5
1
9780323415163
A Financial Management Framework 1
Introduction and Overview 3
Chapter Goals 3
Introduction 3
A Financial Management Framework 3
The Health Care Environment 3
Financial Management and Nursing Leadership in the Health Care Organization 4
Key Issues in Applied Economics 4
Quality, Costs, and Financing 5
Financial Accounting 5
Accounting Principles 5
Financial Statement Analysis 6
Cost Analysis 6
Cost Management 6
Determining Health Care Costs and Prices 6
Recruiting and Retaining Staff 7
Planning and Control 7
Strategic Management 7
Budgeting Concepts and Budget Preparation 7
Controlling Operating Results and Variance Analysis 8
Benchmarking, Productivity, and Analysis of Costs 8
Managing Financial Resources 8
Short-Term Financial Resources 9
Long-Term Financial Resources 9
Additional Management Tools 9
Management Information Systems and Computers 9
Forecasting and OtherDecision-Making Methods 9
Marketing 10
The Nurse as Entrepreneur 10
Nursing and Financial Management: Current Issues and Future Directions 10
The Health Care Environment 11
Chapter Goals 11
Introduction 11
The Key Participants in the Health Care System 12
Providers 12
Nurses 12
Physicians 13
Hospitals 14
Government 14
Other Providers 15
Suppliers 15
Consumers 15
Regulators 16
Payers 17
Individual Consumers 17
Insurers 18
Employers 18
Government 19
Financing the Health Care System 19
The Medicare and Medicaid Programs 20
The Insurance System 21
Moral Hazard 22
Coinsurance, Deductibles, and Co-Payments 22
Customary and Reasonable Charges 23
Other Sources of Financing 23
Alternative Payment Approaches 24
Paying Health Care Providers 25
Hospital Payment 25
Cost-Based Reimbursement 25
Charity Care 26
Prospective Payment Systems 26
Negotiated Rates 27
Pay-for-Performance 27
Nurse Payment 28
Physician Payment 29
Home Health Agency Payment 29
Nursing Home Payment 29
Methods Use to Control Payments for Care 30
Managed Care 30
Health Maintenance Organizations 30
Preferred Provider Organizations 31
Point of Service 32
Implications for Nurse Managers 32
Key Concepts 33
Suggested Readings 34
The Role of Financial Management and Nurse Leadership in Health Care Organizations 35
Chapter Goals 35
Introduction 35
The Role of Management 36
The Hierarchy of Health Care Organizations 36
The Top Management Team 37
Line vs. Staff Authority 38
Formal Lines of Authority 39
Informal Lines of Authority 42
Centralized vs. Decentralized Organizations 43
The Role of the CFO and Other Financial Managers 44
The Finance Function 45
The Financial Accounting Function 46
The Managerial Accounting Function 46
Internal Control Function 47
The Role of the CNE in Financial Management 47
The Role of Mid- and First-Level Nurse Managers in Financial Management 48
Transition from Staff Nurse to Nurse Manager 49
The Role of Staff Nurses in Financial Management 50
Interactions Between Fiscal and Nurse Managers 50
Responsibility Accounting 51
Responsibility Centers 52
Incentives and Motivation 52
Power and Politics 53
Networking 53
Implications for Nurse Managers 54
Key Concepts 54
Suggesting Readings 55
Key Issues in Applied Economics 56
Chapter Goals 56
Introduction 56
Fundamental Concepts of Economics 57
Economic Goods 57
Utility 57
Marginal Utility 58
Marginal Cost 58
Savings 58
Supply and Demand 58
Free Enterprise 58
An Example of Supply and Demand 59
Elasticity of Demand 60
Economies of Scale 61
Increasing Returns to Scale 61
Decreasing Returns to Scale 61
Economics and Incentives 62
Market Efficiency 62
Redistribution of Resources 63
Collective Action 63
Equity Improvement 63
Market Failure 63
Government Intervention 63
Lack of Full Information 65
Lack of Direct Patient Payment 65
Monopoly Power 65
Monopsony Power 66
Government-Induced Inefficiency 67
Externalities 67
The Market for Nurses 67
Implications for Nurse Managers 68
Key Concepts 69
Suggesting Readings 70
Quality, Costs, and Financing 71
Chapter Goals 71
Introduction 71
What Is Quality and How Is it Measured? 72
The Impetus for Integrating Quality, Cost, and Financing 75
Quality Reporting 79
Balanced Scorecards 81
The Magnet Movement 82
The Baldridge Award 83
Relationships Among Health Care Quality, Costs, and Financing 84
A Business Case for Quality 86
Implications for Nurse Managers 87
Key Concepts 90
Suggested Readings 91
Financial Accounting 93
Accounting Principles 95
Chapter Goals 95
Introduction 95
The Basic Framework of Accounting 96
The Key Financial Statements 97
The Statement of Financial Position 97
The Operating Statement 98
Accounting Terminology 98
Assets 98
Liabilities and Owners' Equity 100
Revenues and Expenses 102
The Recording and Reporting Process 103
Journal Entries 103
Ledgers 103
Reporting Information 104
Generally Accepted Accounting Principles 104
The Entity Concept 104
Going Concern 105
The Matching Principle and Cash vs. Accrual Accounting 105
The Cost Principle 105
Objective Evidence 105
Materiality 106
Consistency 106
Full Disclosure 106
Fund Accounting 107
Implications for Nurse Managers 107
Key Concepts 108
Suggested Readings 108
Analysis of Financial Statement Information 109
Chapter Goals 109
Introduction 109
