The challenge of prospective pricing: work smarter.

Nursing administrators are faced with the challenge of containing costs under Medicare's prospectively set reimbursement limits. The author suggests that nurses "work smarter" by utilizing the unique aspects of prospective pricing in a program that will maintain professionalism while improving "bottom line" outcomes. A pro-active strategy for administrators within nursing departments, on a hospital-wide basis, and in the entire health care delivery system is described. The author shows how determining nursing costs and revenues by diagnosis can be a way to validate both the cost-effectiveness of an RN staff and a high professional standard of practice. She outlines four elements of a trustworthy, effective change process.