Costing out nursing care

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Rusnak, Mary C.
Ryan, Marilyn E.
Issue Date
Thesis (M.S.)
School of Nursing
Other Identifiers

The spiraling costs of healthcare is a paramount issue in the healthcare arena. Today cost containment programs and budgetary costs affect all hospital departments, especially nursing. The purpose of this study was to identify the current and planned mechanisms in which selected hospitals cost out nursing care. The utilization of patient classification systems and patient care hours has also explored in relation to costing out nursing care. The significance of the study was to establish an information base for hospitals regarding methodologies to cost out nursing care and to describe current methodologies of costing out nursing care in select hospitals. The sample was a convenience sample of 30 hospitals identified as charging for nursing services and utilizing variable billing for nursing services. Thirty questionnaires were mailed. Procedures for the protection of human subject rights were followed. Thirteen questionnaires (43%) were returned with eleven (36%) questionnaires fully completed. The results indicated that approximately one-half (50%) of the hospitals currently bill patients for care actually received based on a patient acuity level. Nursing was primarily responsible for costing out nursing care once the program had been implemented. The costs of nursing care included a variety of items and varied across institutions. The majority (45.5%) included salary, benefits, indirect administrative costs and indirect overhead costs. Almost all the respondents stated the hospital used a patient classification system (91%) and the concept "hours of care" (100%). The majority (54.5%) of the hospitals had patient class systems adopted from another hospital. The time included in hours of care varied greatly between the institutions. Despite the variance, all the facilities related hours of care to acuity levels of the patient classification system either a pre-determined hour of care requirement or an acuity level generated by hours of care determined. Findings from this study concluded that costing out nursing care is a viable method in which the nursing profession can charge for nursing care rendered. The data concerning methodologies to cost out nursing care demonstrated several of the limitations defined in nursing literature, e.g. variations in patient classification systems and variations of items included in hours of care. Therefore the conclusion was that although the majority of respondent hospitals cost out nursing care, the charges vary due to the variation in methodologies. The profession of nursing must work to overcome these variations and make the concept of costing out nursing care a commonly performed practice.