Reply to Peer: Revenue
Week 3 Discussion
To understand the financial aspects of the Advanced Practice Registered Nurse (APRN) practice, one must be able to comprehend the strategies for financial success in the healthcare industry. According to Waxman (2018), the Essentials of Doctoral Education for Advanced Nursing Practice address the financial skills APRNs need in the healthcare delivery system (Waxman, 2018). The assignment for this week’s discussion revolves around contributions to practice, generation of revenue, evaluation of overhead in a practice area, and opportunities to add value and improve patient care quality.
Healthcare financial literacy is essential in addressing the APRNs contributions to the practice and ability to generate revenue. Rick Muller (2013) provides an interesting perspective on understanding the dynamics and choices made in healthcare (Muller, 2013). According to Muller, money flows to areas that generate revenue. Therefore, nurses in practice, management, and executive-level positions must articulate vital financial indicators and finances to influence organizational decisions. Once knowledge is obtained about the language of finance, the APRN is more positioned to develop strategies for financial success.
According to Waxman (2018), the ability to assess the contribution one makes to practice is the most critical skill an APRN can acquire (Waxman, 2018). This aspect determines adequate compensation and sustainability of one’s position. Furthermore, the author states that one needs to track their services over a representative sample of time to assess the worth of practice. For the APRN in clinical practice, the following items are essential in calculating the value of a Nurse Practitioner (NP): identifying the number of times each billing code is used for services per week and determining the rates for those services; determining if the billing is done under the NP’s provider number or the physician’s billing number; and calculating the amount of revenue generated per week to determine the cash flow into the practice (Waxman, 2018).
As a per diem employee in a rural health clinic, this writer utilized the table provided by Waxman to calculate the contributions to practice requested for this assignment. The contributions will be presented hypothetically as the writer cannot obtain the financial information from the clinic to supply real-time data. Utilizing the average reimbursement totals shown in Table 5.4 presented by Waxman, the following information is provided. On average, fifteen (15) patients are seen per week for a total of 60 patients per month.
Percentage of Visits Average Reimbursement per Visit Amount Reimbursement per Week
Problem-focused level 21% of 15=3/week $35 $105
Expanded problem-focused level 33% of 15=5/week $50 $250
Detailed 13% of 15=2/week $75 $150
Comprehensive 33% of 15=5/week $90 $450
Totals 15 visits/week $955
As a per diem employee, this writer works an average of 24 weeks per year. Therefore, the revenue generated is 24 weeks x $955 of reimbursement/week or $22,920 per year. The NP works at this facility pro bono in an effort to maintain clinical hours for recertification and licensure. Therefore, the money generated goes back into the clinic to use as delineated by the owner.
The writer cannot evaluate overhead for this clinic, as the physician was not willing to share this information. However, the following aspects of the practice are to be considered in the evaluation of overhead: salary for one office staff (receptionist); salary for one certified medical assistant; malpractice insurance for the physician, salary for one part-time physician assistant; rent for clinic space; utilities and office supplies, laboratory and medical supplies, telephone and computer expenses, and outsourcing of billing services to a contract agency. Moreover, the clinic does not have an electronic health record (EHR) system. Paper charts continue to be utilized for documentation.
Opportunities for the practice involve incorporating an EHR system for documentation and follow-up of patient diagnostics and care. According to Waxman, improved documentation via the implementation of electronic records will result in an immediate increase in revenue and money available for salary and profits (Waxman, 2018). Another opportunity for the clinic would be to re-evaluate the workflow of the physician, physician assistant, and NP when all three are working together.
DNP-educated nurses are not only functioning in clinical roles but executive leadership positions. As such, they must apply those fundamental concepts of economics to organizations and use business models to reshape healthcare delivery. The policy arena affords this opportunity for APRNs involved in policy review and policy development. Nurse executives’ core business competencies include financial management, human resource management, strategic management, and information and technology management (Nursing, 2018).
References
Muller, R. (2013). Bull’s eye! Hitting the financial knowledge target. Nursing Management, 53-55.
