Purpose:
Clinical Nurse Specialists provide expert care to patients with complex conditions and advance the practice of nursing in a variety of ways. Our practice is consistently targeted toward achieving quality, cost-effective patient-focused outcomes across 3 spheres of influence: patient, staff, and system.
Significance:
The NACNS statement on CNS Practice and Education mentions cost-effective care at least 10 times. But what does quality, cost-effective care mean? What does the CNS need to know about the cost/quality equation? This presentation will answer those questions.
Background/Design:
A 489-bed community hospital instituted the role of Clinical Utilization Specialist to guide the implementation of the Clinical Utilization Program. Clinical Utilization is a standardized,structured, coordinated, interdisciplinary process of resource acquisition, allocation, and expense management and results in safe, high-quality, and cost-effective patient care. The role was filled by anexpert CNS with over 16 years of experience, primarily in critical care.
Methods:
This presentation will provide an overview of financial outcomes related to the practice of a CNS. It will include the definitions of the types of costs usually applied in the healthcare setting. In addition to costs, understanding the reimbursement side of healthcare is important for the CNS to understand. An overview of the DRG-based payment system is included. Understanding these principles help to bring focus to understanding the outcomes related to quality cost-effective care. The CNS recognizes that changes to either quality or cost can significantly impact the other component. Examples of completing a DRG analysis with emphasis to improving the quality of care and the resulting impact to cost will be provided.
Findings:
The program started by looking at approximately 25 different DRGs and identified a goal of reducing the cost of care by $1.5 million. Over the next 3 years, this program expanded the focus to over 50 DRGs and has successfully reduced the direct cost of care by over $19 million.
Conclusions:
The role of the CNS as been instrumental in leading various teams throughout the organization to achieve this success.
Implications for Practice:
The importance of understanding financial outcomes is key to demonstrate the impact of the CNS role.