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| A Financial Management Framework | |
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| Introduction and Overview | |
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| Chapter Goals | |
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| Introduction | |
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| A Financial Management Framework | |
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| The Health Care Environment | |
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| Financial Management and Nursing Leadership in the Health Care Organization | |
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| Key Issues in Applied Economics | |
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| Quality, Costs, and Financing | |
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| Financial Accounting | |
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| Accounting Principles | |
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| Financial Statement Analysis | |
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| Cost Analysis | |
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| Cost Management | |
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| Determining Health Care Costs and Prices | |
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| Recruiting and Retaining Staff | |
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| Planning and Control | |
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| Strategic Management | |
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| Budgeting Concepts and Budget Preparation | |
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| Controlling Operating Results and Variance Analysis | |
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| Benchmarking, Productivity, and Analysis of Costs | |
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| Managing Financial Resources | |
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| Short-Term Financial Resources | |
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| Long-Term Financial Resources | |
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| Additional Management Tools | |
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| Management Information Systems and Computers | |
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| Forecasting and Other Decision-Making Methods | |
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| Marketing | |
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| The Nurse as Entrepreneur | |
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| Nursing and Financial Management: Current Issues and Future Directions | |
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| The Health Care Environment | |
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| Chapter Goals | |
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| Introduction | |
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| The Key Participants in the Health Care System | |
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| Providers | |
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| Nurses | |
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| Physicians | |
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| Hospitals | |
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| Government | |
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| Other Providers | |
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| Suppliers | |
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| Consumers | |
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| Regulators | |
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| Payers | |
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| Individual Consumers | |
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| Insurers | |
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| Employers | |
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| Government | |
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| Financing the Health Care System | |
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| The Medicare and Medicaid Programs | |
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| The Insurance System | |
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| Moral Hazard | |
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| Coinsurance, Deductibles, and Co-Payments | |
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| Customary and Reasonable Charges | |
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| Other Sources of Financing | |
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| Alternative Payment Approaches | |
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| Paying Health Care Providers | |
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| Hospital Payment | |
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| Cost-Based Reimbursement | |
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| Charity Care | |
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| Prospective Payment Systems | |
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| Negotiated Rates | |
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| Pay-for-Performance | |
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| Nurse Payment | |
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| Physician Payment | |
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| Home Health Agency Payment | |
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| Nursing Home Payment | |
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| Methods Use to Control Payments for Care | |
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| Managed Care | |
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| Health Maintenance Organizations | |
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| Preferred Provider Organizations | |
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| Point of Service | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| The Role of Financial Management and Nurse Leadership in Health Care Organizations | |
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| Chapter Goals | |
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| Introduction | |
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| The Role of Management | |
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| The Hierarchy of Health Care Organizations | |
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| The Top Management Team | |
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| Line vs. Staff Authority | |
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| Formal Lines of Authority | |
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| Informal Lines of Authority | |
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| Centralized vs. Decentralized Organizations | |
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| The Role of the CFO and Other Financial Managers | |
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| The Finance Function | |
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| The Financial Accounting Function | |
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| The Managerial Accounting Function | |
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| Internal Control Function | |
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| The Role of the CNE in Financial Management | |
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| The Role of Mid- and First-Level Nurse Managers in Financial Management | |
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| Transition from Staff Nurse to Nurse Manager | |
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| The Role of Staff Nurses in Financial Management | |
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| Interactions Between Fiscal and Nurse Managers | |
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| Responsibility Accounting | |
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| Responsibility Centers | |
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| Incentives and Motivation | |
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| Power and Politics | |
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| Networking | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggesting Readings | |
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| Key Issues in Applied Economics | |
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| Chapter Goals | |
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| Introduction | |
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| Fundamental Concepts of Economics | |
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| Economic Goods | |
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| Utility | |
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| Marginal Utility | |
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| Marginal Cost | |
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| Savings | |
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| Supply and Demand | |
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| Free Enterprise | |
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| An Example of Supply and Demand | |
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| Elasticity of Demand | |
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| Economies of Scale | |
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| Increasing Returns to Scale | |
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| Decreasing Returns to Scale | |
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| Economics and Incentives | |
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| Market Efficiency | |
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| Redistribution of Resources | |
