2. DISCHARGE COSTANALYSIS 2
Table of Contents
Discharge Cost Analysis ..................................................................................................... 3
Client’s current medical status............................................................................................ 4
Cost Incurred During Hospitalization................................................................................. 6
Cost Incurred for Two Months After Discharge ................................................................. 7
Resource Allocation............................................................................................................ 8
References..........................................................................................................................11
Tables ................................................................................................................................ 12
3. DISCHARGE COSTANALYSIS 3
Discharge Cost Analysis
Cost is a very important factor when dealing with health care. It is one of the main factors when
making health care decisions for people that struggle financially. If you’ve ever been admitted to
the hospital before, you know the hospital bills can be overwhelming. I myself was in an
automobile accident in January 2015 and at the time I had no idea the debt I was accruing. From
the ambulance ride to the 18 hours I stayed in the hospital room, my bill ended up at $38,000. I
was mortified! If I had known the costs of certain procedures of medications, I feel that I
could’ve made decisions that would’ve fit my financial situation a little better. As nurses, we
make our priority caring for the patient, but sometimes we don’t take into account how they will
be able to pay their hospital bill. I feel like this project will help understand these costs and help
us be more knowledgeable about giving this information to our patients.
4. DISCHARGE COSTANALYSIS 4
Client’s current medical status
I chose my patient for this assignment based on the fact that her condition was very intriguing to
me. She is a 70 year old Caucasian female admitted for failure to thrive, intermittent abdominal
pain, and dehydration. Her weight was 91 pounds. She was taken to WilMed ED where they
further diagnosed her with COPD, depression, insomnia, anxiety. The ED report also stated that
she was SOB and had dyspnea. Looking further into her chart, I also found that she had a
significant history of depression and chronic tobacco use; one pack of cigarettes a day for over
30 years more than likely leading to her chronic shortness of breath. I decided to look through
her family history. Her father had died from a lung collapse and aspiration pneumonia; he was
also a smoker. Her sister smoked as well and died from lung cancer. The COPD and
hypertension history in her family was significant. I met her daughter and son while caring for
my patient and they were very concerned about their mothers’ health. Her son expressed worries
regarding her weight loss. When performing my initial physical assessment, I noted that she was
alert and oriented to self and place but was mildly confused. She was not oriented to date or time.
Her oxygen saturation was 95% on room air and I did auscultate her lungs and documented that I
heard rales bilaterally and the lung sounds were moderately diminished. She had more difficulty
with inhalation than exhalation. I then asked about her abdominal pain and she stated she did not
have any pain anywhere in her body. She didn’t have many meds ordered, but the ones that were
ordered were pretty expected with her conditions. The underlying cause of her FTT diagnosis
seemed to be depression. She was started on Celexa, which is an SSRI used for depression. The
side effects worried me because I felt that this medication would worsen her already diagnosed
conditions. The most common side effects are fatigue, abdominal pain, anorexia, insomnia, and
anxiety. Most of these were part of her medical history already. I expressed these concerns with
5. DISCHARGE COSTANALYSIS 5
the nurse and she stated that this was the first anti-depressant medication the physician wanted to
start her on. If there were any problems with the medicine, he would change her to a different
one. She also had a PRN order of DuoNeb, which is a bronchodilator, in case she had episodes of
dyspnea. She was not administered this medication while I was there. My patient also had PRN
orders of Zofran for nausea, Colace for constipation, and Tylenol for mild pain or fever. She did
not state complaints of any of these problems, therefore these meds were also not administered.
The chest x-ray showed a gray lesion on her right lung and her chart said “possible pneumonia.”
After the physician documented the findings, he then ordered a PPD skin test and Azithromycin
injection. A discharge date had not been set for my patient so I’m not sure what services or
procedures she would have done once I left. I also don’t know what the physician would have
ordered once she was discharged. I have attached a table with estimates of how much my
patient’s procedures will cost. The average cost of a hospitalization at Wilson Medical Center for
a patient admitted for failure to thrive is $22, 048.43. My patient has Medicare and BCBS.
