Multiple factors contribute to increasing costs for quality healthcare. One key factor in decreasing cost is through prevention and management of chronic diseases. A chronic disease can be defined as a health condition lasting over one year; that either hinders one’s ability to complete activities of daily living or requires continual medical management, or both (CDC, 2018). According to the CDC (2018) approximately one in two adults have been diagnosed with a chronic disease. PBS News hour (2012) further elaborates on how chronic disease accounts for 99% of Medicare spending and approximately 84% of overall health care costs within the United States.

With the population becoming more obese and growing older by the minute comes the need for increased medical care. It has never been more important of a time to educate our patients on risk factors associated with chronic diseases, such as tobacco and alcohol use, lack of physical activity, and poor nutrition (CDC, 2018). Prevention, education, and management of chronic conditions will help improve quality of life for our patients and reduce costs associated with chronic diseases.

References

National Center for Chronic Disease Prevention and Health Promotion. (2018). Health and  economic costs of chronic diseases. CDC.gov. Retrieved from https://www.cdc.gov/ chronicdisease/about/costs/index.htm

PBS New Hour. (2012). Seven factors driving up your health care costs. PBS. Retrieved from https://www.pbs.org/newshour/health/seven-factors-driving-your-health-care-costs

What is quality healthcare? From the provider side of healthcare this question is easy to answer. Evidence-based healthcare practices that provide the highest level of care for the lowest consumer cost, of course. This question is much harder to answer from the patient perspective according to Kash and McKahan (2017). Patient perception of quality is often linked to a patients’ predisposition of cares needed based on their own research or past experiences, regardless of associated risk. Furthermore, validity of patient satisfaction is of question related to the lack of medical knowledge most patients are lacking (Kash and McKahan, 2017).

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is one of several readily available survey frequently used to assess patient satisfaction for entire inpatient visit; covering a wide range of topics including food, provider, comfort and respect (CMS.gov, 2018 and Lavella &Gallan, 2014). This measurement style is known as a quantitative approach via the use of a structured questionnaire. According to Lavella and Gallan (2014) when effective evaluation is noted positive clinical outcomes ensue; such as enhancement of safety, improvement in quality of care, and changes to system processes for the better. All of which apply to the development of a STEMI protocol and monitoring tool. The main purpose of the STEMI protocol is to improve system processes to ensure rapid diagnosis and transfer of patient, thus improving overall safety, quality of care and optimal well-being.

References

CMS.gov. (2017) HCAHPS: Patients’ perspectives of care survey. Retrieved from  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/HospitalQualityInits/Hospital/

Kash, B., McKahan, M. (2017). The evolution of measuring patient satisfaction. Journal of Primary Health Care and General Practice, 1(1): 1-4. Retrieved from https://scientonline.org/open-access/the-evolution-of-measuring-patient-satisfaction.pdf

Lavela,S., & Gallan, A. (2014). Evaluation and measurement of patient experience. Patient Experience Journal, 1(1): 27-36. Retrieved from https://pxjournal.org/cgi/viewpoint.cgi?article=1003&context=journal

What is fraud? According to Penner (2014) fraud occurs when intentional deception is used to obtain something of worth. In healthcare this deception is committed to obtain monies for services not rendered or up coding of patient diagnosis and/or services (Grant-Kels, Kim, & Graff, 2016). The National Health Care Anti-Fraud Association (NHCAA) 2018 is led to believe the majority of health care fraud is committed by a minute number of unethical providers. These unethical providers have belittled the profession and tarnished the trust between provider and patient.

Nursing plays a key factor in ensuring fraud is caught when suspicions arise. According to Penner (2014) the nurse should diligently chart to ensure cares provided are accurately depicted. Remember those days in which our instructors and preceptors continually told us “if it wasn’t charted it wasn’t done”. Well here is a perfect example of why charting is such an important part of patient care. Penner (2014) goes on to add the importance of nurses understanding how and what should be billed.  Lastly, ensuring two patient identifiers are used for verification of patient to avoid identity fraud, as well as, healthcare fraud.

According to the NHCAA healthcare fraud comes with a hefty penalty. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established health care fraud as a federal crime. Large fines, and up to ten years in a federal prison are just some of the rewards one will gain for committing fraud.

References

Grant-Kels, J. M., Kim, A., & Graff, J. (2016). Billing and up coding: What is a doctor-patient to  do? International Journal of Women’s                   Dermatology, 2(4): 149–150.  doi: 10.1016/j.ijwd.2016.08.003

National Health Care Anti-Fraud Association. (2018). The challenge of health-care fraud. Retrieved from                                                                           https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the- challenge-of-health-care-fraud.aspx

Penner, S. J. (2014). Economics and financial management for nurses and nurse leader, (2nd ed.). New York, NY: Springer

