Respond 

This sounds very complicated and intensive. It is good that the employees have an understanding of the final budget so they can know their responsibility.

Dr. Strong

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Week 3: Process of Budget Preparation

After exploration of the types of budgets and the processes for their development at your institution. How and from whom is input into the budgets acquired and used? Where does control of the budget lie? What influence do unit and midlevel managers have on the various kinds of budgets?

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Respond

EXPERIENCE

I had been a bedside nurse for 24 years before I transitioned into my current position as an Accreditation Specialist. I have been in my position a little over two years and due to being a bedside nurse I never had to deal with any budgeting issues. My husband tends to all our personally finances. I honestly have to admit, I am not good with money. My husband is so much better in planning and saving for the future, I have more of a spontaneous personality. I paying more attention and asking more questions to my department manager and director in regards to our budget. They have quarterly leadership meeting where our organizations financial information is discussed. After these meetings, my leaders share the information and are willing to answer any of our questions. They want to be transparent to allow us to be educated and knowledgeable in regards to our organization.

REFLECTION

The pre-conceived notion I had of healthcare financial and budgeting principle is of staffing. I did not realize developing a staffing budget consisted of a certain formula. I was unaware of the number of factors related to identifying the full-time equivalents (FTEs) needed to staff a hospital floor. I now understand that an FTE consisted of 2,080 hours/year for a full-time employee. And patient hours are a major factor, the percentage of direct admits from the emergency room (ER). The budget also has to take into consideration the skill mix needed for your organization.

Two concepts that were very interesting to me were the nonprofit and for-profit concepts. They only difference is that non-profit organizations do not pay taxes. For profit hospitals are owned and operated by financial cooperation’s and have access to larger sums of money when needed. Nonprofit organizations are more community oriented and focuses on what the community needs. They are typically in area that are financially well off but that is not the case for the organization I am affiliated with. My community is poor and Medicaid and Medicare are a high percentage of our reimbursement. Quality verses quantity is always a main focus for us. We do not provide a lot of specialty services but what we offer is quality care with the capability to stabilize and transfer to affiliated hospitals. We like to ensure our patients are receiving quality care not matter where they are sent.

IMPLICATIONS FOR THE FUTURE

My proposed project is implementing a sepsis bundle checklist to improve sepsis bundle compliance in the Emergency Department (ED) to improve patient outcomes. This project is not a high cost to the organization. The sepsis bundle checklist can be created by our quality department and once passed through the form committee for approval it can be rolled out for use. The education department will be involved to develop the education for the staff and providers to ensure the checklist is getting implemented correctly. The checklist will be printed in our print shop so each department, mainly ED, will order and charged to their cost center. There are no areas of additional financial or budgeting data that I feel will be affected by this proposal. 

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Respond 

EXPERIENCE

The demographics at the CVAMC is a wide mix of veterans.  We have different levels of service connection, privately insured patients as well as many patients with no other forms of insurance, and a high rate of homeless veterans.  As discussed in the first touchpoint, many of the patients rely on Medicare and the federal government benefits gained through active military service to pay for their healthcare.  With a shared governance delivery system, the VA encourages the patient to have an active hands-on approach with their healthcare, placing the veterans and their families at the forefront of decision making.  While this is easy for the VA to state, its not as easier to perform to the standards, as the constraints of federal funding may pose hinderance on the quality or type of care the veteran may receive.  Currently, the VA uses a volume-based reimbursement system.  As stated previously, it is difficult to navigate the VA reimbursement system, as there are so many different rules and regulations.  There are even regulations on what Medicare (one of the top reimbursements) can reimburse for.  The VA isn’t allowed to receive Medicare payment for the treatment of nonservice-connected medical conditions on enrolled Medicare-eligible veterans, even if their health care is routinely covered under Medicare (American Legion, 2011).  This simple rule is one of many that makes it difficult to place the VA under simply the value or volume-based reimbursement system, but yet, shows that it is appropriate to use a mix of the two in order to be the most fiscally responsible in billing and reimbursement funding. 

REFLECTION

The type and quality of care provided at the VAMC should still be at the optimal level, regardless of where the funding is coming from.  In order to achieve excellence in patient outcomes, the organization must adhere to and follow the mission, vision, and values.  Consistently remembering that the organization exists because of the veterans and their service to our nation is something that can be easily forgotten or overlooked, but is the most important aspect of this business.  Following the American Nurses Credentialing Center’s (ANCC) model for magnet recognition will also be an excellent guide to increasing patient outcomes while maintaining fiscal responsibility.  Excelling in transformational leadership, structural empowerment, exemplary professional practice, learning new knowledge, innovation, & improvements will lead to empirical quality results (American Nurses Credentialing Center (ANCC), (n.d)). 

Strategic management will make goals and objectives for clinical service, determine the resources needed to be allocated to achieving those goals and objectives, and will establish policies for getting and using resources.  Strategies that take into account incentives and responsibilities faced by the veterans who receive care and the payors that reimburse for that care are important to consider when developing relationship building with providing availability to different types of care at the VAMC (Finkler, Jones, & Kovner, 2013). 

IMPLICATIONS FOR THE FUTRUE

Erroneous colorectal cancer screening is a major fiscal hindrance.  Proper screening is an absolute must for facilities to decrease expenditures.  The average cost for colonoscopies as a screening tool is almost four times the amount of a FIT/FOBT test.  Patients that are average or low-risk with no family history should be screened with a FIT/FOBT test for cost effectiveness for both the facility and the patient.  Actual costs of clinical services are highly dependent on the ability to negotiate payment rates with providers, therefore making the actual cost of the clinical services dependent on the provider supply.  Colorectal cancer screening programs incur substantial non-clinical costs, regardless of whether the program is colonoscopy- or FOBT/FIT-based (Subramanian et al., 2017).    

Correct colorectal cancer screening will help eliminate incorrect costs for the CVAMC and the patients.  Even though it is a federal government facility, many patients still pay out of pocket expenses and must submit charges to their private insurance companies.  Appropriate colorectal cancer screening will eliminate erroneous use of staff’s time and the facility’s resources.  Proper colorectal cancer screening will also eliminate stress for the patients and assist with the proper education to the patients.  Adjustments such as teaching methods or timeframes for education of the providers will have to be routinely evaluated, along with the amount of staff available to implement this project.

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 Staffing is one of the largest expenditures for healthcare organizations. It stands to reason that for some organizations a mandatory staffing ratio could negatively impact their financial bottom line. Sometimes ratios can be different within an organization based on acuity of patients or type of unit. Explore your own organization staffing ratio policy. What is/are the ratio(s) and how they are determined? What variables affect the ratios? Have they been mandated by state legislation or organizational policy? How is your operational budget (unit or department) affected by the staffing ratio assigned to it? 

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