Question 1

A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week.How many FTEs is this position?

Accepted Answer

Assuming that a full-time RN works 2080 hours/year (40 hours ´ 52 weeks),the nurse works (24 hours ´ 52 weeks + 8 hours ´ 26 weeks)/2080,which is 0.7 FTE.

Question 2

Which of the following factors is not implicated in rising healthcare costs?

Accepted Answer

Unintentional injuries,socioeconomic conditions (e.g.,poverty and violence),marketing of pharmaceuticals,and the rising expectations of consumers with regard to what should be done to manage health concerns all contribute to rising healthcare costs.The costs of Medicare are not considered in relation to rising costs of health care.

Question 3

After a major flu vaccination campaign,an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement.This is an example of which major payment method?

Accepted Answer

Because the agency is submitting costs after the campaign is completed and in accordance with an established schedule of allowable costs,a retrospective,cost-based reimbursement payment method is being utilized.If a desire for profit was indicated,then the answer would be "charges."

Question 4

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care.The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs.Which of the following would most likely prompt the action of administrators?

Accepted Answer

Length of stay (LOS)is the most important predictor of healthcare costs and extra days are a cost to the organization in terms of both the extra days and decreased patient volume.The situation,as outlined,does not indicate that there is a bed shortage and therefore,there is no evidence that other patients are being denied access to services or that additional patient volume is not being captured.The hospital would be concerned about the impact on its income because of the additional,uncompensated care costs incurred for patients who exceed the usual length of stay explicitly calculated under PPS and the DRGs.

Question 5

The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to:

Accepted Answer

Total hours are critical for determining the total number of hours that need to be paid for the year.Productive hours are needed to determine what hours are actually available for patient care.The number of FTEs required is determined by dividing the total patient care hours required by the number of productive hours.

Question 6

In preparing her budget,a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year.Based on a 40-hour week,this means that the nurse manager has determined that the budget will provide for _____ hours.

Accepted Answer

From the information given,it is not possible to determine how many non-productive hours (vacation,holiday,sick time,education)the nurse manager has accounted for in her budget calculations and therefore whether the total number of hours (40 hours ´ 52 weeks ´ 6 staff = 12,480 paid hours)is productive (paid time that is worked)or non-productive hours.12,480 accurately reflects the total number of hours of work paid per year.

Question 7

After reviewing her monthly budget report,the nurse manager sees that she has a negative variance,which prompts her to change the staffing schedule.A negative or unfavorable variance in a monthly expense report may result from:

Accepted Answer

Variance reflects the difference between what was projected and the actual performance in a budget.When the variance is negative or unfavorable,the amount spent is more than what was budgeted (expenses exceed revenue); this may be a result of higher acuity.To help managers interpret and use variance information better,some institutions use flexible budgets that automatically account for census variances.

Question 8

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money.However,with the federal guidelines of paying agencies based on capitation,the chief nursing office faces a challenge.Capitation provides incentives for healthcare providers to control costs by:

Accepted Answer

In a capitated environment,a single fee is paid for all services provided.To be financially viable under this reimbursement model,organizations would be interested in decreasing the volume of services used and increasing the volume of patients.High-technology treatments and second opinions may increase the number of services used.

Question 9

Of the following,which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings?

Accepted Answer

Reducing overtime hours needs to be carefully assessed against the reasons for overtime (e.g.,staff overload,recent illnesses,increased acuity)in terms of whether this reflects an ongoing or temporary situation and therefore whether it is a necessary variance or not.Reducing staff may or may not be effective,depending on the services being provided.Making decisions for the patient misses an important opportunity to invite the patient into discussion about patient priorities and needs and relative costs of options,which may lead to improved adherence with regimens and less waste of resources.An effective approach to cost containment is ensuring that supplies are accurately accounted for and charged in a timely manner.

Question 10

In preparing a budget,the nurse manager needs to anticipate the cost of benefits (e.g.,health,life insurance,pension,and retirement plans).Based on the usual cost of benefits,how much should a nurse manager include for a total full-time salary cost of $312,000?

Accepted Answer

The average cost of benefits is approximately 25% to 30% of a full-time employee's salary.In this example,the correct response is obtained by multiplying the total full-time salary cost by 0.25 and 0.30.

Question 11

An example of an initiative that may reduce total healthcare costs would be:

Accepted Answer

Total healthcare costs are a function of prices that are established for various services and the volume or quantity of services used.Utilization of high-tech diagnostic services and lowering of copayments have been implicated in increasing total healthcare costs (thus C and D would not be correct),as well as attitudes and behaviors of consumers of health care.In general,consumers prefer to "be fixed" when something goes wrong rather than to practice prevention.Many consumers still believe that the physician knows best,so they do not seek much information related to costs and effectiveness of different healthcare options.When information is sought,it is not readily available or understandable.Also,consumers are not accustomed to using other,less costly healthcare providers,such as nurse practitioners.

