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?

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.

HACs and Business Plans

How are the HAC provisions related to costs?

• added treatment costs, for example, the added cost of a pressure ulcer that develops after hip surgery
  
• increased length of stay
  
• potential fines or litigation
  
• potential accreditation, reputation and referral problems

How are the HAC provisions related to revenues?

• Medicare will withhold additional payment for these conditions if they were not present on admission, resulting in lost revenues.

What about quality?

• The Centers for Medicare and Medicaid (CMS) is proposing additions to the current list of HACs:

Surgical Site Infections Following Elective Procedures:

• Total Knee Replacement


• Laparoscopic Gastric Bypass and Gastroenterostomy


• Ligation and Stripping of Varicose Veins

Legionnaires’ Disease

Glycemic Control:

• Diabetic Ketoacidosis


• Nonketotic Hyperosmolar Coma


• Diabetic Coma


• Hypoglycemic Coma

Iatrogenic Pneumothorax

Delirium

Ventilator-Associated Pneumonia (VAP)

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

Staphylococcus aureus Septicemia

Clostridium difficile-Associated Disease (CDAD)

How does this relate to writing business plans?

If you're trying to make a business case for your idea, showing that you will improve quality, reduce costs and capture revenue makes your plan convincing. We can use HACs (current and proposed) as examples of ideas for business plans.

What this Blog is About

I'm working on a co-authored book to help nurses and other health care professionals write business plans and grant proposals. I teach masters of nursing students how to write these documents, and hope to share this information with nurse managers and others who might find it helpful.

Currently, half of the hospitals in the US have zero profit margins, or are losing money. It's a prime time for health care workers, especially managers, to learn how to generate funds for their departments.

I hope to get ideas about what interests and needs nurses and other professionals have in learning to write business plans and grant proposals, and to share the experience and some of the content of our forthcoming book as we work on it over the coming year.