| Course | NUR-8250 Health Economics and Finance |
|---|---|
| Module | Module 2 |
| Paper type | Economics paper: business plan for a nurse-led service |
| Length | About 1,055 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for NUR 8250 Module 2
Seven Thousand Six Hundred Dollars Against Twelve Thousand: A Business Plan for an Advanced Practice Nurse Transitional Care Service in Freehold
Student Name
Doctor of Nursing Practice, Thomas Edison State University
NUR-8250: Health Economics and Finance
Mentor Name
Month Day, Year
Seven Thousand Six Hundred Dollars Against Twelve Thousand: A Business Plan for an Advanced Practice Nurse Transitional Care Service in Freehold
The Opportunity
No real organization is described here: the health system is a 260-bed hospital in Freehold, a medical group of 70 clinicians and a Medicare Advantage partnership covering 11,000 members. Older patients discharged after heart failure, chronic lung disease and pneumonia return to the hospital often, and the system's medical group bills few of the Medicare codes that pay for structured care after discharge. The DNP-prepared director of advanced practice nursing has been asked to propose a service and show whether it pays for itself.
The system's own data frame the size of the opportunity. Last year 1,940 Medicare patients aged 65 and older were discharged with heart failure, chronic lung disease or pneumonia, and 22 percent returned within 30 days. The medical group billed transitional care management for only 6 percent of eligible discharges, mostly because clinicians did not know the requirements or the visit was not scheduled within the time window. Each readmission costs the system about $11,000 in uncovered costs under its Medicare Advantage contract, which pays a fixed amount per member.
The Clinical Evidence
Naylor et al. (1999) randomly assigned 363 hospitalized adults aged 65 or older at two Philadelphia hospitals to usual care or to a discharge planning and home follow-up protocol run by advanced practice nurses. By 24 weeks after discharge, 37.1 percent of control patients had returned to the hospital at least once, against 20.3 percent of those receiving the intervention, and the intervention group had fewer patients with multiple readmissions and fewer hospital days, 1.53 compared with 4.09 per patient.
Naylor et al. (2004) then tested a three-month advanced practice nurse program for 239 older adults hospitalized with heart failure at six Philadelphia hospitals. Over a year, the intervention group took longer to be readmitted or die, had 104 readmissions against 162 in the control group, and had lower mean total costs, $7,636 compared with $12,481. Quality of life improved only in the short term.
The Payment Opportunity
Bindman and Cox (2018) studied Medicare's transitional care management codes, which pay clinicians who reach the patient by the second business day after discharge and see them inside seven or fourteen days. Among 18.8 million eligible beneficiaries from 2013 to 2015, the codes were billed after only 3.1 percent of eligible discharges in 2013, rising to 7.0 percent in 2015. In the following month, total Medicare costs were lower for those who received the service, $3,033 compared with $3,358, and mortality was lower, 1.0 compared with 1.6 percent. The study was observational and could not rule out that healthier patients were more likely to receive the service.
The Service
The service enrolls Medicare patients aged 65 and older discharged with heart failure, chronic lung disease or pneumonia who have two or more chronic conditions. Three advanced practice nurses and one registered nurse coordinator meet patients in the hospital, visit them at home within 72 hours, see them in clinic within seven days and follow them by phone and visit for 60 days, coordinating with the primary care clinician and specialists.
A typical patient shows how the service runs. A 79-year-old woman with heart failure is discharged on a Friday with a new water pill and a reduced salt diet. The advanced practice nurse meets her before discharge, visits her home on Monday, finds that she cannot read the label on the new bottle and has kept taking an old pill as well, sorts the medicines into a weekly box, checks her weight and swelling and calls her cardiologist about a dose. She is seen in clinic on Thursday, within seven days, which meets the billing requirement for the higher-complexity code.
Revenue and Cost
Revenue comes from three sources: transitional care management codes billed for eligible patients, chronic care management codes for those who continue in the system's care, and a shared-savings payment under the Medicare Advantage contract, based on lower hospital costs among members. Costs include salaries and benefits, mileage, phones and tablets, a share of billing staff and overhead.
| Year | Patients enrolled | Revenue | Costs | Net |
|---|---|---|---|---|
| 1 | 300 | $310,000 | $640,000 | -$330,000 |
| 2 | 650 | $690,000 | $665,000 | $25,000 |
| 3 | 800 | $850,000 | $690,000 | $160,000 |
| 4 | 850 | $905,000 | $715,000 | $190,000 |
| 5 | 900 | $960,000 | $740,000 | $220,000 |
Break-Even and Sensitivity
At an average net revenue of about $1,060 per enrolled patient and fixed costs of about $640,000 in the first year, the service breaks even at roughly 605 patients a year, reached early in year two. The plan tests three risks. If enrollment reaches only 70 percent of projections, break-even moves to year three. If the Medicare Advantage shared-savings payment is half of what is expected, the service still covers its costs by year three. If billing of transitional care codes falls below 60 percent of eligible patients, the service loses money every year, so billing workflow is treated as a critical success factor.