Nursing, D. U. (2018, July 17). The role of business and finance as a DNP-prepared nurse. Retrieved from https://onlinenursing.duq.edu/blog/role-business-finance-dnp-prepared-nurse
Waxman, K. (2018). Financial and business management for the Doctor of Nursing Practice, 2nd ed. New York: Springer Publishing.
Discussion Board Initial Posting Rubric
Discussion Board Initial Posting Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeRelevance to the topic or problem 20 pts
Exemplary
18-20 points. The posting directly addresses key issues, questions, or problems related to the text and the discussion activity. The posting applies course concepts well, connecting them to the actual activity. 17 pts
Satisfactory
15-17 points. The posting addresses key issues, questions or problems related to the text and the discussion activity, but in some cases only indirectly or obliquely. It does not always apply course concepts fully. 0 pts
Unsatisfactory
0-14 points. The posting does not directly address the question or problem posted by the discussion activity.
20 pts
This criterion is linked to a Learning OutcomeInsight and application of course concepts 40 pts
Exemplary
37-40 points. The posting offers original or thoughtful insight, analysis, or observation that demonstrates a strong grasp of concepts and ideas pertaining to the discussion topic. 36 pts
Satisfactory
30-36 points. The posting does offer some insight, analysis, or observation related to the topic, but may not demonstrate a full understanding or knowledge of concepts and ideas pertaining to the discussion topic. 0 pts
Unsatisfactory
0-29 points. The posting does not offer any significant insight, analysis or observation related to the topic. No knowledge or understanding is demonstrated regarding concepts and ideas pertaining to the discussion topic.
40 pts
This criterion is linked to a Learning OutcomeUse of evidence and support 25 pts
Exemplary
23-25 points. The posting supports all claims and opinions with either rational argument or evidence. Evidence is documented with appropriate citations. 22 pts
Satisfactory
19-22 points. The posting generally supports claims and opinions with evidence or argument, but may leave some gaps where unsupported opinions still appear. 0 pts
Unsatisfactory
0-18 points. The posting does not support its claims with either evidence or argument. The posting contains largely unsupported opinion.
25 pts
This criterion is linked to a Learning OutcomeGrammar, Punctuation & APA 15 pts
Exemplary
14-15 points. The posting has less than 3 errors in grammar, Punctuation, and/or APA. 13 pts
Satisfactory
11-13 points. The posting has 3-5 errors in Grammar, Punctuation, and/or APA. 0 pts
Unsatisfactory
0-10 points. The posting has more than 5 errors in Grammar, Punctuation, and/or APA.
15 pts
Total Points: 100
Reply to Peer: Revenue
Doctor of Nursing Practice (DNP) nurses lead change in their organizations by identifying and supporting the implementation of opportunities that add value to revenue generation and improve the quality of patient care. An important area to focus on is the integration of modern technology to advance the quality of healthcare delivery and help healthcare organizations to track the services that they are providing to patients. Such technologies also promote effective billing and enhance time reimbursements (Alotaibi & Federico, 2017). Your discussion highlights an important practice opportunity for nurses related to health technology integration. The opportunity that you have identified in your practice setting involves incorporating an electronic health record (EHR) system for documentation and follow-up of patient diagnostics and care. Waxman (2018) acknowledges the importance of technology-based documentation in enhancing an immediate rise in revenue and money available for profits and salaries. Notably, an increase in the amount of money available for salaries will enable the facility to channel additional funds to meet employee benefits and compensation costs. High payment for employees will increase their satisfaction and engagement thereby improving patient care quality.
Even as doctorally-prepared nurses advocate for the integration of EHR technology into healthcare delivery in your practice setting, they must also identify possible barriers to successful implementation and how to address them. As Reisman (2017) points out, ensuring usability and interoperability of the EHR system is a big challenge experienced by organizations that implement the technology. A EHR system must be able to receive data from other systems and allow a smooth exchange of that information. To address this challenge, doctorally-prepared nurses must collaborate with other stakeholders to ensure effective EHR usability and interoperability.
References
Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
Reisman M. (2017). EHRs: The challenge of making electronic data usable and interoperable. P & T: A Peer-reviewed Journal for Formulary Management, 42(9), 572–575.
Waxman, K. (2018). Financial and business management for the Doctor of Nursing Practice, 2nd ed. New York: Springer Publishing.