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| Collective Action | |
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| Equity Improvement | |
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| Market Failure | |
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| Government Intervention | |
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| Lack of Full Information | |
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| Lack of Direct Patient Payment | |
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| Monopoly Power | |
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| Monopsony Power | |
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| Government-Induced Inefficiency | |
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| Externalities | |
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| The Market for Nurses | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggesting Readings | |
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| Quality, Costs, and Financing | |
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| Chapter Goals | |
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| Introduction | |
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| What Is Quality and How Is it Measured? | |
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| The Impetus for Integrating Quality, Cost, and Financing | |
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| Quality Reporting | |
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| Balanced Scorecards | |
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| The Magnet Movement | |
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| The Baldridge Award | |
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| Relationships Among Health Care Quality, Costs, and Financing | |
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| A Business Case for Quality | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Financial Accounting | |
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| Accounting Principles | |
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| Chapter Goals | |
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| Introduction | |
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| The Basic Framework of Accounting | |
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| The Key Financial Statements | |
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| The Statement of Financial Position | |
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| The Operating Statement | |
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| Accounting Terminology | |
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| Assets | |
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| Liabilities and Owners' Equity | |
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| Revenues and Expenses | |
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| The Recording and Reporting Process | |
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| Journal Entries | |
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| Ledgers | |
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| Reporting Information | |
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| Generally Accepted Accounting Principles | |
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| The Entity Concept | |
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| Going Concern | |
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| The Matching Principle and Cash vs. Accrual Accounting | |
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| The Cost Principle | |
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| Objective Evidence | |
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| Materiality | |
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| Consistency | |
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| Full Disclosure | |
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| Fund Accounting | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Analysis of Financial Statement Information | |
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| Chapter Goals | |
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| Introduction | |
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| The Audit | |
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| Balance Sheets and Operating Statements | |
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| The Statement of Cash Flows | |
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| Statement of Changes in Net Assets or Equity | |
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| Notes to Financial Statements | |
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| Ratio Analysis | |
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| Common Size Ratios | |
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| Liquidity Ratios | |
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| Solvency Ratios | |
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| Efficiency Ratios | |
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| Profitability Ratios | |
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| Management Reports | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Additional Sample Financial Statements | |
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| Cost Analysis | |
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| Cost Management | |
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| Chapter Goals | |
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| Introduction | |
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| Basic Cost Concepts | |
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| Definitions | |
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| Fixed vs. Variable Costs | |
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| Cost Graphs and the Relevant Range | |
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| The Impact of Volume on Cost per Patient | |
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| Marginal Cost Analysis | |
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| Relevant Cost Case Study | |
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| Cost Estimation Techniques | |
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| Adjusting Costs for Inflation | |
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| High-Low Cost Estimation | |
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| Regression Analysis | |
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| Mixed Costs and Regression Analysis | |
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| Multiple Regression Analysis | |
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| Break-Even Analysis | |
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| Example of Break-Even Analysis | |
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| Using Break-Even Analysis for Decision-Making | |
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| Break-Even and Capitation | |
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| Break-Even Analysis Cautions | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Determining Health Care Costs and Prices | |
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| Chapter Goals | |
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| Introduction | |
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| Costs for Reporting vs. Costs for Management Control | |
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| Traditional Cost-Finding Methods | |
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| The Medicare Step-Down Approach | |
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| A Detailed Look at the Cost-Finding Approach | |
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| Accumulate Direct Costs for Each Cost Center | |
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| Determine Bases for Allocation | |
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| Allocate from Cost Centers to Revenue Centers | |
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| Allocate Costs to Units of Service | |
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| Is Good-Enough Cost Finding Good Enough? | |
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| Costing Out Nursing Services | |
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| Solutions to the Costing Problem | |
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| Why Change the Costing Approach? | |
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| Should Costing Be Linked to DRGs? | |
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| Specific Approach to Costing Nursing Services | |
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| Limitations of the RVU Approach | |
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| Patient Classification vs. Other Work-Load Measurement | |
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| Indirect Nursing Costs | |
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| Staffing Mix | |
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| Product-Line Costing | |
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| Direct Care Hours | |
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| Standard Costs | |
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| Activity-Based Costing | |
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| Setting Prices | |
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| Total Financial Requirements | |
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| Rate-Setting Approaches | |
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| Cost-Based Prices | |
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| Negotiated Prices | |
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| Market Prices | |
