

ANS: B, C, D, E The nurse demonstrates financial responsibility to the patient by assessing the patient's resources and determining the ability to pay for prescriptions, setting the patient up for Meals on Wheels, giving the patient information on free support groups, and calling local churches to see what services they can offer the patient.

What action can nurses take to be fiscally responsible? a. Give patients their discharge instructions and let them determine if the cost of their medications fit into their budget. b. Allow nurses to work on the unit when the census drops. c. Use proper hand hygiene. d. Document minimally on each patient.

ANS: C Nurses can be fiscally responsible in many different ways. This includes fiscal responsibility to the patient, such as assessing the patient's resources for purchasing medication. The nurse is also expected to have fiscal responsibility for the organization. This includes sending nurses home or to another unit when the census drops and using proper hand hygiene to prevent infections, which would result in increased health care spending to treat. The nurse should also consider fiscal responsibility to the payer of care and practice documenting thoroughly to show the patients need for the care given.

The case manager is educating the nurse about health care costs. The case manager knows that the education has been effective when the nurse states: a. "Health care costs are increasing because demand is decreasing." b. "Health care costs are steadily decreasing." c. "The aging population is requiring more health care services, causing the costs to increase." d. "The aging population is requiring less health care services, causing the costs to decrease."

ANS: C The case manager would know that the teaching was effective if the nurse states: "Health care costs are continuing to increase because the aging population requires more health care services." The other statements are false regarding health care costs.

What is the nurse's fiscal responsibility to the patient? a. To provide the best health care that the patient can afford b. To provide the best health care that the insurance company will allow c. To use the most cost-efficient resources to provide maximum health care to the patient d. To use the most efficient method of providing nursing care to patients whose resources are limited

ANS: C The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. In clinical practice, fiscal responsibility does not relate to insurance or how the patient is paying for service. The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. Providing the best health care is about quality improvement.

To provide quality care, the Affordable Care Act of 2010 a. reduced the number of patients accepted into Medicaid. b. kept the Medicaid system the same. c. made changes to slow growth in spending. d. increased Medicaid spending to ensure adequate patient care.

ANS: C To provide quality care, the Affordable Care Act of 2010 made changes to slow growth in spending. Other changes were aimed at improving Medicaid benefits and improving delivery of care.

Which statement is true about patient classification systems? a. The systems measure all the needs of patients. b. The systems provide an absolute formula for unit staffing. c. The systems should not be used to make patient care assignments because acuity systems are more accurate. d. The systems provide historical data of the usage of nursing time, which is helpful when developing the department budget.

ANS: D A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. It is helpful for developing a department budget. It is not a formula for unit staffing and does not measure all the needs of the patients.

The nurse would identify which of the following as an example of a strategy that represents fiscally responsible clinical nursing practice? a. Begin discharge planning as soon as it is evident when a patient will be discharged. b. Encourage patients to consider being admitted the evening before a major surgical procedure. c. Use unlicensed personnel as much as possible in the delivery of nursing care. d. Accurately document the current status of a patient with regard to the patient's ongoing needs.

ANS: D Documentation that accurately reflects the current status of the patient is critical to the institution obtaining reimbursement for the care of the patient. For example, if there are "no problems" with a patient, then perhaps the patient could be cared for in a less expensive environment. Use of unlicensed personnel is important but only to the extent of their training, and this is not a relevant factor in a great deal of nursing care. Discharge planning considerations should begin when the patient is admitted and not left until the patient is about to be discharged. It would be unnecessary and costly to have the patient admitted the evening before surgery because this would cost an extra day of hospitalization.

A case manager is educating a patient on health care insurance. Which statement by the patient shows that the teaching has been effective? a. "All health care is covered by insurance." b. "Insurance does not cover inpatient hospital stays." c. "All health care coverage is the same." d. All health insurance companies have rules about what services will be covered."

ANS: D The case manager will know that teaching has been effective when the patients states: "All health insurance companies have rules about what services will be covered." Each insurance company is different and will provide different coverage depending on the plan and the patient's preexisting conditions.

Which statement by the nurse is accurate regarding the current health care American's receive? a. "The distribution of services is efficient across the population." b. "The distribution of care is even across the population." c. "Access to care related to income is improving." d. "Many Americans receive care that causes harm."

ANS: D The nurse with an adequate understanding of current health care would state that many Americans receive care that causes harm. The distribution of services is inefficient and uneven across the population, and access to care related to income is worsening.