Financial Management for Nurse Managers and Executives / Edition 2

Financial Management for Nurse Managers and Executives / Edition 2

by Steven A. Finkler, Christine Tassone Kovner, Christine T. Kovner
     
 

ISBN-10: 0721677142

ISBN-13: 9780721677149

Pub. Date: 12/03/1999

Publisher: Elsevier Health Sciences

A clear understanding of budgeting and finance will help you prepare to be an effective nurse manager. This book explains what you need to know! It covers essential tools and techniques, including accounting principles, cost analysis, and managing resources. In addition to coverage of the latest issues and trends, this book provides concrete examples to help you apply

Overview

A clear understanding of budgeting and finance will help you prepare to be an effective nurse manager. This book explains what you need to know! It covers essential tools and techniques, including accounting principles, cost analysis, and managing resources. In addition to coverage of the latest issues and trends, this book provides concrete examples to help you apply financial concepts to the real world.

Inside you'll find: Four New chapters: Quality, Costs, and Financing, Revenue Budgeting, Variance Analysis: Examples, Extensions, and Caveats, Benchmarking, Productivity, and Cost-Benefit and Cost-Effectiveness Analysis. Coverage of the new Medicare prescription bill and its impact on health care management. A discussion of the transition from the role of bedside or staff nurse to the role of nurse manager and nurse executive, Updated information on nursing shortages and staff recruiting and retention, A focus on health financing and the computer software used in accurate budgeting and forecasting, A comprehensive glossary with all key terms.

Product Details

ISBN-13:
9780721677149
Publisher:
Elsevier Health Sciences
Publication date:
12/03/1999
Edition description:
Older Edition
Pages:
518
Product dimensions:
7.42(w) x 10.44(h) x 1.12(d)

