The Budget Analysis Assignment Paper
The Budget Analysis Assignment Paper
This week you will need to prepare a budget. Identify a nursing intervention, such as inserting an IV. Create a cost analysis for this procedure. What are the costs of each supply used? What is the cost for the nursing time? Should this be a billable intervention? Propose a billable cost. Support your figures with industry figures and references. This should be presented in a table format. An excel spreadsheet is preferred as you can embed formulas to auto calculate totals The Budget Analysis Assignment Paper.
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Budget Analysis of Labor Epidural
- Nursing Intervention.
The selected nursing intervention for my budgetary analysis is labor pain management via epidurals. An epidural is an anesthetic procedure where an injection is done to a patient’s back to numb pain in lower body parts. Epidurals are extensively used to manage pain during childbirth, and during and after some surgical procedures. Epidural injections can be combined with a steroid injection to manage leg or back pain caused by sciatica or slipped vertebral disc. In an epidural, a needle is utilized to insert a catheter into the patient’s spine in proximity to the nerves that transmit pain impulses to the brain. The needle is afterward removed, leaving the catheter in place. Pain medication is then administered through the catheter manually or automatically on a dosage level determined by a physician. The point of insertion varies depending on the area in need of pain relief. For labor pain, epidurals are typically inserted between the L3 and L4 lumbar vertebrae. Epidurals can only be done by a general anesthesiologist or a certified registered nurse anesthetist. Due to the reimbursement rate and frequency of administration in a hospital, epidurals are a potentially profitable nursing intervention (Wiramus et al, 2015)The Budget Analysis Assignment Paper.
- Cost analysis
The cost dimensions for an epidural are devices, drugs, and labor. On devices, there’s peridural set, surgical gowns, sterile gloves, 5 ml syringe, 50 ml syringe, tube for epidural insertion, and a needle. On drugs, there’s cutaneous disinfectant, lidocaine 10 mg/ml, 1 bupivacaine bag, and sufentanil 50 ug/10ml. I have referred to Tilleul et al (2012) on materials used in epidurals. Even though too dated for use with cost estimate, the study provided accurate information on anesthesia resource utilization. On labor, there’s nurse time for preparation, nurse time for epidural administration, and nurse time in post anesthesia care (Tilleul et al, 2012)The Budget Analysis Assignment Paper.
- Cost of materials
| Medical devices | Cost $ |
| Peridural set | 90.11 |
| Surgical gowns | 7.34 |
| Sterile gloves | 1.53 |
| 5 ml syringe | 0.12 |
| 50 ml syringe | 0.82 |
| Tube for epidural insertion | 53.03 |
| Needle | 0.04 |
| Subtotal A | 153.00 |
| Drugs | |
| Cutaneous disinfectant | 16.62 |
| 1 bupivacaine bag | 5.76 |
| Lidocaine 10 mg/ml | 218.53 |
| Sufentanil 50ug/10ml | 8.45 |
| Subtotal B | 249.36 |
| TOTAL | 402.36 |
Cost of drugs and devices estimated using the wholesale acquisition costs from the Truven Health Analytics Red Book, the Government services Administration database and the medical care consumer price index as at 2016 (Corman et al, 2018).
- Nursing time cost
On labor the mean bedside anesthesia staff time used was 90 minutes per patient as suggested by Bell (2000). This is for both the epidural procedure and post anesthesia care. Preparation time used was 10 minutes as indicated by Tilleul et al. (2018). The value of nursing time of 100 minutes applies to normal delivery. For Caesarean section deliveries, the value of 4.4 hours is used. This is because Caesarean deliveries require dedicated staffing during operation, unlike in normal deliveries where intermittent staffing is adequate. Therefore, Caesarean deliveries have higher full time equivalent (FTE) hours. Caesarean section account for31.8% of all deliveries in the United States (CDC.gov, 2022). The present CRNA average rate per hour in the United States is $108.47 (Ziprecruiter, 2022)The Budget Analysis Assignment Paper. Costing for nursing time is tabulated below:
| FTEs | CRNA Charge Rate ($/hour) | Nursing time cost ($) | |
| Vaginal Delivery | 1.67 | 108.47 | 181.14 |
| Caesarean section deliveries | 4.4 | 108.47 | 477.27 |
| Nursing time cost ($) | Materials Cost ($) | Total Cost ($) | |
| Vaginal Delivery | 181.1449 | 402.36 | 583.50 |
| Caesarean section deliveries | 477.268 | 402.36 | 879.63 |
- Billability of nursing intervention.
