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Hospital finance team and nursing leaders drive value jointly

New reimbursement incentives lack alignment with what frontline provider staff considers best practices

Healthcare finance professionals must better understand how value is delivered by frontline providers, and simultaneously offer providers business insight, said an expert on nursing management today at the HFMA ANI 2014 conference.

Pamela Thompson, CEO of the Association of Nurse Executives, offered insight about how to best align nurses and finance professionals to drive value at hospitals and health systems. She said developing reimbursement models to match the care that is delivered is the critical next step for U.S. healthcare.
“The value of nursing is beyond the individual task performed,” she said. “The value is the health outcomes achieved per dollar of cost spent.”

[See also: Strategic concerns drive healthcare M&A.]

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Thompson outlined five key areas in which nursing leaders and hospital finance executives must work closely in order to raise value and reduce costs. They are (1) understanding cost and quality outcomes; (2) patient safety and quality; (3) workforce; (4) program planning; and (5) education.

She critiqued a simplistic concept of quality, asking finance executives to think beyond any singular definitions.

“The term ‘quality’ covers many different areas,” she said, and some are easier to measure than others. Indeed, quality outcomes can encompass disease-specific evidence, patient safety or avoidance of error, patient satisfaction with the process of care, as well as access to care and convenience of access.
Thompson said hospitals can and must look beyond the acute care experience in measuring quality. Quality measures the “recovery of health and the sustainability of health,” she said. “For the patient, recovery is just as important as the technical moment of care. Outcomes truly are a moving target.”

The science around patient safety is becoming increasingly sophisticated, and Thompson said nurses are applying it in ways that have implications for finance.
“We have to create ‘safety cultures,’” she said. “But it costs money to create those cultures.” Providers need training, education, resources and a clear set of values. Reporting errors is a core aspect of a safety culture, but such a culture is not easy to achieve. Traditionally, providers have been afraid to report errors for failure of repercussions and retaliation.

[See also: Nurse staffing, burnout linked to HAIs.]

“We have to convey the message that every time we reduce harm, we reduce costs,” Thompson affirmed. “But we still need to work together to better determine the cost of allowing harm to occur. How do we measure the total patient harm rate per discharge?”

Coordinated planning around workforce development and hospital programs is essential to financial success, Thompson said, and nurse leaders should be intimately involved with the finance team in the process.

“We’re developing new models of care delivery for acute and primary care, but we need to plan carefully for this transition,” she said. Hospitals must be able to deploy workforces efficiently during provider shortages, and they must train staff to work in multidisciplinary teams, as “you can’t just move staff from one role to another, without their input.”

Often, new reimbursement incentives lack alignment with what frontline provider staff considers best practices. Thus, it’s essential that nurses and the finance team “help each other become competent players in this new world we find ourselves in,” Thompson said.

“We have shared core leadership competencies,” she noted. “Our commitments are very similar, we just articulate them differently. We have to align our goals, understand the interfaces and realize where coordination is essential.”

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