Chapter 19 managing cost and budgets

Which definition by a nurse indicates understanding of a "daily room charge" used by hospitals?

"Bill to insurance based on the relative value of nursing services provided each day"

Match the Medicare plan to the coverage description.

Part A: An insurance plan for the hospital, hospice, home health, and skilled nursing care paid for through Social Security taxes. Nursing home care that is mainly custodial is not covered. Part B: An optional insurance that covers physician services, medical equipment, and diagnostic tests.It is funded through federal taxes and monthly premiums paid by the recipients. Part C:It is not a separate benefit.It allows private health insurance companies to provide Medicare benefits, known as Medicare Advantage Plans. Part D:It offers outpatient drug prescriptions.

Which statement made by a staff member indicates an understanding of the difference between for-profit (FP) and not-for-profit (NFP) organizations?

The government specifies how profits can be used by not-for-profit organizations.

Which information would the manager include when discussing strategies for cost-conscious nursing practice with unit staff? Select all that apply. One, some, or all responses may be correct.

Using time efficiently Evaluating cost-effectiveness of new technologies Using research to evaluate standard nursing practices

Which term is used to describe the quantity or volume of services provided?

Utilization

An individual may have to pay out-of-pocket for which service?

herbal supplements

Which method can assist nurses in capturing charges in a hospital setting to help contain costs? Select all that apply. One, some, or all responses may be correct.

keeping accurate documentation of procedures Knowing the supplies that are to be charged to each patient

Which statement by a nurse indicates an understanding of how capitation has affected nursing services?

"I will do my best with each patient visit to decrease the risk of complications."

Which statement by a nurse demonstrates an understanding of patient care costs and reimbursement?

"Length of stay is the most important predictor of hospital costs." Patients staying extra days cost the hospital a considerable amount. Decreasing LOS allows increasing patient volume and hospital revenues.

Which statement made by nursing staff demonstrates understanding of the structure of an operating budget related to the maximum number of nursing staff needed?

"Nursing staff is a variable cost."

Which healthcare payment system is based on usual and customary charges?

Cost-based

Implementation of a prospective payment system (PPS) with diagnosis-related groups (DRG) has resulted in which outcome? Select all that apply. One, some, or all responses may be correct.

Decreased length of stay (LOS) in hospitals Greater demand for home care Increased need for hospital and community-based nurses

Which goal would the nurse understand to be the major focus of managed care?

Decreasing unnecessary services

Despite rising healthcare costs, which poor outcome continues to occur or worsen in the United States? Select all that apply. One, some, or all responses may be correct.

Disparities in health status related to gender, race, and socioeconomic status High infant mortality rate Increase in violence-related injuries and unintentional injuries

Nurses must consider how nursing practice adds value for patients by providing services with which characteristic? Select all that apply. One, some, or all responses may be correct.

High quality Affect health outcomes positively Financially considerate

Which statement is true of organized delivery systems?

Hospitals, physicians, and payers share the financial risks of the enterprise. Organized delivery systems comprise networks of hospitals, physicians, and insurance companies. These joint ventures aim to collectively develop and market a comprehensive healthcare package that will meet the largest numbers of consumers. Hospitals, physicians, and payers share the financial risks of the enterprise.

Which strategy could reduce costs by making more efficient use of nursing time and the facility's resources?

Identifying a staffing mix that supports delegation of non-nursing tasks

Health maintenance organizations (HMOs) are a type of which healthcare plan?

Managed care system HMOs are a type of managed care system in which the primary physician serves as a gatekeeper who determines what services the patient uses.

Which healthcare delivery reform strategy consists of networks of organizations, providers, and payers?

Organized delivery systems

Which societal problem has increased the volume of health services needed? Select all that apply. One, some, or all responses may be correct.

Obesity Heart disease Homelessness Drug addiction Violence

Which quality is true of the Patient Protection and Affordable Care Act (ACA)?

Preexisting conditions do not disqualify individuals

Which determinants will the nurse manager integrate into the formula when performing the calculation for a break-even analysis (BEA)? Select all that apply. One, some, or all responses may be correct.

Price Fixed cost Variable cost per patient

Which outcome is a possible result of a not-for-profit facility whose revenues exceed expenses? Select all that apply. One, some, or all responses may be correct.

Profit reinvestment Facilities upgrade Service expansion Inflation costs are mitigated

Match the strategy nurses can use to increase revenue with the environment in which that strategy would be effective.

Reduce return visits Capitated Increase the volume of services Fee-for-service Understand the reimbursement methodology Value-based purchasing

Match the factor that contributes to increased use of medical services to the associated description.

Services that do not contribute to the well-being of a patient Unnecessary care Belief that the physician knows the best Consumer attitudes Lack of incentive for consumers to consider charges when choosing among providers Healthcare financing Customers are unaware of the total cost of a medication Increased cost of drugs

Significant healthcare costs impact the economy in which way? Select all that apply. One, some, or all responses may be correct.

There is less funding available for the environment. The price of goods and services is increased, compromising the country's competition in the international marketplace. Funds are diverted from needed social programs, such as housing and education. The healthcare industry is more vulnerable to external influences.

Which statement describes cost-effectiveness?

achieving a specific outcome for the lowest possible cost Cost-effectiveness is achieving a specific outcome for the lowest possible cost.