Payson A A
Health Prog. 1987 May;68(4):50-1, 80.
The traditional method of apportioning nursing care costs ona per diem basis does not consider nursing intensity or patients' special needs and often includes nonnursing duties. Many hospitals now favor a fee-for-service concept and are determining direct patient care costs to identify the true nursing cost. A patient classification system correlated with the diagnosis-related group (DRG) classification improves nursing cost analyses. For each patient, nurse managers need systems to determine quantified nursing tasks and patient acuity levels for each day. This information can be used to adjust staffing and to establish variable billing procedures. Then they can institute variable billing methods that are based on direct care costs as well as indirect costs of administration, education, and supplies. Variable billing identifies revenue cost centers, allows systematic monitoring of nursing services, and improves budget planning. The entire nursing staff must become involved in the financial system so the hospital can obtain an accurate data base for rate setting and third-party reimbursement.
传统的按日分摊护理成本的方法没有考虑护理强度或患者的特殊需求，而且常常包含非护理职责。现在许多医院倾向于采用服务收费理念，并在确定直接的患者护理成本以识别真正的护理成本。与诊断相关分组（DRG）分类相关的患者分类系统能改进护理成本分析。对于每位患者，护士长需要有系统来确定每天的量化护理任务和患者 acuity 水平。这些信息可用于调整人员配置并建立可变计费程序。然后他们可以制定基于直接护理成本以及管理、教育和用品间接成本的可变计费方法。可变计费能识别收入成本中心，允许对护理服务进行系统监测，并改进预算规划。全体护理人员必须参与到财务系统中，这样医院才能获得用于费率设定和第三方报销的准确数据库。
