Chargemasters

Masters of nursing students in my current financial management class are now working on one of their most frustrating assignments: reviewing California hospital chargemasters, and trying to figure out why the prices are so disparate between institutions. I use this assignment as a way to get students started reviewing financial documents, and to see how so much information is still hidden, even when these documents are made public. Later in the semester I'll lecture about concepts hospital administrators use when they set prices (cost-shifting, for example).

Do you have access to your hospital's chargemaster? Is this a resource for you when developing business plans?

Many countries that provide universal health coverage standardize and regulate hospital pricing. This is one area that I have not seen discussed in our current health reform debates. What are your thoughts about the implications of making all US hospital chargemasters public, and requiring greater regulation and standardization of hospital prices?

Jobs!

After teaching the first sessions of my two fall classes, I can share a major concern of entry-level masters of nursing students: jobs.

At least in the San Francisco Bay Area, hospital-based new graduate orientation programs largely ended with the economic downturn beginning the last quarter of 2008. Although the professional nurse population in America is aging, the recession caused many nurses to postpone or come out of retirement, at a time when hospitals may have to cut back related to dwindling profits, or limited public funds.

With Baby Boomers turning 65 beginning in 2011, including a lot of our current nursing workforce, I wonder about ideas for grant proposals or business plans that might help increase employment opportunities for new graduate nurses. Are nurse managers and health care administrators waiting for health reform to kick in?

Palliative care

I'm well aware there's been some unfortunate press about "death panels" related to health reform proposals. Sigh. One of the most timely business plans my students submitted this summer was to train hospital staff nurses on principles of palliative care, to improve their assessment and care planning skills in this important area. With Baby Boomers starting to turn 65 in 2011, isn't it time we started thinking about financial and quality of care implications of end-of-life conditions?

I would welcome thoughts about this issue.

Vascular Catheter Infections

One of the HACs I reviewed in June referred to prevention of vascular catheter related infections. Over the summer, I had a terrific group of CNL (Clinical Nurse Leader) masters of nursing students. Two of the teams prepared business plans that recommended dedicated teams of nurses to start and manage vascular catheters, on medical-surgical units and in the newborn intensive care units (NICUs).

Other than labor, there were few additional costs other than purchasing a portable sonogram to facilitate line placement. With the increased focus on infection prevention and compliance with patient safety provisions, I wonder how many of you are thinking about approaches to this problem, and would be interested in seeing how a business plan might develop around this topic.

The Summer's Over!

It's time to stop putting things off...the fall semester's starting this week, with another course to teach in financial management. I'll have 25 or so graduate nursing students coming up with creative ideas for business plans and grant proposals.

Until I start seeing some comments, it will take a real leap of faith to start posting regularly. However, I'm determined to see whether nursing and other health care managers are interested in learning and discussing about this topic.

At any rate, I'm back from vacation! Let's see where these ideas take us...