Table of Contents


A Financial Management Framework     1
Introduction and Overview     3
Chapter Goals     3
Introduction     3
A Financial Management Framework     3
The Health Care Environment     3
Financial Management and Nursing Leadership in the Health Care Organization     4
Key Issues in Applied Economics     4
Quality, Costs, and Financing     5
Financial Accounting     5
Accounting Principles     5
Financial Statement Analysis     6
Cost Analysis     6
Cost Management     6
Determining Health Care Costs and Prices     6
Recruiting and Retaining Staff     7
Planning and Control     7
Strategic Management     7
Budgeting Concepts and Budget Preparation     7
Controlling Operating Results and Variance Analysis     8
Benchmarking, Productivity, and Analysis of Costs     8
Managing Financial Resources     8
Short-Term Financial Resources     9
Long-Term Financial Resources     9
Additional Management Tools     9
Management Information Systems and Computers     9
Forecasting and OtherDecision-Making Methods     9
Marketing     10
The Nurse as Entrepreneur     10
Nursing and Financial Management: Current Issues and Future Directions     10
The Health Care Environment     11
Chapter Goals     11
Introduction     11
The Key Participants in the Health Care System     12
Providers     12
Nurses     12
Physicians     13
Hospitals     14
Government     14
Other Providers     15
Suppliers     15
Consumers     15
Regulators     16
Payers     17
Individual Consumers     17
Insurers     18
Employers     18
Government     19
Financing the Health Care System     19
The Medicare and Medicaid Programs     20
The Insurance System     21
Moral Hazard     22
Coinsurance, Deductibles, and Co-Payments     22
Customary and Reasonable Charges     23
Other Sources of Financing     23
Alternative Payment Approaches     24
Paying Health Care Providers      25
Hospital Payment     25
Cost-Based Reimbursement     25
Charity Care     26
Prospective Payment Systems     26
Negotiated Rates     27
Pay-for-Performance     27
Nurse Payment     28
Physician Payment     29
Home Health Agency Payment     29
Nursing Home Payment     29
Methods Use to Control Payments for Care     30
Managed Care     30
Health Maintenance Organizations     30
Preferred Provider Organizations     31
Point of Service     32
Implications for Nurse Managers     32
Key Concepts     33
Suggested Readings     34
The Role of Financial Management and Nurse Leadership in Health Care Organizations     35
Chapter Goals     35
Introduction     35
The Role of Management     36
The Hierarchy of Health Care Organizations     36
The Top Management Team     37
Line vs. Staff Authority     38
Formal Lines of Authority     39
Informal Lines of Authority     42
Centralized vs. Decentralized Organizations     43
The Role of the CFO and Other Financial Managers     44
The Finance Function     45
The Financial Accounting Function     46
The Managerial Accounting Function     46
Internal Control Function     47
The Role of the CNE in Financial Management     47
The Role of Mid- and First-Level Nurse Managers in Financial Management     48
Transition from Staff Nurse to Nurse Manager     49
The Role of Staff Nurses in Financial Management     50
Interactions Between Fiscal and Nurse Managers     50
Responsibility Accounting     51
Responsibility Centers     52
Incentives and Motivation     52
Power and Politics     53
Networking     53
Implications for Nurse Managers     54
Key Concepts     54
Suggesting Readings     55
Key Issues in Applied Economics     56
Chapter Goals     56
Introduction     56
Fundamental Concepts of Economics     57
Economic Goods     57
Utility     57
Marginal Utility     58
Marginal Cost     58
Savings     58
Supply and Demand      58
Free Enterprise     58
An Example of Supply and Demand     59
Elasticity of Demand     60
Economies of Scale     61
Increasing Returns to Scale     61
Decreasing Returns to Scale     61
Economics and Incentives     62
Market Efficiency     62
Redistribution of Resources     63
Collective Action     63
Equity Improvement     63
Market Failure     63
Government Intervention     63
Lack of Full Information     65
Lack of Direct Patient Payment     65
Monopoly Power     65
Monopsony Power     66
Government-Induced Inefficiency     67
Externalities     67
The Market for Nurses     67
Implications for Nurse Managers     68
Key Concepts     69
Suggesting Readings     70
Quality, Costs, and Financing     71
Chapter Goals     71
Introduction     71
What Is Quality and How Is it Measured?     72
The Impetus for Integrating Quality, Cost, and Financing     75
Quality Reporting     79
Balanced Scorecards     81
The Magnet Movement     82
The Baldridge Award     83
Relationships Among Health Care Quality, Costs, and Financing     84
A Business Case for Quality     86
Implications for Nurse Managers     87
Key Concepts     90
Suggested Readings     91
Financial Accounting     93
Accounting Principles     95
Chapter Goals     95
Introduction     95
The Basic Framework of Accounting     96
The Key Financial Statements     97
The Statement of Financial Position     97
The Operating Statement     98
Accounting Terminology     98
Assets     98
Liabilities and Owners' Equity     100
Revenues and Expenses     102
The Recording and Reporting Process     103
Journal Entries     103
Ledgers     103
Reporting Information     104
