Community/ Public / Population Health

Collaborating to improve the financial health of health care

Nurses are collaborative by nature, especially when providing patient care. We embrace team-based care, and we welcome family members as partners. We know that collaboration adds value—it allows us to see the bigger picture and to head off communication breakdowns.
That’s also true of our role as financial stewards of our institutions. To be a good steward, we need to collaborate with our colleagues in the finance department. At first thought, they may seem like unlikely allies, but collaboration between the nursing and finance staffs can improve both patient outcomes and the bottom line.

Demonstrating value
With our current uncertain economy and the ever-present threats to healthcare reimbursement, we need to make sure our financial colleagues are our allies. That starts with appreciating this fact: Money keeps health care healthy. It buys cutting-edge technology. It builds new facilities to replace the crumbling structures built 50 years ago in the heyday of American hospitals. And it pays the staff’s salaries and benefits.
Nurses are already learning the language of finance, such as case mix index, conditions present on admission, CMI adjusted length of stay, cost versus reimbursement, and profit margin. Also, nurses know that the rollercoaster of financial ups and downs affects not only their budgets at home, but also their employer’s budget. The rising costs of supplies and the fuel to transport them increase the cost of doing business. Many times, as employers adapt to escalating costs and scramble to stay in business, staff salaries don’t keep pace.
In most healthcare organizations, the greatest expense is the staff. In hospitals, that means nurses. But nurses are also an organization’s greatest asset. We hold the keys to improved outcomes and efficiency—words that are music to the ears of the finance team. Typically, better outcomes and more efficiency mean greater cost-effectiveness and no loss of reimbursement dollars in our pay-for-performance world.
However, nurses must do more than be valuable; we must make our value known. Nurses know exactly where waste can be eliminated and how to decrease complications and adverse outcomes. This knowledge is precious and powerful: The best leverage for competitive compensation is to demonstrate value.

Seeing both sides now
Nurses see the need for compassion and care for patients as well as the need to resolve physiologic problems.
Finance staff members see the need to collect money owed and maximize financial health. Both see the facility from their own point of view—as they should. We don’t need to change the point of view of our financial colleagues; we just need to help them understand and appreciate the challenges of patient care. If nurses believe the finance staff is making decisions that limit access to critical resources, or if the finance staff thinks nurses have no regard for the budget or costs, the wrong messages are being sent.
As clinical leaders, nurses make financial decisions every day. We carefully align resources with the budget and look for creative ways to reduce waste through process improvements and supply cost reductions. This is responsible financial stewardship.
More than ever, healthcare organizations are feeling the financial strain of providing uncompensated care. Some stories of uninsured patients who are refused care can break your heart, but sometimes providing care can break a hospital’s budget. More and more, people with permanent disabilities who require long-term care lack health insurance and family resources, don’t qualify for Medicaid, are too sick to go home, or have no home. To nurses, refusing care is unthinkable. But there are no easy answers, just difficult financial challenges we all must face.
By sharing data, a common language, and the stories that describe our experiences, the nursing and financial staffs can help each other. With mutual respect and appreciation, we can meet the twin challenges of great patient outcomes and fiscal accountability.

Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC
Editor-in-Chief


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