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| Financial Reimbursement for Nursing Services | |
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| Pay-for-Performance (P4P) | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Costs and Other Issues Related to Recruiting and Retaining Staff | |
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| Chapter Goals | |
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| Introduction | |
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| Retaining Staff | |
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| Nurse Satisfaction | |
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| Fringe Benefits | |
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| Retention Programs | |
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| Clinical Ladders | |
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| Determining the Cost | |
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| Recruiting Staff | |
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| Marketing | |
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| Recruiting and Retaining "Older" Nurses | |
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| Use of Alternative Health Care Employees | |
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| Agency Nurses | |
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| Foreign Nurse Recruitment | |
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| Alternative Care Givers | |
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| The Use of Computers | |
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| The Nursing Shortage | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Planning and Control | |
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| Strategic Management | |
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| Chapter Goals | |
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| Introduction | |
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| Quality Management | |
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| Strategic Planning | |
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| The Elements of a Strategic Plan | |
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| The Mission Statement or Philosophy | |
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| Statement of Long-Term Goals | |
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| Statement of Competitive Strategy | |
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| Statement of Organizational Policies | |
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| Statement of Needed Resources | |
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| Statement of Key Assumptions | |
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| Benefits of the Strategic Planning Process | |
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| Implementing a Strategic Management Process | |
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| Long-Range Planning | |
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| Program Budgeting and Zero-Base Budgeting | |
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| Zero-Base Budgeting | |
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| ZBB Case Study: Hemodialysis | |
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| Ranking Decision Packages | |
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| Business Plans | |
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| What Is a Business Plan? | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Budgeting Concepts | |
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| Chapter Goals | |
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| Introduction | |
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| Types of Budgets | |
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| Operating Budget | |
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| Long-Range Budgets | |
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| Program Budgets | |
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| Capital Budgets | |
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| Generation of Capital Budget Proposals | |
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| Justification of Capital Requests | |
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| Evaluation of Capital Budget Proposals | |
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| Product-Line Budgets | |
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| Cash Budgets | |
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| Cash Budget Preparation | |
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| Cash Budget Example | |
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| Special Purpose Budgets | |
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| The Budget Process | |
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| Budget Timetable | |
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| Statement of Environmental Position | |
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| General Goals, Objectives, and Policies | |
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| Organization-Wide Assumptions | |
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| Specification of Program Priorities | |
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| Specific, Measurable Operating Objectives | |
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| Budget Preparation | |
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| Budget Negotiation and Revision | |
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| Control and Feedback | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Time Value of Money | |
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| Operating Budgets | |
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| Chapter Goals | |
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| Introduction | |
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| Workload Budget | |
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| Activity Report | |
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| Adjusting Units of Service | |
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| Calculating Workload | |
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| Expense Budget: Personnel Services | |
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| Average Daily Census and Occupancy Rate | |
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| Staffing Requirements and Full-Time Equivalents | |
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| Productive vs. Non-Productive Hours | |
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| Assignment of Staff by Type and Shift | |
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| Fixed Staff | |
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| Converting Staff and FTEs to Positions | |
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| Calculating FTEs by Type and Shift | |
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| Establishing Positions | |
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| Calculating Labor Cost | |
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| Straight-Time and Overtime Salaries | |
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| Differentials and Premiums | |
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| Fringe Benefits | |
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| Special Situations | |
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| Expense Budget: Other-than-Personnel Services | |
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| Budget Submission, Negotiation, and Approval | |
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| Implementing the Approved Budget | |
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| Implications for Nurse Mangers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Revenue Budgeting | |
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| Chapter Goals | |
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| Introduction | |
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| The Revenue Budget | |
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| Why Aren't All Nursing Units Revenue Centers? | |
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| Why Are Nurse Managers Responsible for a Revenue Budget? | |
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| The Elements of a Revenue Budget | |
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| Prices or Rates | |
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| Volume Estimates | |
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| Environmental Scan | |
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| Revenues from Managed Care | |
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| Capitation vs. Fee-for-Service | |
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| Money Flows Under Capitation | |
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| Developing Capitated Rates | |
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| Setting a Capitation Rate: An Example | |
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| Incentive Risk Pools | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Performance Budgeting | |
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| Chapter Goals | |
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| Introduction | |
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| When Is Performance Budgeting Appropriate? | |
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| The Performance Budgeting Technique | |
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| Determining Key Performance Areas | |
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| Technical Steps in Performance Budgeting | |
