NUR 8250 Module 6 Health Economics Communication Paper: Presenting a Financial Case to a Board and a Community Example

One Slide, Three Numbers and a Patient's Story: Presenting a Nursing Investment to a Finance Committee in Hackensack

Student Name

Doctor of Nursing Practice, Thomas Edison State University

NUR-8250: Health Economics and Finance

Mentor Name

Month Day, Year

One Slide, Three Numbers and a Patient's Story: Presenting a Nursing Investment to a Finance Committee in Hackensack

The Situation

The 420-bed Hackensack hospital in this sample is invented. Over the past year the DNP-prepared nurse executive has developed two proposals: an advanced practice nurse transitional care service and a move to lower medical-surgical nurse ratios. Each has a business case. The finance committee meets in three weeks and will hear competing requests for capital and operating funds. The community advisory council, which includes patients, clergy and local officials, will also review the hospital's community benefit plans. The paper prepares the communication for both audiences.

The committee's composition shapes the approach. Of its nine members, five are business leaders from the community, two are physicians and two are hospital executives. None is a nurse. Past nursing requests were presented with long slides of research and were deferred. The chief financial officer has advised that the committee responds to clear numbers, comparisons with other investments and a sense that the presenter has thought about what could go wrong. The paper builds the communication plan around that advice.

Know What Value Means to Each Audience

Porter (2010) framed value as the results patients care about, divided by what it costs to get them over the whole course of a condition. For the finance committee, the paper translates value into net financial effect, risk and timing. For the community council, it translates value into what patients will experience: fewer return trips to the hospital, a nurse who visits after discharge and a safer ward. Both are honest descriptions of the same investment.

Choose the Decision Tools

The finance committee is used to seeing net present value, payback period and return on investment. The paper presents each proposal's five-year net present value using the hospital's 6 percent discount rate, the payback period and a sensitivity range. Because the two proposals compete with other requests, it adds a weighted decision matrix that scores each request on financial return, quality and safety effect, strategic fit, risk and community benefit, with weights the committee agreed on last year.

The numbers are simple to state. The transitional care service has a five-year net present value of about $380,000 and pays back its start-up loss in year two. The staffing change has a net present value near zero but reduces risks the committee already worries about, such as agency spending and safety events that bring regulatory scrutiny. Showing the two side by side lets the committee see that one proposal is a modest financial gain and the other is a safety investment that roughly pays for itself.

Be Honest About Mixed Evidence

Leaders trust presenters who show the limits of their case. The transitional care proposal partly responds to the Medicare readmission penalty. Zuckerman et al. (2016) reported the national readmission rate for the penalized conditions dropping to 17.8 percent, from 21.5, in 3,387 hospitals as the program took hold, while observation stays rose. The paper tells the committee that penalties have pushed readmissions down, but that the goal is better care after discharge, and that the service will track deaths after discharge as well as returns, so that the hospital does not improve one number at patients' expense.

Explain Where the Money Goes

Committee members often ask why nursing proposals do not simply bill for more. The paper explains the cost of getting paid. Tseng et al. (2018) found at an academic system that billing and insurance work ran from $20.49 per primary care visit to $215.10 per inpatient operation, and Himmelstein et al. (2020) estimated that administration took 34.2 percent of U.S. health spending in 2017. The transitional care service's revenue projection therefore includes the cost of billing its codes, which strengthens the credibility of the net figure.

Build the Presentation

The finance committee receives a one-page summary in advance and sees one slide per proposal in the meeting: the request, three numbers (cost, net present value and payback) and a single patient's story, with permission, of a heart failure readmission that the service would have prevented. Backup slides hold the pro forma, sensitivity analysis and evidence. The community council receives a handout in everyday words, printed in both English and Spanish, a short presentation by a staff nurse and a patient, and time for questions.

Prepare for Questions

The chief nursing officer rehearses with the chief financial officer, who plays a skeptical committee member. Likely questions are prepared: what if enrollment is lower, what if nurses cannot be hired, why staffing instead of technology, and how will the committee know it worked. Each answer points to a measure on the proposed dashboard.

The community council needs different preparation. Its members ask about access and fairness: whether the transitional care nurses will visit patients in the poorest neighborhoods, whether visits are available in Spanish and Korean, both common in Hackensack, and whether patients without insurance will be served. The answers are prepared in advance, and the service's eligibility rules are adjusted so that uninsured patients discharged with heart failure are included, funded through the hospital's community benefit budget.

The Dashboard

A quarterly dashboard will report, for each initiative, its spending against budget, its financial effect and its quality measures, such as readmissions, deaths after discharge, falls and nurse turnover, so the committee can hold nursing accountable for the promised results.

Conclusion

A sound financial case can fail if it is poorly communicated. This paper translates value into the terms each audience uses, presents decision tools the committee already trusts, shows the mixed evidence honestly, explains the cost of billing and builds a short presentation, a plain-language community briefing, a rehearsal and a dashboard that keeps the promises visible.

References

Himmelstein, D. U., Campbell, T., & Woolhandler, S. (2020). Health care administrative costs in the United States and Canada, 2017. Annals of Internal Medicine, 172(2), 134-142. https://doi.org/10.7326/M19-2818

Porter, M. E. (2010). What is value in health care? New England Journal of Medicine, 363(26), 2477-2481. https://doi.org/10.1056/NEJMp1011024

Tseng, P., Kaplan, R. S., Richman, B. D., Shah, M. A., & Schulman, K. A. (2018). Administrative costs associated with physician billing and insurance-related activities at an academic health care system. JAMA, 319(7), 691-697. https://doi.org/10.1001/jama.2017.19148

Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the Hospital Readmissions Reduction Program. New England Journal of Medicine, 374(16), 1543-1551. https://doi.org/10.1056/NEJMsa1513024