Posted: February 27th, 2023

DNP- 840 PEER RESPONSES

I need help responding to the attached 3 peers’ posts in 200 words for each. Also, please provide references with each.  

2

DNP-840A Leadership for Advanced Nursing Practice

QUESTION: Describe three factors that impact cost or revenue within your organization. How might these variables impact your DPI Project deliverables?

Shabnampreet Kaur

Feb 16, 2023, 9:50 PM(edited)

There are many factors in the healthcare industry that can impact cost or revenue. Costs or revenue of the overall Healthcare environment is impacted by a growing population, increased longevity, disease prevalence or incidence, medical service utilization by population, service charges or price, technological advancements, lack of information or education among consumers about the use of medical plans, policy and legislation, different payment model, and healthcare staffing shortages. My practice site is a primary care clinic located in urban New York. It is a large multispeciality clinic with offices at four different sites in the state. At my practice site, the factors impacting cost or revenue are direct costs, overhead costs, and the number of clients served/seen(Halladay, 2022). Direct costs are directly associated with patients or particular departments. In this clinic, direct costs are related to the patients. Patients are charged on the basis of visits they have and thus direct costs measure the expenses relating to the specific service provided to the patients at the site. It includes a fee for the practitioner seeing the patient, telehealth visits made to the patient, prescriptions, or lab tests used at the time of service.

The proposed DPI project is based on the use of tai chi in fall prevention, so the direct cost will definitely impact the costs and revenue of the organization by adding a component of patient fall risk screening and assessment. The majority of the patients aged 65 years and above which is the population for the project, have enrolled in managed long-term care, and their costs are being paid by Medicaid and Medicare, so direct costs can create issues in direct payments for these patients. Overhead costs in healthcare are the expenses that are not directly related to the patient’s medical care such as documentation, billing, use of EHR systems, office supplies, staff, and physician’s salaries, benefits rent paid by the site, durable medical equipment, or supplies, and marketing insurance(Bernard, 2022). Since this is a primary care clinic, the average practice overhead can be more than expected which becomes a variable in the DPI project and impacts the DPI project deliverables. The number of clients served by the clinic is another aspect that is impacting the cost or revenue. The primary care clinics’ main goal is to improve public health by providing easy access to healthcare and providing patient advocacy by distributing an equitable care service/ The practice site is very busy in terms of patient volumes. Sometimes the patients are sent to the other units of the clinic, which is an urgent care 3 blocks away from the main clinic to meet the high patient volume. So, the high patient volume can directly impact the cost and revenue within the organization(Smith et al., 2020). More patients mean more money, and the DPI project is a little bit time-consuming since comprehensive fall risk assessment screening and referral to a tai chi evidence-based fall prevention program is altogether a new practice for the organization which will incur time. More time on one patient can lead to a disturbance in the flow of revenues, so this issue needs to be dealt with to improve the delivery of the project at the site. 

Bernard, R., MD. (2022, June 1). Direct care financial realities: What you need to know about income and overhead.
MedicalEconomics.

https://www.medicaleconomics.com/view/direct-care-financial-realities-what-you-need-to-know-about-income-and-overhead

Halladay, J. (2022, August). Understanding the direct and indirect costs of transformation to medical homes.
Agency for Healthcare Research and Quality.

https://www.ahrq.gov/ncepcr/funding/grants/cost/profiles/halladay.html

Smith, V. A., Morgan, P. A., Edelman, D., Woolson, S. L., Berkowitz, T. S., Van Houtven, C. H., Hendrix, C. C., Everett, C. M., White, B. S., & Jackson, G. L. (2020). Utilization and Costs by Primary Care Provider Type.
Medical Care,
58(8), 681–688.

https://doi.org/10.1097/mlr.0000000000001326

Misty Walton

Feb 16, 2023, 3:22 PM

Multiple factors impact costs and revenue within my organization, an extensive non-profit system spanning the southwest and north regions on the east coast. Under the Affordable Care Act, Medicaid and Medicare has expanded coverage in thirty-one states providing more accessible care, preventative care, and educational programs (Sommers & Grubber, 2017). Pricing, inventory, and channels are constantly impacting revenue in healthcare. Costs are being impacted, especially in the current inflation, which is affected by the length of stay, volume, and expenses. The current inflation, also directly impacts the volume, costs, and performance on each unit and area (DeNisco, 2021). An admitting diagnosis-related group (DRG) is provided with a set length of stay for each hospital admission. Then based on the DRG from the admitting diagnosis, the provider enters the anticipated discharge date in the epic and works closely with clinical care management. The average length of stay for total knee arthroplasty is three midnights; for total hip arthroplasty, the length of stay is one point eight (Shah et al., 2019). This attributes to costs and loss of revenue because the increased length of stay costs are not covered by insurance, which also impacts future scheduling and flows within the acute care facility. Pay for performance and technological innovations driving engagement and more patient-centric care may help to mitigate costs and increase revenue (Moro & Morea, 2020).