The Audit 110
Balance Sheets and Operating Statements 111
The Statement of Cash Flows 111
Statement of Changes in Net Assets or Equity 114
Notes to Financial Statements 115
Ratio Analysis 116
Common Size Ratios 117
Liquidity Ratios 118
Solvency Ratios 119
Efficiency Ratios 121
Profitability Ratios 122
Management Reports 123
Implications for Nurse Managers 124
Key Concepts 124
Suggested Readings 125
Additional Sample Financial Statements 126
Cost Analysis 135
Cost Management 137
Chapter Goals 137
Introduction 137
Basic Cost Concepts 137
Definitions 138
Fixed vs. Variable Costs 140
Cost Graphs and the Relevant Range 141
The Impact of Volume on Cost per Patient 142
Marginal Cost Analysis 143
Relevant Cost Case Study 144
Cost Estimation Techniques 145
Adjusting Costs for Inflation 146
High-Low Cost Estimation 147
Regression Analysis 148
Mixed Costs and Regression Analysis 149
Multiple Regression Analysis 151
Break-Even Analysis 152
Example of Break-Even Analysis 153
Using Break-Even Analysis for Decision-Making 155
Break-Even and Capitation 156
Break-Even Analysis Cautions 156
Implications for Nurse Managers 157
Key Concepts 158
Suggested Readings 159
Determining Health Care Costs and Prices 160
Chapter Goals 160
Introduction 160
Costs for Reporting vs. Costs for Management Control 161
Traditional Cost-Finding Methods 162
The Medicare Step-Down Approach 162
A Detailed Look at the Cost-Finding Approach 163
Accumulate Direct Costs for Each Cost Center 163
Determine Bases for Allocation 163
Allocate from Cost Centers to Revenue Centers 164
Allocate Costs to Units of Service 167
Is Good-Enough Cost Finding Good Enough? 168
Costing Out Nursing Services 168
Solutions to the Costing Problem 170
Why Change the Costing Approach? 173
Should Costing Be Linked to DRGs? 175
Specific Approach to Costing Nursing Services 176
Limitations of the RVU Approach 178
Patient Classification vs. Other Work-Load Measurement 178
Indirect Nursing Costs 179
Staffing Mix 179
Product-Line Costing 179
Direct Care Hours 180
Standard Costs 181
Activity-Based Costing 183
Setting Prices 185
Total Financial Requirements 185
Rate-Setting Approaches 186
Cost-Based Prices 186
Negotiated Prices 186
Market Prices 186
Financial Reimbursement for Nursing Services 187
Pay-for-Performance (P4P) 188
Implications for Nurse Managers 189
Key Concepts 190
Suggested Readings 191
Costs and Other Issues Related to Recruiting and Retaining Staff 193
Chapter Goals 193
Introduction 193
Retaining Staff 194
Nurse Satisfaction 194
Fringe Benefits 195
Retention Programs 196
Clinical Ladders 199
Determining the Cost 199
Recruiting Staff 201
Marketing 201
Recruiting and Retaining "Older" Nurses 203
Use of Alternative Health Care Employees 204
Agency Nurses 204
Foreign Nurse Recruitment 204
Alternative Care Givers 206
The Use of Computers 206
The Nursing Shortage 207
Implications for Nurse Managers 208
Key Concepts 209
Suggested Readings 209
Planning and Control 211
Strategic Management 213
Chapter Goals 213
Introduction 213
Quality Management 214
Strategic Planning 216
The Elements of a Strategic Plan 217
The Mission Statement or Philosophy 217
Statement of Long-Term Goals 218
Statement of Competitive Strategy 218
Statement of Organizational Policies 220
Statement of Needed Resources 220
Statement of Key Assumptions 221
Benefits of the Strategic Planning Process 221
Implementing a Strategic Management Process 222
Long-Range Planning 222
Program Budgeting and Zero-Base Budgeting 223
Zero-Base Budgeting 224
ZBB Case Study: Hemodialysis 225
Ranking Decision Packages 227
Business Plans 227
What Is a Business Plan? 227
Implications for Nurse Managers 228
Key Concepts 229
Suggested Readings 230
Budgeting Concepts 232
Chapter Goals 232
Introduction 232
Types of Budgets 233
Operating Budget 233
Long-Range Budgets 233
Program Budgets 234
Capital Budgets 234
Generation of Capital Budget Proposals 235
Justification of Capital Requests 236
Evaluation of Capital Budget Proposals 237
Product-Line Budgets 238
Cash Budgets 238
Cash Budget Preparation 239
Cash Budget Example 239
Special Purpose Budgets 240
The Budget Process 240
Budget Timetable 241
Statement of Environmental Position 242
General Goals, Objectives, and Policies 242
Organization-Wide Assumptions 242
Specification of Program Priorities 243
Specific, Measurable Operating Objectives 243
Budget Preparation 243
Budget Negotiation and Revision 243
Control and Feedback 244
Implications for Nurse Managers 244
Key Concepts 245
Suggested Readings 246
Time Value of Money 247
Operating Budgets 260
Chapter Goals 260
Introduction 260
Workload Budget 261
Activity Report 262
Adjusting Units of Service 262
Calculating Workload 262
Expense Budget: Personnel Services 263
Average Daily Census and Occupancy Rate 264
Staffing Requirements and Full-Time Equivalents 264
Productive vs. Non-Productive Hours 265
Assignment of Staff by Type and Shift 265
Fixed Staff 267
Converting Staff and FTEs to Positions 267
Calculating FTEs by Type and Shift 267
Establishing Positions 268
Calculating Labor Cost 270
Straight-Time and Overtime Salaries 270
Differentials and Premiums 272
