Should Nurses know procedural costs?

K+MgSO4, BSN · Mar 22, 2015

Personally I belive that this function should be carried out by the patient billing team. Admittedly in my experience in Australia it is infrequent but why should this be a nursing role?

AspiringNurseMW · Mar 22, 2015

Nope, that's what the billing department is for. I think it would only complicate things, medical insurance is a monster, and often one price is billed to insurance but there is another price billed for self pay clients. On top of that, final costs, especially in an inpatient setting involves so much more than the procedure itself.

MunoRN, RN · Mar 22, 2015

I used to find pricing to be beyond my ability to understand, but it's actually not all that complicated. More importantly, providing a patient with that sort of information when asked is a core part of patient advocacy. If the costs of healthcare is not something a nurse is interested in then I'd argue they aren't interested in being the patient's nurse.

While prices paid to insurance companies vary widely, the price something will cost if not covered by insurance is a set price and can be found on the hospitals "chargemaster", which is something every hospital has.

In theory you could just direct patients to your hospital's billing department, although that isn't of much for providing patients with information about what their various services will cost since they aren't available after hours and weekends and typically aren't very timely with their responses.

MatrixRn · Mar 26, 2015

Nope. We do not need to share that information. Now, that said I know some of the costs of procedures for my area, but there is no way I would talk about them. That is the task of customer service.

amoLucia · Mar 26, 2015

OP's question was asking if nurses should KNOW prices. Without question, I say YES YES YES. It should not be my obligation to quote $ numbers to pts, much like I am not responsible to explain all the details involved with explaining 'informed consent' information. As others comment, that should be the responsibility of the billing dept.

But a close, general knowledge of costs could make a nurse more aware of how true operational costs affect a facility's bottom line. If healthcare providers AND consumers understood how expensive the costs are, there might be a shift away from ordering every test and procedure known to man because the thought is 'oh, insurance will pay for it'. No, insurance doesn't always pay for it! That has something to do with all those pre-authorization thingeys.

Years ago, by some quirk, I learned the cost of a routine throat C&S. My M/S teaching unit had 3 pts with low grade temp elevations - nothing wild. The first year intern ordered throat & nasal cultures on the WHOLE unit's census (40 pts). I stopped him. I told him the price and asked if he thought he could justify the costs to his dept head, esp considering my unit was primarily indigent care, so the hospital would be eating the costs. He changed that order real quick.

I think staff should know costs - I remember using sterile 4x4 sponges for coasters to mop up spilled coffee. After I learned some basic costs for supplies, I never did that again.

So yes, staff should have some idea about costs. It can help to prevent waste of supplies & gentle, conscientious use of equip (how many temp scans and pulse oximeters have been carelessly dropped or lost in bed linens (or stolen).

I've had many conversations with pts who were un-insured or under-insured, but they struggled to pay off their debts. They knew they would have a hard-time with a significant hospital bill. They wanted needed care but not all the frilly bells & whistles.

Going back to the original question, I vote YES.

Libby1987 · Mar 26, 2015

I used to find pricing to be beyond my ability to understand, but it's actually not all that complicated. More importantly, providing a patient with that sort of information when asked is a core part of patient advocacy. If the costs of healthcare is not something a nurse is interested in then I'd argue they aren't interested in being the patient's nurse.
While prices paid to insurance companies vary widely, the price something will cost if not covered by insurance is a set price and can be found on the hospitals "chargemaster", which is something every hospital has.
In theory you could just direct patients to your hospital's billing department, although that isn't of much for providing patients with information about what their various services will cost since they aren't available after hours and weekends and typically aren't very timely with their responses.

There is so much itemization how would you accurately know what to quote?

I know our cash prices and I know our costs for our supplies (I take those in consideration when I order for our stock or specific patient) but those are simple and straightforward.

BrandonLPN, LPN · Mar 28, 2015

This would only lead to patients saying "But the nurse said that procedure only cost Xâ€‹ number of dollars..."

elkpark · Mar 28, 2015

I prefer to stay out of the financial end of healthcare; if I knew what we were charging people, my conscience probably wouldn't let me go to work ... :) I actually made an effort to find out, several years ago, what the typical daily cost was for the inpatient psych units in the facility in which I worked. It was surprisingly difficult to get anyone in the organization to give me a clear answer!

Re: equipment and supplies, I assume all hospital supplies are ridiculously overpriced, and do my best to be a good steward of the hospital's resources and not make healthcare any more unconscionably expensive than it already is.

My general opinion is that I have more than enough that I need to know and keep track of already, without also making an effort to keep track of what the hospital charges for the many services and procedures offered. Also, as has been widely reported in the media coverage of healthcare costs and the lack of transparency in healthcare billing, what an individual gets charged for a particular service or procedure is largely based on that person's insurance coverage and what the specific insurance company has negotiated with the hospital. How on earth are individual nurses supposed to keep track of that? I certainly do not want to be responsible for giving anyone bad information about costs and charges (as BrandonLPN noted). As hard as I usually try to avoid saying this, this is someone else's job.

Editorial Team / Admin · Mar 29, 2015

I know what most of our surgical supplies cost, but that doesn't mean that's the price charged to the patient. The facility charges somewhere between 2 and 3 times its own cost. So get a $7,000 heart valve implanted, and the patient will be charged $14,000 - $21,000.

AspiringNurseMW · Mar 29, 2015

I agree, it would be beneficial for a nurse to know, but in no way should a nurse be communicating these things with the patient in any form

MunoRN, RN · Mar 30, 2015

Advocating for the patient is actually a basic responsibility of nursing. Ensuring that a patient's questions regarding a procedure they are considering consenting to have been answered is also a basic responsibility of nursing. Nurses are free to defer patients to a more appropriate source so long as that source is available to answer their question in a timely manner. I've never worked anywhere that the billing department is open any other time than regular business hours, or about one quarter of the time, yet procedures are being ordered for patients 24/7.

When I call the billing department to ask for the billing cost of a procedure, they are looking at an excel spreadsheet that has all the prices, which I'm just as capable of looking at myself and why it's posted on our intranet for all staff to refer to when needed. All hospitals have one of these lists which is called a "chargemaster". Typically things aren't actually billed by each supply used, they are bundled prices so it doesn't matter which guidewire they're using in the angiogram, it's a set price for a diagnostic cath including supplies.