Generally Accepted Accounting Principles     104
The Entity Concept     104
Going Concern     105
The Matching Principle and Cash vs. Accrual Accounting     105
The Cost Principle      105
Objective Evidence     105
Materiality     106
Consistency     106
Full Disclosure     106
Fund Accounting     107
Implications for Nurse Managers     107
Key Concepts     108
Suggested Readings     108
Analysis of Financial Statement Information     109
Chapter Goals     109
Introduction     109
The Audit     110
Balance Sheets and Operating Statements     111
The Statement of Cash Flows     111
Statement of Changes in Net Assets or Equity     114
Notes to Financial Statements     115
Ratio Analysis     116
Common Size Ratios     117
Liquidity Ratios     118
Solvency Ratios     119
Efficiency Ratios     121
Profitability Ratios     122
Management Reports     123
Implications for Nurse Managers     124
Key Concepts     124
Suggested Readings     125
Additional Sample Financial Statements     126
Cost Analysis     135
Cost Management     137
Chapter Goals      137
Introduction     137
Basic Cost Concepts     137
Definitions     138
Fixed vs. Variable Costs     140
Cost Graphs and the Relevant Range     141
The Impact of Volume on Cost per Patient     142
Marginal Cost Analysis     143
Relevant Cost Case Study     144
Cost Estimation Techniques     145
Adjusting Costs for Inflation     146
High-Low Cost Estimation     147
Regression Analysis     148
Mixed Costs and Regression Analysis     149
Multiple Regression Analysis     151
Break-Even Analysis     152
Example of Break-Even Analysis     153
Using Break-Even Analysis for Decision-Making     155
Break-Even and Capitation     156
Break-Even Analysis Cautions     156
Implications for Nurse Managers     157
Key Concepts     158
Suggested Readings     159
Determining Health Care Costs and Prices     160
Chapter Goals     160
Introduction     160
Costs for Reporting vs. Costs for Management Control     161
Traditional Cost-Finding Methods     162
The Medicare Step-Down Approach     162
A Detailed Look at the Cost-Finding Approach     163
Accumulate Direct Costs for Each Cost Center     163
Determine Bases for Allocation     163
Allocate from Cost Centers to Revenue Centers     164
Allocate Costs to Units of Service     167
Is Good-Enough Cost Finding Good Enough?     168
Costing Out Nursing Services     168
Solutions to the Costing Problem     170
Why Change the Costing Approach?     173
Should Costing Be Linked to DRGs?     175
Specific Approach to Costing Nursing Services     176
Limitations of the RVU Approach     178
Patient Classification vs. Other Work-Load Measurement     178
Indirect Nursing Costs     179
Staffing Mix     179
Product-Line Costing     179
Direct Care Hours     180
Standard Costs     181
Activity-Based Costing     183
Setting Prices     185
Total Financial Requirements     185
Rate-Setting Approaches     186
Cost-Based Prices     186
Negotiated Prices     186
Market Prices     186
Financial Reimbursement for Nursing Services     187
Pay-for-Performance (P4P)     188
Implications for Nurse Managers     189
Key Concepts     190
Suggested Readings     191
Costs and Other Issues Related to Recruiting and Retaining Staff     193
Chapter Goals     193
Introduction     193
Retaining Staff     194
Nurse Satisfaction     194
Fringe Benefits     195
Retention Programs     196
Clinical Ladders     199
Determining the Cost     199
Recruiting Staff     201
Marketing     201
Recruiting and Retaining "Older" Nurses     203
Use of Alternative Health Care Employees     204
Agency Nurses     204
Foreign Nurse Recruitment     204
Alternative Care Givers     206
The Use of Computers     206
The Nursing Shortage     207
Implications for Nurse Managers     208
Key Concepts     209
Suggested Readings     209
Planning and Control     211
Strategic Management     213
Chapter Goals     213
Introduction      213
Quality Management     214
Strategic Planning     216
The Elements of a Strategic Plan     217
The Mission Statement or Philosophy     217
Statement of Long-Term Goals     218
Statement of Competitive Strategy     218
Statement of Organizational Policies     220
Statement of Needed Resources     220
Statement of Key Assumptions     221
Benefits of the Strategic Planning Process     221
Implementing a Strategic Management Process     222
Long-Range Planning     222
Program Budgeting and Zero-Base Budgeting     223
Zero-Base Budgeting     224
ZBB Case Study: Hemodialysis     225
Ranking Decision Packages     227
Business Plans     227
What Is a Business Plan?     227
Implications for Nurse Managers     228
Key Concepts     229
Suggested Readings     230
Budgeting Concepts     232
Chapter Goals     232
Introduction     232
Types of Budgets     233
Operating Budget     233
Long-Range Budgets     233
Program Budgets      234
Capital Budgets     234
Generation of Capital Budget Proposals     235
Justification of Capital Requests     236
Evaluation of Capital Budget Proposals     237
Product-Line Budgets     238
Cash Budgets     238
Cash Budget Preparation     239
Cash Budget Example     239
Special Purpose Budgets     240
The Budget Process     240
Budget Timetable     241
Statement of Environmental Position     242
General Goals, Objectives, and Policies     242
Organization-Wide Assumptions     242
Specification of Program Priorities     243