Applications such as my chart not only engage patients and families in their care but helps care coordination across the continuum of care, including outside organizations. Exploration of ways to control or decrease variable costs for my DPI project will help buy-in from the stakeholders. Minimizing medications and length of stay also driving improved patient experience with pain control is a positive impact. The cost versus the benefits for my DPI project deliverables must ultimately outweigh. The charges will accrue for the education of the teammates, including the equipment needed. Time and patient education during the pre-operative joint class will also increase costs. The educational materials provided to the patient’s families and teams will require approval and costs for print. The loss of music listening equipment that may be damaged or lost must also be considered. As the deliverables are planned for the DPI project, approval must be ahead to maintain forward movement with the DPI project. Orthopedics is a high volume within my facility as the musculoskeletal institute for the region. Impacting pain control helps participation in physical therapy, patient experience scores, and reduction in adverse events from decreased mobility or opiate usage.  

References

DeNisco, S. M. (2021).
Advanced Practice Nursing: Essential Knowledge for the Profession. (4th ed.). Jones & Bartlett. 

Moro Visconti, R., & Morea, D. (2020). Healthcare digitalization and pay-for-performance incentives in innovative hospital project financing.
International Journal of environmental research and public health, 
17(7), 2318. 

Shah, A., Memon, M., Kay, J., Wood, T. J., Tushinski, D. M., & Khanna, V. (2019). Preoperative patient factors affecting the length of stay following total knee arthroplasty: a systematic review and meta-analysis.
The Journal of arthroplasty, 
34(9), 2124-2165. 

Sommers, B. D., & Gruber, J. (2017). Federal funding insulated state budgets from increased spending related to Medicaid expansion.
Health Affairs, 36(5), 938-944. https//doi.org/10.1377/hlthaff.2016.1666 

Bonnie Flores

Feb 16, 2023, 11:24 AM

The organization where my direct practice improvement (DPI) project will take place is a large Health Maintenance Organization (HMO). This is a national organization; however, the project location is in the Southern California region in Los Angeles. The goal of this organization is to provide excellent quality care that focuses on primary health prevention, thus, reducing costs associated with illness (DeNisco, 2021). They provide a variety of health promotion classes on tobacco cessation, healthy eating, and increased physical activity to educate patients and actively promote vaccinations to prevent the disease from occurring (DeNisco, 2021). As with most HMOs, this organization benefits from collecting a monthly fee with limited co-pays. Optimally, they will collect a premium from healthy patients with limited healthcare needs. They lose money with patients who are chronically ill and require care from multiple services. The primary care physicians will assess patients and determine if they need a referral to specialty services. This model helps reduce costs by giving patients what they need rather than what they think they need (DeNisco, 2021). The outpatient profit margin is very high. However, the profit margin decreases once patients are admitted to the hospital. From my own perspective, costs are not spared once admitted to the hospital. Tests that were difficult to obtain in the outpatient setting become much more readily available. The goal is to get patients back to their baseline so they can be discharged, thus reducing costs by reducing the length of stay. Therefore, some factors that impact inpatient costs in the Intensive Care Unit (ICU) are hospital length of stay, medications, diagnostic imaging, and physician and nursing care.

The factors that increase costs are directly related to hospitalizations. Patients in the ICU are critically ill and require specialty care with expensive medications (e.g., sedative and vasopressor drips), blood products, frequent imaging (e.g., daily chest x-rays for intubated patients, CT scans, MRIs), more nurses as the nurse-to-patient ratios are smaller, and multiple medical specialists to care for the patients. Additionally, the longer patients stay immobilized, the higher the prevalence of hospital-acquired pressure injury development, which is non-reimbursable by Medicare (Padula & Delarmente, 2019). Pressure injuries cost the United States healthcare system between $3.3 to $11 billion dollars annually (Padula & Delarmente, 2019). Research shows that while ICU is only 5% of the patients admitted to the hospital, they consume as much as 30% of the hospital budget (Kilic et al., 2019). Therefore, with the implementation of a DPI that has been shown to reduce days on the ventilator, reduce delirium, and reduce the length of stay, the organization and the patient will benefit (Pun et al., 2019). Healthcare resources are finite, and all providers must do their part to reduce waste and minimize costs so there will be enough for all who need it. Implementing doctoral DPIs can potentially provide even greater benefits than we might realize.

References

DeNisco, S. M. (2021). 
Advanced Practice Nursing: Essential Knowledge for the Profession. (4th ed.). Jones & Bartlett.

Kilic, M., Yüzkat, N., Soyalp, C., & Gülhaş, N. (2019). Cost analysis on intensive care unit costs based on the length of stay. 
Turkish journal of anaesthesiology and reanimation, 
47(2), 142.

Padula, W. V. & Delarmente, B. A. (2019). The national cost of hospital‐acquired pressure injuries in the United States. 
International wound journal, 
16(3), 634-640.

Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., Byrum, D., Carson, S. S., Devlin, J. W., Engel, H. J., Esbrook, C. L., Hargett, K. D., Harmon, L., Hielsberg, C., Jackson, J. C., Kelly, T. L., Kumar, V., Millner, L., Morse, A., Perme, C. S., … Ely, E. W. (2019). Caring for critically ill patients with the ABCDEF bundle: Results of the ICU Liberation collaborative in over 15,000 adults. 
Critical Care Medicine, 
47(1), 3–14. https://doi.org/10.1097/CCM.0000000000003482

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298815/