An epidural should be a billable intervention as it is a process that utilizes medications, medical devices, and consumes the time of highly specialized nurses. Epidurals are also recognized by Medicare and private insurance providers as a billable service. So why not charge for it? With a total cost element of $583.50 for vaginal deliveries and $879.63 for Caesarean section deliveries, the billed amount should lie between $1300 and $2132 (Sidecar Health, 2022)The Budget Analysis Assignment Paper. This price range caters for both vaginal and Caesarean section delivery. Charges for epidurals lie within this range in most states in the United States.
As a care intervention, administering epidurals is dependent on a number of variables. First, it is only one of a number of pain management procedures available to patients. Secondly, patients have to request for the service, meaning that care facilities cannot do epidurals on discretion. Thirdly, the number of epidurals administered varies with the number of births in a hospital. However, given that approximately 61% of mothers elect for an epidural (Osterman & Martin, 2011)The Budget Analysis Assignment Paper, healthcare facilities that offer the intervention stand to boost their profitability.
With an intervention rate of 10 times per day, the costs, revenue and profit for a year are:
| Cost | Cost per procedure ($) | Number of deliveries | Cost of 10 interventions per day ($) | Days/year | Yearly cost of intervention ($) |
| Vaginal Delivery | 583.50 | 4.00 | 2,334.02 | 365.00 | 851,917.15 |
| Caesarean section deliveries | 879.63 | 6.00 | 5,277.77 | 365.00 | 1,926,385.32 |
| Revenue | Revenue per procedure ($) | Number of deliveries | Revenue from 10 interventions per day ($) | Days/year | Yearly revenue from intervention ($) |
| Vaginal Delivery | 1,300.00 | 4.00 | 5,200.00 | 365.00 | 1,898,000.00 |
| Caesarean section deliveries | 2,132.00 | 6.00 | 12,792.00 | 365.00 | 4,669,080.00 |
| Profit | Yearly revenue from intervention ($) | Yearly cost of intervention ($) | Projected Profit per Year ($) |
| Vaginal Delivery | 1,898,000.00 | 851,917.15 | 1,046,082.85 |
| Caesarean section deliveries | 4,669,080.00 | 1,926,385.32 | 2,742,694.68 |
References
Bell, E. D., Penning, D. H., Cousineau, E. F., White, W. D., Hartle, A. J., Gilbert, W. C., &
Lubarsky, D. A. (2000). How much labor is in a labor epidural? Manpower cost and American Society of Anesthesiologists, 92(3), 851-858.
CDC.gov. (2022). FastStats – Births – Method of Delivery. [online] Available at:
<https://www.cdc.gov/nchs/fastats/delivery.htm> [Accessed 23 July 2022].
Corman, S., Shah, N., & Dagenais, S. (2018). Medication, equipment, and supply costs for
common interventions providing extended post-surgical analgesia following total knee arthroplasty in US hospitals. Journal of Medical Economics, 21(1), 11-18.
Cost of epidural steroid injection by state | Sidecar Health. Cost.sidecarhealth.com. (2022)The Budget Analysis Assignment Paper.
Retrieved 23 July 2022, from https://cost.sidecarhealth.com/ts/epidural-steroid-injection- cost-by-state.
Osterman, M. J., & Martin, J. A. (2011). Epidural and spinal anesthesia use during labor: 27-
state reporting area, 2008. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 59(5), 1-13.
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Thompson, E., Green, A., Hartsilver, E., Stott, M., Meikle, K., Ormerod, V., Lilaonitkul, M. &
Powell, R. (2020). A Comparison of Continuous Wound Infiltration Plus Patient Controlled Analgesia Versus Epidural Analgesia after Open Renal Surgery. Urol. Androl. Open J, 4, 20-26.
Tilleul, P., Aissou, M., Bocquet, F., Thiriat, N., Le Grelle, O., Burke, M. J., Hutton, J. &
Beaussier, M. (2012). Cost-effectiveness analysis comparing epidural, patient-controlled intravenous morphine, and continuous wound infiltration for postoperative pain management after open abdominal surgery. British journal of anaesthesia, 108(6), 998- 1005.
Wiramus, S., Delahaye, D., Parratte, S., Albanese, J., & Argenson, J. N. (2015). Cost-
Effectiveness of the Various Modalities for Pain Control. In Perioperative Medical Management for Total Joint Arthroplasty (pp. 131-139). Springer, Cham.
Ziprecruiter (2022). How Much Do CRNA Jobs Pay per Hour?. [online] Available at:
<https://www.ziprecruiter.com/Salaries/CRNA-Salary-per- Hour#:~:text=As%20of%20Jul%2015%2C%202022,percentile)%20across%20the%20U nited%20States.> [Accessed 23 July 2022].
241120_Exemplar_Budget Assignment (1)