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Laurie Zone-Smith

Publications and source records attributed to Laurie Zone-Smith.

5 recordsLinked to original sources
PubMed2006

Nursing intensity billing.

UNLABELLED: Hospital nursing care has traditionally been billed using a fixed daily room and board rate. This approach hides the variability of nursing care within and across nursing units and does not align nursing costs with daily charges for actual patient care. Anew nursing intensity billing (NIB) model for assigning hospital daily room charges is proposed, and initial results are reported. METHODS: Two charge methods, one using traditional room and board daily billing and another using an NIB approach, were developed for 12 adult medical or surgical units at the Medical University of South Carolina (MUSC) Medical Center using retrospective data from January 1 to May 31, 2005. The room and board charge was assigned as private room or intermediate care based primarily on patient location. The NIB model added an additional focused care charge between private and intermediate care, and the charge for the 3 levels was based on daily nursing intensity entered as actual hours of nursing care delivered. The mean and sum of charges were compared between the 2 methods. Charge rates were simulated at $700, $950, and $1,200 for the 3 levels, which correlated with the existing proprietary room rates. Nursing cost-to-charge ratios were calculated for room and board and NIB methods. RESULTS: The NIB model resulted in a 32.2% increase in charges or a total sum of $4,870,250 for the 12 nursing units over the 5-month period. The variability of nursing cost-to-charge ratio was reduced from 0.34 to 0.80 for room and board to 0.33 to 0.45 for the NIB method. CONCLUSION: The NIB method of assigning charges based on nursing intensity rather than on patient location increased overall charges and more evenly distributed direct nursing costs to daily charges. Assigning charges based on nursing intensity is appealing as it reflects actual care given in the acute care environment. The NIB provides evidence to support higher charge rates and has the ability to redistribute hospital charges based on nursing care. The relationship between increased daily hospital charges and actual reimbursement is unknown.

Hospital Charges↗
PubMed2006

Nursing intensity: In the footsteps of John Thompson.

The Nursing Minimum Data Set (NMDS) provides a way to incorporate nursing data into the hospital discharge abstract to potentially compare nursing care across institutions. An extension of this framework is to use these data for directly billing and reimbursing hospital nursing care. We provide a review of the existing literature and new empirical evidence to support hospital nurse billing. Two existing large data sets are compared, one using nursing diagnosis and the other a nursing intensity based tool to collect daily nursing times. These NMDS data sources are compared to diagnostic related groups (DRG) and hospital outcomes from the UB92 discharge abstract using multivariate regression and logistic regression. Either NMDS approach provides additional explanatory power (improvements in R2) over DRG alone. The findings strengthen the argument to use primary nursing data such as nursing intensity as a basis for direct costing, billing, and reimbursement of hospital nursing care.

Diagnosis-Related Groups↗
PubMed2005

Organizational commitment to professional practice models.

Magnet hospitals must show evidence of professional practice models. A professional practice organizational environment is necessary, but not sufficient, to create professional practice models. The authors analyze the relationship between a professional practice environment and a professional practice and explore organizational commitments required to ensure professional practice at the unit level.

Benchmarking↗
PubMedDate not supplied

Hospital nursing costs, billing, and reimbursement.

Nursing intensity, estimated direct nursing costs, and daily billing were compared for 12 adult medical or surgical units at an academic medical center from January 1 to May 31, 2005 (22,649 patient days). Two main findings, nursing intensity and direct nursing costs, were highly variable within and across each of the study nursing units (mean 429 dollars, SD 160 dollars); direct costs of nursing care were significantly higher for private room rates compared to intermediate room per diem charges billed at a higher rate (441 dollars vs. 426 dollars, F 37.77, p < 0.001). The results demonstrate that the direct costs of nursing care are not aligned with current billing practices at this university hospital. The use of fixed room and board charges to account for nursing care in U.S. hospitals may be obsolete and an alternative nurse-centric costing, billing, and reimbursement model is proposed.

Academic Medical Centers↗