Assignment: NURS 6565 Week 3 Discussion: Quality and Cost Measurements

Assignment: NURS 6565 Week 3 Discussion: Quality and Cost Measurements

Assignment: NURS 6565 Week 3 Discussion: Quality and Cost Measurements

NURS 6565 Week 3 Discussion: Quality and Cost Measurements – As nurse practitioners continue to expand their role in delivering health care, it is imperative for NPs to provide the data and evidence to demonstrate the impact of NP care on patient outcomes. There are several challenges that advanced practice nurses face to provide quality care and meet productivity goals of an organization. This week it is important to explore the connection of quality care and performance measures. Some questions to consider as we discuss this topic are:

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  • Why are quality measures important?
  • What is the difference between quality measures and performance indicators?
  • What performance measures are used for NP productivity?
  • Why are incentive plans used in clinical organizations?


To prepare FOR NURS 6565 Week 3 Discussion: Quality and Cost Measurements:

Read the article, An Incentive Plan for Advanced Practice Registered Nurses: Impact on Provider and Organizational Outcomes, by Catherine A. Rhodes, Mavis Bechtle, and Molly McNett (2015)

Explore quality measures and identify at least one clinical performance measure, such as the Agency for Healthcare Research and Quality (AHRQ)

By Day 3 OF NURS 6565 Week 3 Discussion: Quality and Cost Measurements

  • Post an explanation of the importance of quality measures using the clinical performance measure you identified as an example.
  • Then, identify the performance measures used for NP productivity in Rhodes, Bechtle, and McNett (2015) article.
  • Finally, share your opinion on incentive payment for care, including external motivators and at least one business model.

Assignment: NURS 6565 Week 3 Discussion: Quality and Cost Measurements

NURS 6565 Week 3 Discussion: Quality and Cost Measurements Resources

Buppert, C. (2015). Measuring Nurse Practitioner Performance. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (469 – 478). Burlington, MA: Jones & Bartlett.

This chapter will cover standards of care, and measures of nurse practitioner performance

Hain, D., & Fleck, L. M. (2014). Barriers to NP practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Note: Retrieved from the Walden Library databases.

Rhodes, C. A., Bechtle, M., & McNett, M. (2015). An Incentive Plan for Advanced Practice Registered Nurses: Impact on Provider and Organizational Outcomes. Nursing Economics, 33(3), 125-131.

Note: Retrieved from the Walden Library databases.

Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . . Weiner, J. P. (2013). The Quality and Effectiveness of Care Provided by Nurse Practitioners. Journal for Nurse Practitioners, 9(8), 492-500. doi:10.1016/j.nurpra.2013.07.004

Note: Retrieved from the Walden Library databases.

Wilkinson, K. (2015). Legal Nuts and Bolts for PNPs in Today s Healthcare Environment [PowerPoint slides]. Retrieved from

NURS 6565 Week 3 Discussion: Quality and Cost Measurements

NURS 6565 Week 3 Practicum Journal wk 3

Each week you will complete a Practicum Journal entry and Time Log that prompts you to reflect on and document your Practicum Experiences.

Practicum Journal

Continue documenting your Practicum Experiences in your Practicum Journal. Reflect on your practicum experiences and relate them to your Professional Goals and Self-Assessment of Clinical Skills that you identified in Week 1.

Follow journal entry format and choose any illness or patient…..


Reflect on a patient who presented with a disease. Describe key signs and symptoms that were consistent with this disease. If you diagnosed the patient with the disease, describe your experience in telling the patient that she had the disease, as well as the patient’s reaction to the diagnosis. Explain how the diagnosis might impact the patient’s life short-term and long-term. Include an explanation of the patient’s medical history, drug therapy and treatments, and follow-up care. If you did not have an opportunity to evaluate a patient with this background during the last four weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.

125NURSING ECONOMIC$/May-June 2015/Vol. 33/No. 3

R ELATIVE VALUE UNITS (RVUs)are used within healthcare organizations to indi-cate resources re quired when determining physician fee schedules. While RVUs typically compose the core of physician fees and are often used in physician incentive plans, these units are not always utilized in advanced prac- tice registered nurse (APRN) mod- els. APRNs have become integral to the provision of quality, cost- effective health care throughout the continuum of care. As health care organizations respond to physician shortages and reim- bursement shifts, the number of APRNs is increasing rapidly, and finding a market advantage for hir- ing and retaining APRNs is imper- ative. Therefore, an innovative incentive plan for APRNs was cre- ated that incorporated both pro- ductivity and quality metrics. Data were gathered before and after

implementation of this program to determine its effectiveness on pro – vider outcomes. The program and associated outcomes are des crib ed.