Specific, Measurable Operating Objectives     243
Budget Preparation     243
Budget Negotiation and Revision     243
Control and Feedback     244
Implications for Nurse Managers     244
Key Concepts     245
Suggested Readings     246
Time Value of Money     247
Operating Budgets     260
Chapter Goals     260
Introduction     260
Workload Budget     261
Activity Report     262
Adjusting Units of Service     262
Calculating Workload     262
Expense Budget: Personnel Services     263
Average Daily Census and Occupancy Rate     264
Staffing Requirements and Full-Time Equivalents     264
Productive vs. Non-Productive Hours     265
Assignment of Staff by Type and Shift     265
Fixed Staff     267
Converting Staff and FTEs to Positions     267
Calculating FTEs by Type and Shift     267
Establishing Positions     268
Calculating Labor Cost     270
Straight-Time and Overtime Salaries     270
Differentials and Premiums     272
Fringe Benefits     273
Special Situations     274
Expense Budget: Other-than-Personnel Services     274
Budget Submission, Negotiation, and Approval     275
Implementing the Approved Budget     276
Implications for Nurse Mangers     276
Key Concepts     277
Suggested Readings     278
Revenue Budgeting     279
Chapter Goals     279
Introduction     279
The Revenue Budget     280
Why Aren't All Nursing Units Revenue Centers?      280
Why Are Nurse Managers Responsible for a Revenue Budget?     281
The Elements of a Revenue Budget     281
Prices or Rates     281
Volume Estimates     284
Environmental Scan     286
Revenues from Managed Care     286
Capitation vs. Fee-for-Service     286
Money Flows Under Capitation     288
Developing Capitated Rates     288
Setting a Capitation Rate: An Example     289
Incentive Risk Pools     291
Implications for Nurse Managers     291
Key Concepts     292
Suggested Readings     293
Performance Budgeting     294
Chapter Goals     294
Introduction     294
When Is Performance Budgeting Appropriate?     295
The Performance Budgeting Technique     295
Determining Key Performance Areas     295
Technical Steps in Performance Budgeting     295
Performance Budget Example     296
Developing Performance Area Measures     299
Quality of Care     299
Staffing     301
Cost Control     301
Increased Productivity     302
Patient and Staff Satisfaction      302
Innovation and Planning     303
Direct Care     303
Indirect Care     303
Other     303
Multiple Measures     303
Implications for Nurse Managers     304
Key Concepts     305
Suggesting Readings     305
Controlling Operating Results     306
Chapter Goals     306
Introduction     306
The Budget as a Tool for Motivation     306
Motivation and Incentives     308
Motivation and Unrealistic Expectations     309
Communication and Control     309
Using Budgets for Interim Evaluation     309
Variance Analysis     310
Traditional Variance Analysis     311
Unit and Department Variances     312
Line-Item Variances     312
Understanding Variances     312
Flexible or Variable Budgets     314
Flexible Budget Variance Analysis     315
The Volume Variance     315
The Price, or Rate, Variance     316
The Quantity, or Use, Variance     316
Determination of the Causes of Variances     316
The Mechanics of Flexible Budget Variance Analysis      317
Flexible Budget Notation     318
An Example of Volume, Price, and Quantity Variances     319
Revenue Variances     322
Implications for Nurse Managers     326
Key Concepts     327
Suggested Readings     327
Variance Analysis: Examples, Extensions, and Caveats     328
Chapter Goals     328
Introduction     328
Aggregation Problems     328
Exception Reporting     330
Interpretation of Variances     330
Rigid Staffing Patterns     332
Flexible Budgeting and Acuity     334
Fixed vs. Variable Costs     335
Causes of Variances     335
Investigation and Control of Variances     336
Performance Budgets and Variance Analysis     336
Implications for Nurse Managers     338
Key Concepts     339
Suggesting Readings     339
Benchmarking, Productivity, and Cost-Benefit and Cost-Effectiveness Analysis     340
Chapter Goals     340
Introduction     340
Benchmarking     341
Benefits of Benchmarking     347
Benchmarking Approaches     342
The Benchmarking Process     343
Requirements for Successful Benchmarking     344
Productivity     344
Productivity Standards     345
Unit-Costing     345
Unit-Costing and Productivity Standards     348
Productivity Improvement     348
Cost-Benefit and Cost-Effectiveness Analysis     350
Cost-Benefit Analysis     350
Determine Project Goals     351
Estimate Project Benefits     351
Estimate Project Costs     351
Discount Cost and Benefit Flows     351
Complete the Decision Analysis     352
Cost-Effectiveness Analysis     352
Implications for Nurse Managers     352
Key Concepts     354
Suggesting Readings     355
Managing Financial Resources     357
Short-Term Financial Resources     359
Chapter Goals     359
Introduction     359
Current Assets     360
Cash and Marketable Securities     360
Short-Term Cash Investment     361
Cash Flow vs. Revenue and Expense     362
Cash Budgets     362
Maintaining Security over Cash     363
Accounts Receivable     363
Preadmission Data Collection     364
Credit Policies     364
Ongoing Data Collection     364
Discharge Review and Billing     365
Aging of Receivables     365
Cash Receipt and Lock Boxes     366
Inventory     366