Fringe Benefits 273
Special Situations 274
Expense Budget: Other-than-Personnel Services 274
Budget Submission, Negotiation, and Approval 275
Implementing the Approved Budget 276
Implications for Nurse Mangers 276
Key Concepts 277
Suggested Readings 278
Revenue Budgeting 279
Chapter Goals 279
Introduction 279
The Revenue Budget 280
Why Aren't All Nursing Units Revenue Centers? 280
Why Are Nurse Managers Responsible for a Revenue Budget? 281
The Elements of a Revenue Budget 281
Prices or Rates 281
Volume Estimates 284
Environmental Scan 286
Revenues from Managed Care 286
Capitation vs. Fee-for-Service 286
Money Flows Under Capitation 288
Developing Capitated Rates 288
Setting a Capitation Rate: An Example 289
Incentive Risk Pools 291
Implications for Nurse Managers 291
Key Concepts 292
Suggested Readings 293
Performance Budgeting 294
Chapter Goals 294
Introduction 294
When Is Performance Budgeting Appropriate? 295
The Performance Budgeting Technique 295
Determining Key Performance Areas 295
Technical Steps in Performance Budgeting 295
Performance Budget Example 296
Developing Performance Area Measures 299
Quality of Care 299
Staffing 301
Cost Control 301
Increased Productivity 302
Patient and Staff Satisfaction 302
Innovation and Planning 303
Direct Care 303
Indirect Care 303
Other 303
Multiple Measures 303
Implications for Nurse Managers 304
Key Concepts 305
Suggesting Readings 305
Controlling Operating Results 306
Chapter Goals 306
Introduction 306
The Budget as a Tool for Motivation 306
Motivation and Incentives 308
Motivation and Unrealistic Expectations 309
Communication and Control 309
Using Budgets for Interim Evaluation 309
Variance Analysis 310
Traditional Variance Analysis 311
Unit and Department Variances 312
Line-Item Variances 312
Understanding Variances 312
Flexible or Variable Budgets 314
Flexible Budget Variance Analysis 315
The Volume Variance 315
The Price, or Rate, Variance 316
The Quantity, or Use, Variance 316
Determination of the Causes of Variances 316
The Mechanics of Flexible Budget Variance Analysis 317
Flexible Budget Notation 318
An Example of Volume, Price, and Quantity Variances 319
Revenue Variances 322
Implications for Nurse Managers 326
Key Concepts 327
Suggested Readings 327
Variance Analysis: Examples, Extensions, and Caveats 328
Chapter Goals 328
Introduction 328
Aggregation Problems 328
Exception Reporting 330
Interpretation of Variances 330
Rigid Staffing Patterns 332
Flexible Budgeting and Acuity 334
Fixed vs. Variable Costs 335
Causes of Variances 335
Investigation and Control of Variances 336
Performance Budgets and Variance Analysis 336
Implications for Nurse Managers 338
Key Concepts 339
Suggesting Readings 339
Benchmarking, Productivity, and Cost-Benefit and Cost-Effectiveness Analysis 340
Chapter Goals 340
Introduction 340
Benchmarking 341
Benefits of Benchmarking 347
Benchmarking Approaches 342
The Benchmarking Process 343
Requirements for Successful Benchmarking 344
Productivity 344
Productivity Standards 345
Unit-Costing 345
Unit-Costing and Productivity Standards 348
Productivity Improvement 348
Cost-Benefit and Cost-Effectiveness Analysis 350
Cost-Benefit Analysis 350
Determine Project Goals 351
Estimate Project Benefits 351
Estimate Project Costs 351
Discount Cost and Benefit Flows 351
Complete the Decision Analysis 352
Cost-Effectiveness Analysis 352
Implications for Nurse Managers 352
Key Concepts 354
Suggesting Readings 355
Managing Financial Resources 357
Short-Term Financial Resources 359
Chapter Goals 359
Introduction 359
Current Assets 360
Cash and Marketable Securities 360
Short-Term Cash Investment 361
Cash Flow vs. Revenue and Expense 362
Cash Budgets 362
Maintaining Security over Cash 363
Accounts Receivable 363
Preadmission Data Collection 364
Credit Policies 364
Ongoing Data Collection 364
Discharge Review and Billing 365
Aging of Receivables 365
Cash Receipt and Lock Boxes 366
Inventory 366
Perpetual Inventory 367
Economic Order Quantity 367
Current Liabilities 367
Accounts Payable 368
Payroll Payable 368
Short-Term Debt 369
Taxes Payable 369
Other Payables Made on Behalf of Employees 369
Implications for Nurse Managers 370
Key Concepts 370
Suggested Readings 371
Long-Term Financial Resources 372
Chapter Goals 372
Introduction 372
Equity Sources of Financing 372
Philanthropy 373
Corporate Stock Issuance 374
Government Grants 374
Retained Earnings 375
Debt Sources of Financing 375
Mortgages and Long-Term Notes 375
Leases 376
Bonds 378
Taxable vs. Tax-Free Bonds 379
Bond Ratings and Insurance 381
Zero-Coupon Bonds 381
Debt Refinancing 382
Feasibility Studies 382
The Future of Health Care Financing 383
Implications for Nurse Managers 384
Key Concepts 385
Suggested Readings 385
Additional Management Tools 387
The Use of Computers in Financial Management 389
Chapter Goals 389
Introduction 389
Computer Hardware and Software 389
Uses of Computers 389
General Information Management 390
Clinical Care 390
Financial Management 390
Financial Management Information 390
Special Purpose Software 393
Forecasting 393
Costing 393
Personnel Management 394
Budgeting 395
Acuity Systems 396