Background Relative value units. RVUs

reflect the relative resources required to furnish a physician fee schedule service. The Centers for Medicare & Medicaid Services (CMS) and other private insurers use the Medicare Physician Fee Schedule (MPFS) to reimburse physician services. The MPFS became effective January 1, 1992 and is funded by Part B. Three sep- arate RVUs are associated with the calculation of a payment und er the MPFS: work RVUs (wRVUs) reflect the relative time and intensity associated with providing a serv- ice and equals ap proximately 50% of the total payment; practice expense RVUs (reflect costs such as renting office space, buying sup-

EXECUTIVE SUMMARY Advanced practice registered

nurses (APRNs) are integral to the provision of quality, cost- effective health care throughout the continuum of care.

To promote job satisfaction and ultimately decrease turnover, an APRN incentive plan based on productivity and quality was formulated.

Clinical productivity in the incentive plan was measured by national benchmarks for work relative value units for nonphysician providers.

After the first year of implemen- tation, APRNs were paid more for additional productivity and quality and the institution had an increase in patient visits and charges.

The incentive plan is a win-win for hospitals that employ APRNs.

Catherine A. Rhodes Mavis Bechtle Molly McNett

An Incentive Pay Plan for Advanced Practice Registered Nurses: Impact

On Provider and Organizational Outcomes

ACKNOWLEDGMENT: The authors ack – nowledge the support and guidance received from Jane Fusilero, MSN, MBA, RN, former vice president and chief nurs- ing officer of The MetroHealth System. The authors also acknowledge support from Dan Lewis, Vice President, Human Resources, The MetroHealth System, dur- ing implementation of this project.

Instructions for Continuing Nursing Education Contact Hours appear on page 132.


CATHERINE A. RHODES, MSN, APRN, WHNP-BC, RNC-OB, SANE-A, is Women’s Health Care Nurse Practitioner and Sexual Assault Nurse Examiner, The MetroHealth System, Cleveland, OH.

MAVIS BECHTLE, MSN, RN, FACHE, is Vice President and Chief Nursing Officer, The MetroHealth System, Cleveland, OH.

MOLLY McNETT, PhD, RN, CNRN, is Director, Nursing Research, The MetroHealth System, Cleveland, OH.

NURSING ECONOMIC$/May-June 2015/Vol. 33/No. 3126

plies and equipment, and staff); and malpractice RVUs (reflect the relative costs of purchasing mal- practice insurance and therefore varies by specialty) (CMS, 2012).

A review of the literature fail – ed to yield descriptions of incen- tive-based programs for APRNs in a hospital setting based specifical- ly on wRVUs. However, within the current organization, a physician incentive plan based on wRVUs had been in place for several years. Physicians were given a default base salary of 90% of the total compensation benchmark. The adjusted base salary was then determined by average perform- ance relative to RVU benchmark for 2 previous calendar years. This model was not adopted for APRNs, however, as variations ex isted in scope of practice for APRNs in dif- ferent departments, and not all were billing providers. Therefore, productivity-based wRVUs would not be at the median benchmark for many of the APRNs, unfairly impacting their compensation.

APRN incentive models. Pro – fit-sharing APRN incentive mod- els are described by Buppert (2006) and Kenny and Balzer (2010). These plans involve a per- centage of profits after cost and benefits paid from revenues. A contract between the APRN and the employer is involved in these models. The practice needs to be vetted and Buppert (2006) recom- mends that if collections in a prac- tice are less than 95% effective, the APRN should ask for a per- centage of the billings rather than the collections to ensure the APRN is incentivized appropriate- ly. This became the base of the model implemented within the organization. This organization is a county-subsidized hospital with a mission to care for all regardless of ability to pay. Therefore, the collection rate is much lower than the 40% described by Buppert (2006). This made full implemen- tation of the Buppert model diffi- cult and not attainable for most APRNs. Another separate incen-

tive plan outlined by Buppert describes taking capitated fees received and dispensing based either by number of APRN visits or by panel size. This pertains to practices that are in a capitated reimbursement situation, and thus was not applicable to many areas of the institution.

The importance of including quality measures as well as pro- ductivity in APRN incentive plans

has been discussed (Buppert, 2006, 2010; Chu, Wang, & Dai, 2009; Hofmann, 2009; Mackey, Rooney, & Skinner, 2009; Scott, 2009). Incorporation of incentive plans can increase quality, patient satisfaction, and provider job sat- isfaction (Challis, 2009; Duffin & Brannigan, 2008; McDonald, Harrison, & Checkland, 2008). While incentives can facilitate attracting, motivating, and retaining nurses (Mackey et


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