Perpetual Inventory     367
Economic Order Quantity     367
Current Liabilities     367
Accounts Payable     368
Payroll Payable     368
Short-Term Debt     369
Taxes Payable     369
Other Payables Made on Behalf of Employees     369
Implications for Nurse Managers     370
Key Concepts     370
Suggested Readings     371
Long-Term Financial Resources     372
Chapter Goals     372
Introduction     372
Equity Sources of Financing     372
Philanthropy     373
Corporate Stock Issuance     374
Government Grants     374
Retained Earnings     375
Debt Sources of Financing     375
Mortgages and Long-Term Notes     375
Leases     376
Bonds      378
Taxable vs. Tax-Free Bonds     379
Bond Ratings and Insurance     381
Zero-Coupon Bonds     381
Debt Refinancing     382
Feasibility Studies     382
The Future of Health Care Financing     383
Implications for Nurse Managers     384
Key Concepts     385
Suggested Readings     385
Additional Management Tools     387
The Use of Computers in Financial Management     389
Chapter Goals     389
Introduction     389
Computer Hardware and Software     389
Uses of Computers     389
General Information Management     390
Clinical Care     390
Financial Management     390
Financial Management Information     390
Special Purpose Software     393
Forecasting     393
Costing     393
Personnel Management     394
Budgeting     395
Acuity Systems     396
Performance Evaluation     398
The Future     398
Implications for Nurse Managers     399
Key Concepts     400
Suggested Readings      400
Forecasting and Other Methods for Decision Making     402
Chapter Goals     402
Introduction     402
Probability Theory: Foundation for Forecasting and Decision Making     403
Quantitative Methods for Forecasting     404
Data Collection     405
Appropriate Data Time Periods     405
What Data Should Be Collected?     406
Graphing Historical Data     407
Analysis of Graphed Data     408
Random Fluctuations     409
Seasonality     410
Trend     410
Seasonality and Trend     411
Forecasting Formulas     412
Random Fluctuations     412
Seasonality     412
Trend     413
Seasonality and Trend     415
Using Computers for Forecasting     416
Qualitative Methods for Forecasting     422
Nominal Group Technique     422
Delphi Technique     422
Other Decision-Making Tools     422
Expected Value     423
Linear Programming     423
Inventory Control     426
Planning and Tracking a Project     428
Gantt Chart      428
Critical Path Method and PERT     428
Implications for Nurse Managers     430
Key Concepts     431
Suggested Readings     432
Marketing     433
Chapter Goals     433
Introduction     433
The Essence of Marketing: Assessing Customer Needs     434
Understanding Customers     435
Why Is Marketing Important for Nurse Managers?     436
Keeping the Organization Current     436
Marketing the Importance of Nursing     437
Marketing Concepts     438
Understanding the Market     438
Market Segmentation     438
Customer Behavior     439
Market Measurement     439
Market Share     440
Market Research     440
Advertising     441
Marketing Plans     441
Organizational Mission/Goals     441
Internal-External Analysis     442
Strategic Marketing Plan     442
The BCG Matrix     446
Life-Cycle Analysis     446
Choice of Strategy     447
Tactics     448
Product     448
Price      449
Place     450
Promotion     451
Marketing Failures     451
The Role of Marketing in Nurse Recruitment     452
Implications for Nurse Managers     452
Key Concepts     453
Suggested Readings     454
The Nurse as Entrepreneur     455
Chapter Goals     455
Introduction     455
Characteristics of Nurse Entrepreneurs     455
Opportunities for Nurse Entrepreneurs     456
Starting Your Own Business     456
Legal and Financial Issues     458
Business Plan     458
The Steps in Developing a Business Plan     459
Project Proposal     459
Product Definition     459
Market Analysis     459
Rough Financial Plan     460
Detailed Operations Plan     460
Detailed Financial Plan     460
Pro Forma Financial Statements     461
Forecasting and Capital Budgeting     467
Sensitivity Analysis     462
Examination of Alternatives     462
The Elements of a Business Plan Package     462
Examples of Entrepreneurs     463
Example 1      463
Example 2     463
Example 3     463
Example 4     463
Key Concepts     464
Suggested Readings     464
The Future     467
Nursing and Financial Management: Current Issues and Future Directions     469
Chapter Goals     469
Introduction     469
Nursing Financial Management Research     469
Current and Future Issues in Financial Management in Nursing     471
The Evolving Role of the Chief Nurse Executive in Financial Management     471
Setting Organizational Policy     472
Continuing Organizational Responsibility for Nursing Expenses     472
Assuming Organizational Responsibility for Nursing Revenues     473
Assuming an Organizational Role in New Ventures     473
Responding to Extraorganizational Changes     473
Government Relations     473
Payer Relations     474
Future Role of First- and Mid-Level Nurse Managers in Financial Management     474
The Nurse as a Policymaker for Financing Health Care     475
Lobbyist     475
Policymaker     475
Implications for Nurse Managers     476
Key Concepts      477
Suggested Readings     477
Glossary     479
Index     503

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