By Rosemary Goodyear PhD, RN
A large percentage of nurses never look at the entire monetary side of health care. They focus on patient care and their paycheck. They do not consider the cost of the service they provide, the equipment they use, or the cost of the dressings or medications they give out. They believe it is not in their job description to know or be concerned with the cost of health care. Not true! The cost of the largest single group of providers in the US health care system is the nurse workforce. In 2017 it is reported that there are 4,153,657 active practicing nurses in the USA.1
Through-out nursing’s history in the USA, costs of the hospital nurse workforce have been difficult to factor or “tease out”. Nursing care was often mingled within the room charge, linen, meals etc. Nurse researchers had a difficult time to arrive at an accurate cost for nursing care services in the hospital systems because of the melding of data.2
The role for nursing is changing and more nurses are working external to hospitals, and many are able to bill insurers, including Medicare and Medicaid, directly. Thus, it is possible to more easily determine funds generated for the services of the nurse, and compare these to the cost of the nurse provider. Research has demonstrated that the NP/APRN is less costly to educate than are physicians, and can provide equal or better patient care, are more accessible to patients for care, and are cost effective.3
It is time for NP/APRNs to take charge of their income as a provider of health care services. NCA can help you to learn how to determine the amount of earnings you generate for yourself, employer, or partner versus what you cost your employer or partner. Once you collect these data you will begin to know your value/worth and take charge of expenses and your earnings. For more information related to costing out your services see the references following these comments4,5.
Here are some items to consider for calculating your value to an organization.
- What is your income before and after taxes?
- How many patients were seen in a specific time frame, say for one month or one pay period?
- What are you billing for your services? (Codes, labs, procedures, referrals, etc.) You will have to be sure you are billing at the correct level, and for all the services/procedures you provided/ordered.
Costs to employer or partner:
- Identify the percentage of overhead that is paid for you to actively practice in the facility. (% of rent, support staff, electricity, cleaning service, waste removal etc.)
- Identify the amount of benefits/support service that the employer pays for you. (Unemployment insurance, workers compensation, health insurance, and payroll service etc.)
- Explore the timeliness of reimbursement/collection of billed services.
This is just a beginning for you to explore your value/worth.
References and Readings:
- Henry J. Kaiser Family Foundation Accessed 3/28/2018 @ https://www.kff.org
- Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F., (2011). The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals with Different Nurse Work Environments. Med Care.
- Pennsylvania Coalition of Nurse Practitioners Accessed 3/28/2018 @ http://www.pacn.org/news/277542/fivenewstudies-
- Buppert, C. The Primary Care Provider’s Guide to Compensation and Quality: How to Get Paid and Not Get Sued. 2000, Aspen Publications.
- Buppert, C., Nurse Practitioner’s Business Practices and Legal Guide 4th ed. 2015. Jones and Bartlet, Burlington, MA.