Performance Evaluation 398
The Future 398
Implications for Nurse Managers 399
Key Concepts 400
Suggested Readings 400
Forecasting and Other Methods for Decision Making 402
Chapter Goals 402
Introduction 402
Probability Theory: Foundation for Forecasting and Decision Making 403
Quantitative Methods for Forecasting 404
Data Collection 405
Appropriate Data Time Periods 405
What Data Should Be Collected? 406
Graphing Historical Data 407
Analysis of Graphed Data 408
Random Fluctuations 409
Seasonality 410
Trend 410
Seasonality and Trend 411
Forecasting Formulas 412
Random Fluctuations 412
Seasonality 412
Trend 413
Seasonality and Trend 415
Using Computers for Forecasting 416
Qualitative Methods for Forecasting 422
Nominal Group Technique 422
Delphi Technique 422
Other Decision-Making Tools 422
Expected Value 423
Linear Programming 423
Inventory Control 426
Planning and Tracking a Project 428
Gantt Chart 428
Critical Path Method and PERT 428
Implications for Nurse Managers 430
Key Concepts 431
Suggested Readings 432
Marketing 433
Chapter Goals 433
Introduction 433
The Essence of Marketing: Assessing Customer Needs 434
Understanding Customers 435
Why Is Marketing Important for Nurse Managers? 436
Keeping the Organization Current 436
Marketing the Importance of Nursing 437
Marketing Concepts 438
Understanding the Market 438
Market Segmentation 438
Customer Behavior 439
Market Measurement 439
Market Share 440
Market Research 440
Advertising 441
Marketing Plans 441
Organizational Mission/Goals 441
Internal-External Analysis 442
Strategic Marketing Plan 442
The BCG Matrix 446
Life-Cycle Analysis 446
Choice of Strategy 447
Tactics 448
Product 448
Price 449
Place 450
Promotion 451
Marketing Failures 451
The Role of Marketing in Nurse Recruitment 452
Implications for Nurse Managers 452
Key Concepts 453
Suggested Readings 454
The Nurse as Entrepreneur 455
Chapter Goals 455
Introduction 455
Characteristics of Nurse Entrepreneurs 455
Opportunities for Nurse Entrepreneurs 456
Starting Your Own Business 456
Legal and Financial Issues 458
Business Plan 458
The Steps in Developing a Business Plan 459
Project Proposal 459
Product Definition 459
Market Analysis 459
Rough Financial Plan 460
Detailed Operations Plan 460
Detailed Financial Plan 460
Pro Forma Financial Statements 461
Forecasting and Capital Budgeting 467
Sensitivity Analysis 462
Examination of Alternatives 462
The Elements of a Business Plan Package 462
Examples of Entrepreneurs 463
Example 1 463
Example 2 463
Example 3 463
Example 4 463
Key Concepts 464
Suggested Readings 464
The Future 467
Nursing and Financial Management: Current Issues and Future Directions 469
Chapter Goals 469
Introduction 469
Nursing Financial Management Research 469
Current and Future Issues in Financial Management in Nursing 471
The Evolving Role of the Chief Nurse Executive in Financial Management 471
Setting Organizational Policy 472
Continuing Organizational Responsibility for Nursing Expenses 472
Assuming Organizational Responsibility for Nursing Revenues 473
Assuming an Organizational Role in New Ventures 473
Responding to Extraorganizational Changes 473
Government Relations 473
Payer Relations 474
Future Role of First- and Mid-Level Nurse Managers in Financial Management 474
The Nurse as a Policymaker for Financing Health Care 475
Lobbyist 475
Policymaker 475
Implications for Nurse Managers 476
Key Concepts 477
Suggested Readings 477
Glossary 479
Index 503
Financial Management for Nurse Managers and Executives / Edition 5 available in Paperback, eBook
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Financial Management for Nurse Managers and Executives / Edition 5
by Cheryl Jones RN, PhD, Steven A. Finkler PhD, CPA, Christine T. Kovner PhD, RN, FAAN, Jason Mose
Cheryl Jones RN
- ISBN-10:
- 0323415164
- ISBN-13:
- 9780323415163
- Pub. Date:
- 02/20/2018
- Publisher:
- Elsevier Health Sciences
- ISBN-10:
- 0323415164
- ISBN-13:
- 9780323415163
- Pub. Date:
- 02/20/2018
- Publisher:
- Elsevier Health Sciences
![Financial Management for Nurse Managers and Executives / Edition 5](http://img.images-bn.com/static/redesign/srcs/images/grey-box.png?v11.8.5)
Financial Management for Nurse Managers and Executives / Edition 5
by Cheryl Jones RN, PhD, Steven A. Finkler PhD, CPA, Christine T. Kovner PhD, RN, FAAN, Jason Mose
Cheryl Jones RN
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Overview
Learn how financial management fits into the healthcare organization. Financial Management for Nurse Managers and Executives, 5th Edition covers the latest accounting and financial management practices distinctly from the nurse manager’s point of view. Topics include how financial management fits into the health care organization, financial accounting, cost analysis, planning and control management of the organization’s financial resources, various management tools, and the future of financial management with respect to healthcare reform and international accounting standards. This new edition includes updated information on the Affordable Care Act, Accountable Care Organizations, Value Based Payment, and Team and Population Based Care.