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| Performance Budget Example | |
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| Developing Performance Area Measures | |
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| Quality of Care | |
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| Staffing | |
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| Cost Control | |
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| Increased Productivity | |
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| Patient and Staff Satisfaction | |
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| Innovation and Planning | |
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| Direct Care | |
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| Indirect Care | |
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| Other | |
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| Multiple Measures | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggesting Readings | |
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| Controlling Operating Results | |
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| Chapter Goals | |
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| Introduction | |
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| The Budget as a Tool for Motivation | |
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| Motivation and Incentives | |
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| Motivation and Unrealistic Expectations | |
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| Communication and Control | |
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| Using Budgets for Interim Evaluation | |
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| Variance Analysis | |
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| Traditional Variance Analysis | |
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| Unit and Department Variances | |
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| Line-Item Variances | |
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| Understanding Variances | |
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| Flexible or Variable Budgets | |
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| Flexible Budget Variance Analysis | |
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| The Volume Variance | |
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| The Price, or Rate, Variance | |
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| The Quantity, or Use, Variance | |
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| Determination of the Causes of Variances | |
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| The Mechanics of Flexible Budget Variance Analysis | |
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| Flexible Budget Notation | |
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| An Example of Volume, Price, and Quantity Variances | |
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| Revenue Variances | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Variance Analysis: Examples, Extensions, and Caveats | |
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| Chapter Goals | |
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| Introduction | |
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| Aggregation Problems | |
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| Exception Reporting | |
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| Interpretation of Variances | |
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| Rigid Staffing Patterns | |
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| Flexible Budgeting and Acuity | |
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| Fixed vs. Variable Costs | |
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| Causes of Variances | |
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| Investigation and Control of Variances | |
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| Performance Budgets and Variance Analysis | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggesting Readings | |
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| Benchmarking, Productivity, and Cost-Benefit and Cost-Effectiveness Analysis | |
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| Chapter Goals | |
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| Introduction | |
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| Benchmarking | |
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| Benefits of Benchmarking | |
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| Benchmarking Approaches | |
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| The Benchmarking Process | |
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| Requirements for Successful Benchmarking | |
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| Productivity | |
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| Productivity Standards | |
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| Unit-Costing | |
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| Unit-Costing and Productivity Standards | |
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| Productivity Improvement | |
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| Cost-Benefit and Cost-Effectiveness Analysis | |
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| Cost-Benefit Analysis | |
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| Determine Project Goals | |
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| Estimate Project Benefits | |
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| Estimate Project Costs | |
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| Discount Cost and Benefit Flows | |
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| Complete the Decision Analysis | |
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| Cost-Effectiveness Analysis | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggesting Readings | |
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| Managing Financial Resources | |
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| Short-Term Financial Resources | |
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| Chapter Goals | |
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| Introduction | |
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| Current Assets | |
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| Cash and Marketable Securities | |
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| Short-Term Cash Investment | |
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| Cash Flow vs. Revenue and Expense | |
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| Cash Budgets | |
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| Maintaining Security over Cash | |
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| Accounts Receivable | |
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| Preadmission Data Collection | |
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| Credit Policies | |
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| Ongoing Data Collection | |
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| Discharge Review and Billing | |
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| Aging of Receivables | |
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| Cash Receipt and Lock Boxes | |
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| Inventory | |
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| Perpetual Inventory | |
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| Economic Order Quantity | |
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| Current Liabilities | |
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| Accounts Payable | |
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| Payroll Payable | |
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| Short-Term Debt | |
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| Taxes Payable | |
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| Other Payables Made on Behalf of Employees | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Long-Term Financial Resources | |
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| Chapter Goals | |
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| Introduction | |
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| Equity Sources of Financing | |
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| Philanthropy | |
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| Corporate Stock Issuance | |
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| Government Grants | |
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| Retained Earnings | |
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| Debt Sources of Financing | |
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| Mortgages and Long-Term Notes | |
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| Leases | |
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| Bonds | |
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| Taxable vs. Tax-Free Bonds | |
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| Bond Ratings and Insurance | |
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| Zero-Coupon Bonds | |
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| Debt Refinancing | |
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| Feasibility Studies | |
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| The Future of Health Care Financing | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Additional Management Tools | |
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| The Use of Computers in Financial Management | |
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| Chapter Goals | |
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| Introduction | |
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| Computer Hardware and Software | |