Nurses are educated to be good stewards of supplies, resources, items entrusted to us by our organizations. However, we have little to no education of how stewardship and cost go hand in hand.  According to Penner 2014 nurses are well aware of direct costs associated with patient care. These types of costs or charges are visible, such as direct patient care staff and medical supplies needed to provide the care.  For my DNP project a STEMI protocol will be created according to the American Heart Association and American College of Cardiology guidelines for door to balloon. This protocol will include policy initiation, updating of ED chest pain order set, creation of an audit tool that tracks cares completed, speed and staff participating in care. The direct costs identified with this project thus far is patient care staff (mid-level provider and registered nurse staffing Emergency Dept.), medical supplies (medications, oxygen, cardiac monitoring, and IV supplies, etc.), and EMTALA paperwork (EMS, Flight team, Receiving Facility). According to Penner 2014 indirect costs account for support staff and administrative costs. Laboratory, Radiology, and Respiratory Services are essential in quick and accurate diagnosis and contribute to UOS. Environmental Services (EVS) cost, supply chain cost, and n agreed upon budgeted administration fee.

After talking with my chief financial officer Amanda V. the initial cost of project development will be incorporated into the Emergency Department budget in which I currently manage. Research and table top meetings will contribute to much of the budget. Unless, I can get staff to volunteer time I will need to transfer their hours to the ED cost center to eat the cost of their time. EMS, ED providers, respiratory, lab, radiology and ED staff, and sister facility with STEMI protocol currently in place will be included within table top sessions. All supplies needed for implementation will be purchased from staples under our corporate account per CFO.

Sustainment of this project will fall under the Emergency Department. Being the manager will ensure an audit tool is completed for every patient that presents to unit with complaint of chest pain, heaviness in chest, SOB with cardiac history to ensure every patient is receiving up to date evidence-based quality health care. Each month the audit tool will be reviewed. ED providers and staff will be held accountable for care received and or neglected to receive.

References

Mukherjee, D. (2017).  2017 ESC guidelines for the management of STEMI. College of   Cardiology. Retrieved from

https://www.acc.org/latest-in-cardiology/ten-points-to-     remember/2017/09/08/09/32/2017-esc-guidelines-for-the-

management-of-stemi

Penner, S. J. (2014). Economics and financial management for nurses and nurse leaders (2nd ed.). New York, NY: Springer

Wordcloud. (2018). 123RF.

As a manager/staff nurse of a rural Emergency Department I find myself between a rock and a hard place frequently. As a nurse my first obligation is to my patient. My patients receive the level of care they expect, and I stand by their decisions because sometimes we are their only advocate within the healthcare team. As a manger my focus is on admissions, income, revenue, patient satisfaction and so forth. This is where cost-effectiveness analysis (CEA) comes into play. According to the World Health Organization 2018 CEA focuses on finding an intervention the provides the outcome expected for the least amount of monies. Whereas Penner 2013 places more of a focus on comparing and contrasting two or more alternative programs and/or interventions to determine cost verse benefit outcome.

Penner 2013 believe by calculating cost per unit of effectiveness (CE) cost can be minimized by choosing the cheapest intervention for the desired achievement or outcome.To determine the CE value, one would take the cost and divide by the effectiveness (Penner,2013). The question at hand is cost decreased by comparing and contrasting two or more alternatives that all produce the desired outcome. A good example would be to compare three different methods to achieving  infection free laparoscopic Cholecystectomies and the costs associated with each. Once cheapest method determined the sound financial choice would be to go with that option. It is a win-win. The patient is provided with optimal patient care, while the organizational cost is minimized for care being provided.

References

Penner, S. J. (2013). Economics and financial management for nurses and nurse leaders, 2^nd ed. New York, NY: Springer Publishing Company, LLC.

World Health Organization. (2018). Cost-effectiveness analysis for health interventions. Health and Environment Linkages Initiative. Retrieved from http://www.who.int/heli/economics/costeffanalysis/en/

According to Penner 2013 a mission statement is meant to communicate the overall purpose of an organization. While the vision effectively communicates what the organization would like to accomplish (Penner, 2013). According to Centura Health 2018 it has stood by the mission statement handed down from their sponsors Adventist Health System and Catholic Health Initiatives from day one. Their mission statement states, “We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities”. Followed by their new vision statement, which was updated in August of 2018 stated as follows, “Every community, every neighborhood, every life – whole and healthy” (Centura Health, 2018).

My personal values closely align with the mission statement and vision of Centura. I went into nursing to provide holistic care for all. My own vision is to provide quality healthcare for every patient every time. I hope to make a positive difference in the life of every patient I come in contact with.  I moved to rural Kansas with my own mission in mind. I wanted to provide a healing ministry to the underinsured, underserved, and immigrant populations in southwest rural Kansas. Centura and I both have a faith-based foundation, however we choose to serve all, no matter the faith, conviction, or denomination one may or may not have.

Sorry, for the late post. We just bought a house and are in the middle of the transition.

References

Centura Health. 2018. Mission and Values. Centura Health. Retrieved from https://www.centura.org/about-centura/mission-and-

values

Penner, S. J. (2013). Economics and financial management for nurses and nurse leaders. New York: Springer Publishing Company.