- Nursing-focused content thoroughly describes healthcare finance and accounting from the nurse manager’s point of view.
- Numerous worksheets and tables including healthcare spreadsheets, budgets, and calculations provide you with specific examples of how to apply financial management principles to nursing practice.
- NEW! Information about the Affordable Care Act details how changes and developments affects coverage for millions of Americans.
- NEW! Value-Based Payment reimbursement information details what nurse executives need to know in order to use this new system
- NEW! Coverage of Accountable Care Organizations provides current information on one of the emerging forms of managed care and how it works within the financial system of healthcare.
- NEW! Team-and Population-Based care information covers how to work with healthcare professionals outside of nursing.
Product Details
ISBN-13: | 9780323415163 |
---|---|
Publisher: | Elsevier Health Sciences |
Publication date: | 02/20/2018 |
Edition description: | New Edition |
Pages: | 432 |
Sales rank: | 988,030 |
Product dimensions: | 8.40(w) x 10.80(h) x 0.60(d) |
About the Author
Table of Contents
A Financial Management Framework 1
Introduction and Overview 3
Chapter Goals 3
Introduction 3
A Financial Management Framework 3
The Health Care Environment 3
Financial Management and Nursing Leadership in the Health Care Organization 4
Key Issues in Applied Economics 4
Quality, Costs, and Financing 5
Financial Accounting 5
Accounting Principles 5
Financial Statement Analysis 6
Cost Analysis 6
Cost Management 6
Determining Health Care Costs and Prices 6
Recruiting and Retaining Staff 7
Planning and Control 7
Strategic Management 7
Budgeting Concepts and Budget Preparation 7
Controlling Operating Results and Variance Analysis 8
Benchmarking, Productivity, and Analysis of Costs 8
Managing Financial Resources 8
Short-Term Financial Resources 9
Long-Term Financial Resources 9
Additional Management Tools 9
Management Information Systems and Computers 9
Forecasting and OtherDecision-Making Methods 9
Marketing 10
The Nurse as Entrepreneur 10
Nursing and Financial Management: Current Issues and Future Directions 10
The Health Care Environment 11
Chapter Goals 11
Introduction 11
The Key Participants in the Health Care System 12
Providers 12
Nurses 12
Physicians 13
Hospitals 14
Government 14
Other Providers 15
Suppliers 15
Consumers 15
Regulators 16
Payers 17
Individual Consumers 17
Insurers 18
Employers 18
Government 19
Financing the Health Care System 19
The Medicare and Medicaid Programs 20
The Insurance System 21
Moral Hazard 22
Coinsurance, Deductibles, and Co-Payments 22
Customary and Reasonable Charges 23
Other Sources of Financing 23
Alternative Payment Approaches 24
Paying Health Care Providers 25
Hospital Payment 25
Cost-Based Reimbursement 25
Charity Care 26
Prospective Payment Systems 26
Negotiated Rates 27
Pay-for-Performance 27
Nurse Payment 28
Physician Payment 29
Home Health Agency Payment 29
Nursing Home Payment 29
Methods Use to Control Payments for Care 30
Managed Care 30
Health Maintenance Organizations 30
Preferred Provider Organizations 31
Point of Service 32
Implications for Nurse Managers 32
Key Concepts 33
Suggested Readings 34
The Role of Financial Management and Nurse Leadership in Health Care Organizations 35
Chapter Goals 35
Introduction 35
The Role of Management 36
The Hierarchy of Health Care Organizations 36
The Top Management Team 37
Line vs. Staff Authority 38
Formal Lines of Authority 39
Informal Lines of Authority 42
Centralized vs. Decentralized Organizations 43
The Role of the CFO and Other Financial Managers 44
The Finance Function 45
The Financial Accounting Function 46
The Managerial Accounting Function 46
Internal Control Function 47
The Role of the CNE in Financial Management 47
The Role of Mid- and First-Level Nurse Managers in Financial Management 48
Transition from Staff Nurse to Nurse Manager 49
The Role of Staff Nurses in Financial Management 50
Interactions Between Fiscal and Nurse Managers 50
Responsibility Accounting 51
Responsibility Centers 52
Incentives and Motivation 52
Power and Politics 53
Networking 53
Implications for Nurse Managers 54
Key Concepts 54
Suggesting Readings 55
Key Issues in Applied Economics 56
Chapter Goals 56
Introduction 56
Fundamental Concepts of Economics 57
Economic Goods 57
Utility 57
Marginal Utility 58
Marginal Cost 58
Savings 58
Supply and Demand 58
Free Enterprise 58
An Example of Supply and Demand 59
Elasticity of Demand 60
Economies of Scale 61
Increasing Returns to Scale 61
Decreasing Returns to Scale 61
Economics and Incentives 62
Market Efficiency 62
Redistribution of Resources 63
Collective Action 63
Equity Improvement 63
Market Failure 63
Government Intervention 63
Lack of Full Information 65
Lack of Direct Patient Payment 65
Monopoly Power 65
Monopsony Power 66
Government-Induced Inefficiency 67
Externalities 67
The Market for Nurses 67
Implications for Nurse Managers 68
Key Concepts 69