The calculation is simple but must be shown. Net revenue per patient combines the transitional care code, an average of two months of chronic care management for half of patients and the expected shared-savings payment spread across enrolled members. Fixed costs are salaries, benefits and equipment that stay the same whether the service enrolls few or many patients within the planned range. Dividing fixed costs by net revenue per patient gives the number of patients needed to break even, and the paper shows each input so the finance committee can change any assumption and see the result.
Risks and Mitigation
Clinical risk is low, since the trials showed benefit. Financial risk comes from enrollment, billing and the shared-savings contract. Operational risk comes from hiring advanced practice nurses in a tight market. The plan responds with a referral workflow built into discharge orders, billing audits each month and a recruitment partnership with a nearby nursing school.
Conclusion
Two randomized trials show that advanced practice nurse transitional care reduces readmissions and, in heart failure, total costs, and a national claims study links transitional care billing to lower costs and deaths. The Freehold service is projected to run a first-year loss and to break even early in year two, with net gains thereafter, provided that enrollment and billing reach their targets. The plan names those risks and how they will be managed.
References
Bindman, A. B., & Cox, D. F. (2018). Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries. JAMA Internal Medicine, 178(9), 1165-1171. https://doi.org/10.1001/jamainternmed.2018.2572
Naylor, M. D., Brooten, D. A., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004). Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial. Journal of the American Geriatrics Society, 52(5), 675-684. https://doi.org/10.1111/j.1532-5415.2004.52202.x
Naylor, M. D., Brooten, D., Campbell, R., Jacobsen, B. S., Mezey, M. D., Pauly, M. V., & Schwartz, J. S. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA, 281(7), 613-620. https://doi.org/10.1001/jama.281.7.613
What the NUR 8250 Module 2 instructions ask for
Developing and analyzing business plans is named directly in TESU's catalog description of NUR-8250, and since TESU keeps the syllabus inside the course, the second module became a business plan for a nurse-led service. Expect a DNP economics paper that describes the opportunity and the organization, grounds the service in clinical evidence, identifies each revenue source and each cost, builds a multiyear pro forma, calculates break-even, tests the plan against realistic risks with a sensitivity analysis and recommends a decision. Some sections assign a nurse-led clinic, a telehealth service or a new nursing unit instead. See if the assignment requires a specific template, such as an executive summary, market analysis and marketing plan, and whether they expect real payment rates or illustrative figures, which should be labeled as such.
How the NUR 8250 Module 2 example is put together
An invented Freehold health system's readmission problem and unused billing codes open the plan. Two Naylor trials supply the clinical case, with their readmission and cost results, and the national claims study of transitional care codes supplies the payment case, with its observational limit noted. The service is described by its staff, patients and timeline. Revenue sources and costs are listed, and a five-year pro forma shows a first-year loss and later gains. Break-even and three sensitivity tests follow, then risks and how they are managed, before a conclusion. The paper's marginal comments explain how evidence is matched to each part of the plan and why the start-up loss is shown openly. One patient's first week, from a mislabeled bottle to a seven-day visit, shows what the service does.
NUR 8250 Module 2 rubric: what earns full marks
Business plan papers are judged on a clear opportunity, a service grounded in clinical evidence, revenue and costs identified source by source, a multiyear pro forma, a break-even calculation, sensitivity analysis on the main risks and a reasoned recommendation. Mentors credit projections that show a start-up loss rather than hiding it. Naming billing workflow as a critical success factor shows understanding of how revenue actually arrives. Matching randomized evidence to the clinical case and claims evidence to the payment case is often rewarded. Figures from the trials must be quoted as published, and invented financial figures should be labeled illustrative, with APA style throughout.
Common NUR 8250 Module 2 mistakes, and how to avoid them
A common weakness is a business plan with only costs or only savings; list every revenue source and every cost. Another is a pro forma that breaks even in month one; show the start-up period. Students often skip sensitivity analysis; test enrollment, payment and billing assumptions. Ground the service in trials, not testimonials. Name the risks and how each will be managed. Label invented figures. With the Freehold plan as a model, your own nurse-led service proposal can take shape quickly, and the first draft written to your mentor's instructions is free. Walk one patient through the service so leaders can see what the money buys.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 8250 Module 2 questions, answered
Where can I find a free NUR 8250 Module 2 sample paper?
The transitional care business plan for an invented Freehold health system, from two Naylor trials to a five-year pro forma, is above in its entirety.
Does advanced practice nurse transitional care reduce readmissions?
In a 363-patient trial, readmission by 24 weeks was 20.3 percent with the nurse-led program against 37.1 percent with usual care.
Does transitional care save money?
In a heart failure trial, mean total costs over a year were $7,636 with advanced practice nurse care compared with $12,481 with usual care.
What are transitional care management codes?
Medicare billing codes that pay a clinician who reaches the patient by the second business day home and sees them within seven or fourteen days, depending on complexity.
How is break-even calculated in a business plan?
By dividing fixed costs by the net revenue each patient contributes, which gives the number of patients needed to cover costs.