Question 12

A nurse manager approves two staff nurses to attend a national conference.When reviewing the budget,the nurse manager looks at which line item?

Accepted Answer

The operating budget includes a personnel budget,which takes into account productive and non-productive paid work hours.Education hours are covered under nonproductive paid work hours in the operating budget.

Question 13

Within a healthcare environment,where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services,it is critical for nurse managers to:

Accepted Answer

To achieve and maintain financial viability,nurse managers must be able to think strategically financially and in terms of nursing care.Cutting costs by deleting programs and bringing in additional revenue through new programs and services are not in themselves strategic unless the decisions made lead to quality care,have positive outcomes,and are efficient in terms of cost.

Question 14

Because of the complexity of reimbursement systems and its implications for the services available to patients,the nurse has a key role in:

Accepted Answer

The specific strategies employed by organizations and nurses to contain costs and increase revenues depend on the reimbursement system(s)within which the organization operates and therefore on whether the volume of services is increased or whether the volume of services is decreased by placing greater emphasis on efficacy in each visit and reducing the number of return visits.Because of the complexity of the reimbursement environment,the nurse is placed in a position of advocacy in terms of what the patient needs and how those needs can be best met within the funding structures.

Question 15

The chief nursing office of a Magnet hospital has conducted a study of ways to improve healthcare services.Healthcare services that add value for clients:

Accepted Answer

Models of reimbursement affect which services and approaches (e.g.,decreasing the number of services used)might be financially viable and add value for clients.It is critical to determine and advertise the value of nursing care.Services that add value are of high quality,affect health outcomes positively,and minimize costs.

Question 16

An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs.A.with a fractured hip.Mrs.A.is stable but requires assistance with bathing,transfer,and mobility,and this will present stress for Mr.A.,who was hospitalized with a mild myocardial infarction last year.Considering their means and health concerns,which of the following might be the best option?

Accepted Answer

Custodial nursing care is not covered under Medicare and therefore,the financial burden of this option may cause further stress for the couple.Medicare Part A is an insurance plan for hospital,hospice,home health,and skilled nursing care that is paid for through Social Security.Because Mrs.A.is stable and not terminal,she does not require hospice care.The assistance provided through home care is covered under Medicare and provides assistance for needs such as those of Mrs.A.

Question 17

In preparing her budget,a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year.The nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education and has averaged 3 sick days a year.RN 2 has 6 weeks of vacation,has asked to attend a 3-day conference and a 2-day workshop,and has no history of sick time.RN 3 is new,and you anticipate 3 weeks of orientation,as well as 4 weeks of vacation.RN 4 has 6 weeks of vacation and has an ongoing health condition,so you anticipate 2 weeks of sick time,as well as 3 days for education.RN 5 has 5 weeks of vacation,has no education planned,and averages 5 sick days per year.RN 6 has 6 weeks of vacation,has no educational opportunities planned,and has been off ill for 4 weeks.How many hours of productive paid time can be anticipated for the budget?

Accepted Answer

From the information given,there are 32 weeks of vacation (40 hours ´ 32 weeks = 1280 hours),11 days of education (11 days ´ 8 hours = 88 hours),15 days of orientation (15 days ´ 8 hours = 120 hours),and 18 days of sick time anticipated (18 days ´ 8 hours = 144)or 1280 + 88 + 120 + 144 = 1632 hours of non-productive time.This will leave 10,848 hours of productive time available,based on the information available and the fact that the manager is not anticipating sick time for RN 6 in the upcoming budget year.

Question 18

The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget.A nurse manager can best describe a budget as a:

Accepted Answer

The budget is an overall financial plan that reflects organizational assumptions,objectives,and standards,and various types of budget planning,including operational and capital budgets,which,in turn,reflect revenues and costs.

Question 19

The difference between a nurse practitioner's charge of $45 for an office visit and the insurance company's payment of $34 is:

Accepted Answer

Because the amount that is allowed for an office visit is less than the amount that the NP charges,this is known as a contractual allowance or discount.If the amount allowed were more than what the NP charges,then a profit would be realized.All of the answers represent sources of revenue.

Question 20

In a nurse managers' meeting,the chief nursing officer encourages the managers to brainstorm ways to reduce costs.Nurse managers have the greatest impact on reducing costs by managing:

Accepted Answer

Because staffing constitutes the largest portion of any healthcare budget,managing the mix and numbers of staff required for patient care to meet identified outcomes will have the largest impact on budgets.

Quiz 20: Managing Costs and Budgets