Suggesting Readings 70
Quality, Costs, and Financing 71
Chapter Goals 71
Introduction 71
What Is Quality and How Is it Measured? 72
The Impetus for Integrating Quality, Cost, and Financing 75
Quality Reporting 79
Balanced Scorecards 81
The Magnet Movement 82
The Baldridge Award 83
Relationships Among Health Care Quality, Costs, and Financing 84
A Business Case for Quality 86
Implications for Nurse Managers 87
Key Concepts 90
Suggested Readings 91
Financial Accounting 93
Accounting Principles 95
Chapter Goals 95
Introduction 95
The Basic Framework of Accounting 96
The Key Financial Statements 97
The Statement of Financial Position 97
The Operating Statement 98
Accounting Terminology 98
Assets 98
Liabilities and Owners' Equity 100
Revenues and Expenses 102
The Recording and Reporting Process 103
Journal Entries 103
Ledgers 103
Reporting Information 104
Generally Accepted Accounting Principles 104
The Entity Concept 104
Going Concern 105
The Matching Principle and Cash vs. Accrual Accounting 105
The Cost Principle 105
Objective Evidence 105
Materiality 106
Consistency 106
Full Disclosure 106
Fund Accounting 107
Implications for Nurse Managers 107
Key Concepts 108
Suggested Readings 108
Analysis of Financial Statement Information 109
Chapter Goals 109
Introduction 109
The Audit 110
Balance Sheets and Operating Statements 111
The Statement of Cash Flows 111
Statement of Changes in Net Assets or Equity 114
Notes to Financial Statements 115
Ratio Analysis 116
Common Size Ratios 117
Liquidity Ratios 118
Solvency Ratios 119
Efficiency Ratios 121
Profitability Ratios 122
Management Reports 123
Implications for Nurse Managers 124
Key Concepts 124
Suggested Readings 125
Additional Sample Financial Statements 126
Cost Analysis 135
Cost Management 137
Chapter Goals 137
Introduction 137
Basic Cost Concepts 137
Definitions 138
Fixed vs. Variable Costs 140
Cost Graphs and the Relevant Range 141
The Impact of Volume on Cost per Patient 142
Marginal Cost Analysis 143
Relevant Cost Case Study 144
Cost Estimation Techniques 145
Adjusting Costs for Inflation 146
High-Low Cost Estimation 147
Regression Analysis 148
Mixed Costs and Regression Analysis 149
Multiple Regression Analysis 151
Break-Even Analysis 152
Example of Break-Even Analysis 153
Using Break-Even Analysis for Decision-Making 155
Break-Even and Capitation 156
Break-Even Analysis Cautions 156
Implications for Nurse Managers 157
Key Concepts 158
Suggested Readings 159
Determining Health Care Costs and Prices 160
Chapter Goals 160
Introduction 160
Costs for Reporting vs. Costs for Management Control 161
Traditional Cost-Finding Methods 162
The Medicare Step-Down Approach 162
A Detailed Look at the Cost-Finding Approach 163
Accumulate Direct Costs for Each Cost Center 163
Determine Bases for Allocation 163
Allocate from Cost Centers to Revenue Centers 164
Allocate Costs to Units of Service 167
Is Good-Enough Cost Finding Good Enough? 168
Costing Out Nursing Services 168
Solutions to the Costing Problem 170
Why Change the Costing Approach? 173
Should Costing Be Linked to DRGs? 175
Specific Approach to Costing Nursing Services 176
Limitations of the RVU Approach 178
Patient Classification vs. Other Work-Load Measurement 178
Indirect Nursing Costs 179
Staffing Mix 179
Product-Line Costing 179
Direct Care Hours 180
Standard Costs 181
Activity-Based Costing 183
Setting Prices 185
Total Financial Requirements 185
Rate-Setting Approaches 186
Cost-Based Prices 186
Negotiated Prices 186
Market Prices 186
Financial Reimbursement for Nursing Services 187
Pay-for-Performance (P4P) 188
Implications for Nurse Managers 189
Key Concepts 190
Suggested Readings 191
Costs and Other Issues Related to Recruiting and Retaining Staff 193
Chapter Goals 193
Introduction 193
Retaining Staff 194
Nurse Satisfaction 194
Fringe Benefits 195
Retention Programs 196
Clinical Ladders 199
Determining the Cost 199
Recruiting Staff 201
Marketing 201
Recruiting and Retaining "Older" Nurses 203
Use of Alternative Health Care Employees 204
Agency Nurses 204
Foreign Nurse Recruitment 204
Alternative Care Givers 206
The Use of Computers 206
The Nursing Shortage 207
Implications for Nurse Managers 208
Key Concepts 209
Suggested Readings 209
Planning and Control 211
Strategic Management 213
Chapter Goals 213
Introduction 213
Quality Management 214
Strategic Planning 216
The Elements of a Strategic Plan 217
The Mission Statement or Philosophy 217
Statement of Long-Term Goals 218
Statement of Competitive Strategy 218
Statement of Organizational Policies 220
Statement of Needed Resources 220
Statement of Key Assumptions 221
Benefits of the Strategic Planning Process 221
Implementing a Strategic Management Process 222
Long-Range Planning 222
Program Budgeting and Zero-Base Budgeting 223
Zero-Base Budgeting 224
ZBB Case Study: Hemodialysis 225
Ranking Decision Packages 227
Business Plans 227
What Is a Business Plan? 227
Implications for Nurse Managers 228
Key Concepts 229
Suggested Readings 230
Budgeting Concepts 232
Chapter Goals 232
