efr ch4 measuring_sr2.4

Copyright © Springer Publishing Company, LLC. All Rights Reserved.

CHAPTER 4: MEASURING NURSING CARE• Explain the importance of measuring all values

included in an indicator over the same time period

• Calculate at least three indicators that measure nursing performance

• Differentiate between capacity, utilization, performance, and financial indicators used in settings where nurses provide care

• Justify the measurement of HPPD related to patient acuity levels

1


REPORTING RULES AND CONVENTIONS• Measure, calculate, and report indicators over

the same time period• Use raw data• Round your results using conventions in your

setting• Percents, rates, and ratios are often used• Benchmarks: internal or industry standards• Use reporting methods and formats following the

policies and conventions in your setting

2


INDICATORS MEASURING NURSING CARE• Capacity indicators measure the extent to which a

health care setting can meet consumer demand • Utilization indicators measure the extent of consumer

demand for services in a health care setting• Performance indicators measure how well the health

care setting’s capacity operates in managing utilization • Financial indicators may be attached to capacity,

utilization, or performance indicators to measure the associated monetary values

3


CAPACITY INDICATORS

• Fixed: does not change with volume

• Variable: changes with changes in volume

• Structural– Inpatient beds– Potential patient days

• Staffing– Outpatient: potential

patient visits per provider

– Inpatient: N/P ratio

4


UTILIZATION INDICATORS

• Is utilization generally fixed or variable?• Patient acuity– Case mix index (CMI)– Hours per patient day (HPPD)

• Patient volume or unit of service (UOS)– Outpatient: referrals, self-referrals, visits– Inpatient: admissions, census, average daily

census (ADC), occupancy rate

5


CASE MIX INDEX (CMI) ADJUSTMENTS• Developed by Medicare as part of the Prospective Payment System

(PPS)• Inpatient CMI represents average diagnosis-related group (DRG)

weight for all Medicare patients treated at a specific hospital over a specific time period

• CMI for an "average" hospital is 1.0• The higher the CMI, the greater the complexity of cases requiring

more services and longer LOS– Increases Medicare reimbursement for the same DRG across various hospitals

• Case mix values may also be calculated for home health, LTC, and other settings including Medicaid

• CMI >1.5 is high and typical of teaching institutions that are referred more complex cases

6


VOLUME MEASURES (SERVICE UNITS)Inpatient (IP) settings:• Patient days• Patient discharges • Patient admissions• Outpatient (OP) settings: • Patient visitsOther volume measures:• Procedures (IP or OP)• Other products such as

medications or durable medical equipment (DME)

Interpretation:• Utilization• Access• Market share, consumer

preference• Seasonal or cyclical changes• Change in reimbursement or

regulations• Other unusual events• Some settings report

discharges, others report admissions

7


PERFORMANCE INDICATORS: STAFFING AND PRODUCTIVITY• Staffing indicators– Job positions– Full-time equivalents (FTEs)

• Fixed FTEs: permanent or indirect staffing

• Flexible FTEs: variable or direct staffing

– FTE coverage factor: why and where is it needed?

– Skill mix

• Productivity indicators– Outpatient: visits

managed by the provider

– Inpatient: • Productive hours, direct

care hours, overtime, agency nurse hours

• Nonproductive hours, nonproductive percent

– Procedures: visits, HPUOS

8


PERFORMANCE INDICATORS: PATIENT FLOW• LOS and ALOS• Outliers• Discharges• Bed turns• Bed turnaround time

9


FINANCIAL INDICATORS

Expense:– Fixed expenses– Variable expenses– Operating expenses– Nonoperating expenses– Personnel expenses– Nonpersonnel expenses

Revenue:– Self-pay or out-of-pocket

payments– Payer mix– Global budgeting– Gross revenue– Net revenue– Contractual allowance– Bad debt

10


STAFFING AND PRODUCTIVITY MEASURES

Full-time Equivalent:•1.0 FTE represents 40 hours of work per week x 52 weeks for a year, resulting in 2080 work hours per year•1.0 FTE represents 260 work days per year (2080 work hours per year ÷ 8 work hours per day)•Hourly employment of health care staff, especially nurses

• Paid hours– vs. scheduled hours– Hours actually worked– Overtime and agency hours are

important to measure and monitor• Interpretation:

– Case mix– Staffing policies, management, and

regulations– Staffing mix– Efficiency – Volume

• Annual Salary ~Hourly Wage x 2000

11


COST MEASURES• Operating costs: expenses

related to the generation of goods or services (operations)

• Salaries and wages: non-hourly and hourly employees

• Benefits: health insurance and other

• Supply costs• Medication costs• Charity care is treated as an

expense• Other relevant sources of costs

Interpretation:•Change in costs•Unexpected costs or cost behavior•Cost management•Related to volume and revenue•Other events affecting costs

12


Monthly Statistics Data or Calculation

Staffed Beds Department Data

Discharges (Admissions)Department Data or Patient Days ÷ LOS

Patient DaysDepartment Data or ADC x days in time period

Average Daily Census (ADC)

Patient Days ÷ Days in Period or Occupancy Rate x Staffed Beds

Occupancy Rate ADC ÷ Beds in Service x 100%

Average Length of Stay (ALOS)Total Patient Days ÷ Total Discharges 13


RN Monthly Variance Report Data or Calculation

RN Direct Hours PPDPolicy, regulation, or RN Direct Hours ÷ Patient Days

RN Direct HoursDepartment Data or RN Hours PPD x Patient Days

RN Overtime (OT) HoursDepartment Data or Total Hours x % OT

Total RN Productive Hours Direct Hours + OT Hours

RN OT as % of Total HoursOT Hours ÷ Total RN Hours x 100%

RN FTEs RN Direct Hours ÷ (2080 ÷ 12)

RN FTEs per Occupied Bed FTEs ÷ ADC 14


RN Monthly Variance Report Data or Calculation

RN Direct Hours Cost @ $50.00 per hour wage Direct Hours x Hourly Wage

RN OT @ 150% of Wages OT Hours x Hourly Wage x 1.5

RN Benefits @ 30% of WagesDirect Hours x Hourly Wage x 0.25

Total RN ExpenseDirect Hours Expense + OT Expense + Benefits

RN Expense PPD Total RN Expense ÷ Patient Days 15

efr ch4 measuring_sr2.4

Documents

scheduled hours hours

work hours

report indicators

directcare hours

agency hours areimportant

case mix staffing policies

patient flow los

staffing flexible ftes