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| Uses of Computers | |
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| General Information Management | |
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| Clinical Care | |
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| Financial Management | |
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| Financial Management Information | |
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| Special Purpose Software | |
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| Forecasting | |
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| Costing | |
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| Personnel Management | |
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| Budgeting | |
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| Acuity Systems | |
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| Performance Evaluation | |
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| The Future | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Forecasting and Other Methods for Decision Making | |
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| Chapter Goals | |
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| Introduction | |
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| Probability Theory: Foundation for Forecasting and Decision Making | |
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| Quantitative Methods for Forecasting | |
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| Data Collection | |
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| Appropriate Data Time Periods | |
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| What Data Should Be Collected? | |
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| Graphing Historical Data | |
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| Analysis of Graphed Data | |
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| Random Fluctuations | |
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| Seasonality | |
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| Trend | |
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| Seasonality and Trend | |
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| Forecasting Formulas | |
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| Random Fluctuations | |
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| Seasonality | |
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| Trend | |
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| Seasonality and Trend | |
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| Using Computers for Forecasting | |
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| Qualitative Methods for Forecasting | |
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| Nominal Group Technique | |
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| Delphi Technique | |
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| Other Decision-Making Tools | |
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| Expected Value | |
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| Linear Programming | |
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| Inventory Control | |
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| Planning and Tracking a Project | |
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| Gantt Chart | |
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| Critical Path Method and PERT | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Marketing | |
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| Chapter Goals | |
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| Introduction | |
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| The Essence of Marketing: Assessing Customer Needs | |
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| Understanding Customers | |
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| Why Is Marketing Important for Nurse Managers? | |
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| Keeping the Organization Current | |
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| Marketing the Importance of Nursing | |
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| Marketing Concepts | |
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| Understanding the Market | |
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| Market Segmentation | |
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| Customer Behavior | |
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| Market Measurement | |
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| Market Share | |
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| Market Research | |
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| Advertising | |
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| Marketing Plans | |
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| Organizational Mission/Goals | |
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| Internal-External Analysis | |
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| Strategic Marketing Plan | |
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| The BCG Matrix | |
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| Life-Cycle Analysis | |
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| Choice of Strategy | |
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| Tactics | |
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| Product | |
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| Price | |
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| Place | |
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| Promotion | |
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| Marketing Failures | |
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| The Role of Marketing in Nurse Recruitment | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| The Nurse as Entrepreneur | |
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| Chapter Goals | |
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| Introduction | |
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| Characteristics of Nurse Entrepreneurs | |
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| Opportunities for Nurse Entrepreneurs | |
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| Starting Your Own Business | |
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| Legal and Financial Issues | |
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| Business Plan | |
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| The Steps in Developing a Business Plan | |
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| Project Proposal | |
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| Product Definition | |
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| Market Analysis | |
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| Rough Financial Plan | |
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| Detailed Operations Plan | |
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| Detailed Financial Plan | |
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| Pro Forma Financial Statements | |
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| Forecasting and Capital Budgeting | |
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| Sensitivity Analysis | |
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| Examination of Alternatives | |
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| The Elements of a Business Plan Package | |
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| Examples of Entrepreneurs | |
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| Key Concepts | |
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| Suggested Readings | |
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| The Future | |
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| Nursing and Financial Management: Current Issues and Future Directions | |
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| Chapter Goals | |
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| Introduction | |
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| Nursing Financial Management Research | |
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| Current and Future Issues in Financial Management in Nursing | |
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| The Evolving Role of the Chief Nurse Executive in Financial Management | |
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| Setting Organizational Policy | |
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| Continuing Organizational Responsibility for Nursing Expenses | |
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| Assuming Organizational Responsibility for Nursing Revenues | |
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| Assuming an Organizational Role in New Ventures | |
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| Responding to Extraorganizational Changes | |
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| Government Relations | |
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| Payer Relations | |
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| Future Role of First- and Mid-Level Nurse Managers in Financial Management | |
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| The Nurse as a Policymaker for Financing Health Care | |
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| Lobbyist | |
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| Policymaker | |
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| Implications for Nurse Managers | |
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| Key Concepts | |
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| Suggested Readings | |
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| Glossary | |
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| Index | |