Introduction 232
Types of Budgets 233
Operating Budget 233
Long-Range Budgets 233
Program Budgets 234
Capital Budgets 234
Generation of Capital Budget Proposals 235
Justification of Capital Requests 236
Evaluation of Capital Budget Proposals 237
Product-Line Budgets 238
Cash Budgets 238
Cash Budget Preparation 239
Cash Budget Example 239
Special Purpose Budgets 240
The Budget Process 240
Budget Timetable 241
Statement of Environmental Position 242
General Goals, Objectives, and Policies 242
Organization-Wide Assumptions 242
Specification of Program Priorities 243
Specific, Measurable Operating Objectives 243
Budget Preparation 243
Budget Negotiation and Revision 243
Control and Feedback 244
Implications for Nurse Managers 244
Key Concepts 245
Suggested Readings 246
Time Value of Money 247
Operating Budgets 260
Chapter Goals 260
Introduction 260
Workload Budget 261
Activity Report 262
Adjusting Units of Service 262
Calculating Workload 262
Expense Budget: Personnel Services 263
Average Daily Census and Occupancy Rate 264
Staffing Requirements and Full-Time Equivalents 264
Productive vs. Non-Productive Hours 265
Assignment of Staff by Type and Shift 265
Fixed Staff 267
Converting Staff and FTEs to Positions 267
Calculating FTEs by Type and Shift 267
Establishing Positions 268
Calculating Labor Cost 270
Straight-Time and Overtime Salaries 270
Differentials and Premiums 272
Fringe Benefits 273
Special Situations 274
Expense Budget: Other-than-Personnel Services 274
Budget Submission, Negotiation, and Approval 275
Implementing the Approved Budget 276
Implications for Nurse Mangers 276
Key Concepts 277
Suggested Readings 278
Revenue Budgeting 279
Chapter Goals 279
Introduction 279
The Revenue Budget 280
Why Aren't All Nursing Units Revenue Centers? 280
Why Are Nurse Managers Responsible for a Revenue Budget? 281
The Elements of a Revenue Budget 281
Prices or Rates 281
Volume Estimates 284
Environmental Scan 286
Revenues from Managed Care 286
Capitation vs. Fee-for-Service 286
Money Flows Under Capitation 288
Developing Capitated Rates 288
Setting a Capitation Rate: An Example 289
Incentive Risk Pools 291
Implications for Nurse Managers 291
Key Concepts 292
Suggested Readings 293
Performance Budgeting 294
Chapter Goals 294
Introduction 294
When Is Performance Budgeting Appropriate? 295
The Performance Budgeting Technique 295
Determining Key Performance Areas 295
Technical Steps in Performance Budgeting 295
Performance Budget Example 296
Developing Performance Area Measures 299
Quality of Care 299
Staffing 301
Cost Control 301
Increased Productivity 302
Patient and Staff Satisfaction 302
Innovation and Planning 303
Direct Care 303
Indirect Care 303
Other 303
Multiple Measures 303
Implications for Nurse Managers 304
Key Concepts 305
Suggesting Readings 305
Controlling Operating Results 306
Chapter Goals 306
Introduction 306
The Budget as a Tool for Motivation 306
Motivation and Incentives 308
Motivation and Unrealistic Expectations 309
Communication and Control 309
Using Budgets for Interim Evaluation 309
Variance Analysis 310
Traditional Variance Analysis 311
Unit and Department Variances 312
Line-Item Variances 312
Understanding Variances 312
Flexible or Variable Budgets 314
Flexible Budget Variance Analysis 315
The Volume Variance 315
The Price, or Rate, Variance 316
The Quantity, or Use, Variance 316
Determination of the Causes of Variances 316
The Mechanics of Flexible Budget Variance Analysis 317
Flexible Budget Notation 318
An Example of Volume, Price, and Quantity Variances 319
Revenue Variances 322
Implications for Nurse Managers 326
Key Concepts 327
Suggested Readings 327
Variance Analysis: Examples, Extensions, and Caveats 328
Chapter Goals 328
Introduction 328
Aggregation Problems 328
Exception Reporting 330
Interpretation of Variances 330
Rigid Staffing Patterns 332
Flexible Budgeting and Acuity 334
Fixed vs. Variable Costs 335
Causes of Variances 335
Investigation and Control of Variances 336
Performance Budgets and Variance Analysis 336
Implications for Nurse Managers 338
Key Concepts 339
Suggesting Readings 339
Benchmarking, Productivity, and Cost-Benefit and Cost-Effectiveness Analysis 340
Chapter Goals 340
Introduction 340
Benchmarking 341
Benefits of Benchmarking 347
Benchmarking Approaches 342
The Benchmarking Process 343
Requirements for Successful Benchmarking 344
Productivity 344
Productivity Standards 345
Unit-Costing 345
Unit-Costing and Productivity Standards 348
Productivity Improvement 348
Cost-Benefit and Cost-Effectiveness Analysis 350
Cost-Benefit Analysis 350
Determine Project Goals 351
Estimate Project Benefits 351
Estimate Project Costs 351
Discount Cost and Benefit Flows 351
Complete the Decision Analysis 352
Cost-Effectiveness Analysis 352
Implications for Nurse Managers 352
Key Concepts 354
Suggesting Readings 355
Managing Financial Resources 357
Short-Term Financial Resources 359
Chapter Goals 359
Introduction 359
Current Assets 360
Cash and Marketable Securities 360
Short-Term Cash Investment 361
