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Cost Effectiveness in Patient Care

Like organizations in most industries, those in healthcare are not immune to rising costs. Nurses make up the largest segment of healthcare professionals, so their input may hold the key to curbing spending while upholding quality patient care. Nurses enrolled in a Master of Science in Nursing Administration (MSN) program gain knowledge and skills to meet the financial challenges inherent to nursing.

What Is the State of Healthcare in the United States?

When it comes to cost effectiveness in healthcare, the U.S. is at a disadvantage compared to other countries. The high cost of healthcare in the U.S. does not translate to better care.

“Not only does the U.S. fare worse in terms of infant mortality and life expectancy than other developed nations, it also tops the list for deaths that are considered preventable with timely and appropriate treatment,” according to the Commonwealth Fund article Better Care at Lower Cost: Is It Possible?

The cost of healthcare continues to rise. The Associated Press article, $10,345 Per Person: U.S. Health Care Spending Reaches New Peak predicts that healthcare costs “will grow at a faster rate than the national economy over the coming decade.”

Healthcare relies on receiving payment from a combination of payers such as insurance companies, government agencies like Medicare and Medicaid, and patients. Some healthcare costs remain unpaid because patients do not have insurance.

As it stands, healthcare providers in the U.S. receive payment based on the volume of patient care they deliver rather than for the delivery of strictly necessary treatment. This is considered a fee-for-service system because providers receive payment for such things as office visits, lab tests and procedures. These services are covered regardless of whether or not a patient really needs them. In some cases, unnecessary testing and surgeries may not help a patient and could even be harmful.

Another reason for increased costs is uncoordinated care. Problems arise when patients are shuffled between primary care physicians, specialists, nurses and other healthcare professionals. Under these circumstances, patients may undergo the same lab tests multiple times or receive prescriptions for a combination of medications that cause severe reactions. The practice of keeping patients in constant transition from hospitals to rehabilitation centers to home care can lead to higher costs and poor care.

What Is the Nurse Administrator’s Role?

Nurse administrators who educate their nursing staff about ways to cut costs can make a difference to the financial stability of their healthcare organization. Nurses with knowledge of the financial and budgeting concerns of their employer have a greater understanding of the importance of reducing costs while caring for patients.

The nurse administrator needs to consider and monitor operating costs such as staffing, activities, and supplies and other items used in the nursing unit. A reduction in overstaffing, excessive overtime and waste of supplies can result in cost effectiveness.

With the support of nurses, nurse administrators can ensure that they are meeting reimbursement requirements, which rely on good patient care outcomes and positive satisfaction ratings. Medicare reimbursement is also denied if patients are readmitted within 30 days of leaving the hospital, so it is imperative that nurses provide optimal care and carefully instruct patients on post-discharge healthcare regimens. In addition, nurses have to be vigilant about situations occurring that Medicare deems “never events.” These cases include pressure ulcers, falls and infections that develop during a patient’s hospital stay.

Can a Balance of Cost Effectiveness and Quality Patient Care Exist?

Nurses can help healthcare organizations deliver cost-effective, high-quality patient care. Open discussions between nurse administrators and nurses regarding finances can promote an efficient working environment in healthcare.

Nurses can identify non-essential costs because of their daily interactions with patients. They are the best resource administrators have for gaining knowledge on how to properly care for patients while eliminating wasteful expenditures.

How Can Nurses Become Effective Nurse Administrators?

Nurses who want to take on a leadership role in nursing should learn about the financial aspect of healthcare in both academic and clinical settings. Lamar University offers an online MSN in Nursing Administration program. The online MSN program includes strategies for improving cost-effectiveness while maintaining quality patient care.

Students will explore ways to analyze human resources and create budgets, as well as examine skills that apply to leadership positions. The online MSN program includes courses such as Healthcare Policy and Finance, Directing and Controlling Healthcare, and Advanced Accounting.

Healthcare is a business whether the organization is for-profit, nonprofit or publicly financed. The flux in the healthcare payment system requires nurses and nurse administrators to be financially aware of expenses and to follow protocols. Nurses who push for improvements in delivery of patient care may also improve an organization’s cost effectiveness, so fostering this link may result in healthcare organizations increasing their revenue.

Learn more about Lamar University’s Master of Science in Nursing in Nursing Administration online.


American Nurse Today: The Business of Caring: What Every Nurse Should Know About Cutting Costs

Health Leaders Media: Nurses Can’t Afford to Ignore Healthcare Costs

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