Cash Flow vs. Revenue and Expense 362
Cash Budgets 362
Maintaining Security over Cash 363
Accounts Receivable 363
Preadmission Data Collection 364
Credit Policies 364
Ongoing Data Collection 364
Discharge Review and Billing 365
Aging of Receivables 365
Cash Receipt and Lock Boxes 366
Inventory 366
Perpetual Inventory 367
Economic Order Quantity 367
Current Liabilities 367
Accounts Payable 368
Payroll Payable 368
Short-Term Debt 369
Taxes Payable 369
Other Payables Made on Behalf of Employees 369
Implications for Nurse Managers 370
Key Concepts 370
Suggested Readings 371
Long-Term Financial Resources 372
Chapter Goals 372
Introduction 372
Equity Sources of Financing 372
Philanthropy 373
Corporate Stock Issuance 374
Government Grants 374
Retained Earnings 375
Debt Sources of Financing 375
Mortgages and Long-Term Notes 375
Leases 376
Bonds 378
Taxable vs. Tax-Free Bonds 379
Bond Ratings and Insurance 381
Zero-Coupon Bonds 381
Debt Refinancing 382
Feasibility Studies 382
The Future of Health Care Financing 383
Implications for Nurse Managers 384
Key Concepts 385
Suggested Readings 385
Additional Management Tools 387
The Use of Computers in Financial Management 389
Chapter Goals 389
Introduction 389
Computer Hardware and Software 389
Uses of Computers 389
General Information Management 390
Clinical Care 390
Financial Management 390
Financial Management Information 390
Special Purpose Software 393
Forecasting 393
Costing 393
Personnel Management 394
Budgeting 395
Acuity Systems 396
Performance Evaluation 398
The Future 398
Implications for Nurse Managers 399
Key Concepts 400
Suggested Readings 400
Forecasting and Other Methods for Decision Making 402
Chapter Goals 402
Introduction 402
Probability Theory: Foundation for Forecasting and Decision Making 403
Quantitative Methods for Forecasting 404
Data Collection 405
Appropriate Data Time Periods 405
What Data Should Be Collected? 406
Graphing Historical Data 407
Analysis of Graphed Data 408
Random Fluctuations 409
Seasonality 410
Trend 410
Seasonality and Trend 411
Forecasting Formulas 412
Random Fluctuations 412
Seasonality 412
Trend 413
Seasonality and Trend 415
Using Computers for Forecasting 416
Qualitative Methods for Forecasting 422
Nominal Group Technique 422
Delphi Technique 422
Other Decision-Making Tools 422
Expected Value 423
Linear Programming 423
Inventory Control 426
Planning and Tracking a Project 428
Gantt Chart 428
Critical Path Method and PERT 428
Implications for Nurse Managers 430
Key Concepts 431
Suggested Readings 432
Marketing 433
Chapter Goals 433
Introduction 433
The Essence of Marketing: Assessing Customer Needs 434
Understanding Customers 435
Why Is Marketing Important for Nurse Managers? 436
Keeping the Organization Current 436
Marketing the Importance of Nursing 437
Marketing Concepts 438
Understanding the Market 438
Market Segmentation 438
Customer Behavior 439
Market Measurement 439
Market Share 440
Market Research 440
Advertising 441
Marketing Plans 441
Organizational Mission/Goals 441
Internal-External Analysis 442
Strategic Marketing Plan 442
The BCG Matrix 446
Life-Cycle Analysis 446
Choice of Strategy 447
Tactics 448
Product 448
Price 449
Place 450
Promotion 451
Marketing Failures 451
The Role of Marketing in Nurse Recruitment 452
Implications for Nurse Managers 452
Key Concepts 453
Suggested Readings 454
The Nurse as Entrepreneur 455
Chapter Goals 455
Introduction 455
Characteristics of Nurse Entrepreneurs 455
Opportunities for Nurse Entrepreneurs 456
Starting Your Own Business 456
Legal and Financial Issues 458
Business Plan 458
The Steps in Developing a Business Plan 459
Project Proposal 459
Product Definition 459
Market Analysis 459
Rough Financial Plan 460
Detailed Operations Plan 460
Detailed Financial Plan 460
Pro Forma Financial Statements 461
Forecasting and Capital Budgeting 467
Sensitivity Analysis 462
Examination of Alternatives 462
The Elements of a Business Plan Package 462
Examples of Entrepreneurs 463
Example 1 463
Example 2 463
Example 3 463
Example 4 463
Key Concepts 464
Suggested Readings 464
The Future 467
Nursing and Financial Management: Current Issues and Future Directions 469
Chapter Goals 469
Introduction 469
Nursing Financial Management Research 469
Current and Future Issues in Financial Management in Nursing 471
The Evolving Role of the Chief Nurse Executive in Financial Management 471
Setting Organizational Policy 472
Continuing Organizational Responsibility for Nursing Expenses 472
Assuming Organizational Responsibility for Nursing Revenues 473
Assuming an Organizational Role in New Ventures 473
Responding to Extraorganizational Changes 473
Government Relations 473
Payer Relations 474
Future Role of First- and Mid-Level Nurse Managers in Financial Management 474
The Nurse as a Policymaker for Financing Health Care 475
Lobbyist 475
Policymaker 475
Implications for Nurse Managers 476
Key Concepts 477
Suggested Readings 477
Glossary 479
Index 503
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