Medicare takes care of 80% of hospital costs and BCBS will cover the other 20%. This is of
course, once the patient has paid their deductible of $1260. I know the physician spoke with the
patient and her family regarding being on oxygen continuously once she went home. He also
mentioned looking into some support groups to help with her depression and continuing with the
Colace if she had no problems while taking it. She was scheduled to consult with a nutritionist
the day after I saw her. The nutritionist will help my patient’s overall health status by educating
her on the nutrients she needs. She was also scheduled to consult with pulmonary to go over the
chest x-ray and chest CT results with her family.
6. DISCHARGE COSTANALYSIS 6
Cost Incurred During Hospitalization
I have done extensive research to estimate about how much my patient will be responsible for in
hospital bills during her hospital stay. This patient has Medicare and Medicaid insurance. Most
individuals qualify for Medicare once they are 65 years of age or if they are disabled. I called
WilMed and spoke with an agent in the coding and billing department. She was very patient and
answered many of the questions I had. I was able to obtain most of my information from her but
I still wanted to do research to find out the costs of the smaller things involved in hospitalization.
I found a website that was extremely helpful and gave me all of the CPT codes and fees that
became effective in 2015. I had the codes and costs available but I still needed to match every
procedure with a code. My patient had many orders in her chart that she refused. Her physician
ordered a chest CT, chest x-ray, mammogram, and pulmonary function test and she refused all of
them. Because of her significant family history, the healthcare team was suspecting she could
possibly have some sort of lung cancer also. I ended up convincing her to have the chest CT and
x-ray done. This chest CT alone was $1638.00. The chest x-ray was $192.00. These numbers
were accurate; I obtained these amounts from billing the day I was in the hospital. The lady I
spoke with only had time to give me those before she was called away. I did use a list from
another hospital to come up with other procedure costs. Another hospital with the name of
“Wilson Hospital” came up when I was doing research and it gave an entire list with prices of the
most common labs, imaging procedures, and surgeries. It included the costs for hospital rooms
and the emergency department cost. I was able to find most of my patient’s medications by
matching them to a code and looking up their cost. They are not specific to our hospital. I have
stated in the Tables 2 & 3 which numbers are accurate and which are estimates.
7. DISCHARGE COSTANALYSIS 7
Cost Incurred for Two Months After Discharge
I have also done research to estimate how much my patient will be responsible for during two
months after discharge. Since I only cared for my patient for one day after she had been
admitted, I don’t know exactly what her doctor’s orders were after she was to be discharged. The
results from her chest x-ray helped me guess what she would have done but I will be guessing on
most of the orders. I know her physician wanted her to continue on Celexa once a day in the
morning. In Table 4, I included the costs for a 30 day supply of Celexa as directed and the price
of ibuprofen in case its needed. Her insurance will pay for medications that are prescribed. I
spoke with my patient and her family about purchasing a standard wheelchair. They seemed to
be against getting one. I feel that the family was not ready to hear that option, but I wanted to
help them find resources in case they decided to; the price is included in Table 4. I also spoke
with them about the need for the patient to quit smoking. I offered a few different options
including nicotine gum to be used throughout the day, and nicotine patches that could be worn
and changed daily. These prices are included in Table 4, but they do vary by pharmacy. There
are also smoking cessation support groups available. These groups are either free or insurance
will cover them. Pulmonary consults were also recommended once the patient is discharged.
These offices charge a specialist copay, which is $80 with BCBS. Medicare takes priority and
covers the copay cost. I believe that the smoking is my patient’s biggest underlying problem,
therefore if she is willing to put forth the effort into quitting, it may cost her insurance less in
overall healthcare costs. If she is to return to the hospital with the same issues, the costs would
equal about the same as for this hospitalization, but her Medicare premium could increase for
next year due to their expenses.
8. DISCHARGE COSTANALYSIS 8
Resource Allocation
All areas of the healthcare field determine how to use resource allocation. I have come up with a
few different examples for each area. Preventative care could save insurance companies and
hospitals a great amount of money. Providing a patient with a home health nurse could benefit
both the patient and the insurance company. The nurse could take better and more careful care of
the patient than the patient could herself. Another resource the insurer could use would be
smoking cessation therapy groups. Most of the ones I found were free of cost or were covered by
insurances such as BCBS. Elderly clients usually receive the services for free because in the long
run, it decreases hospitalizations and complications from smoking. I also came up with resource
allocation examples that the hospital could use. I’m not sure if it was done after I left my patient,
but she could have had an oncology consult. Oncologists do a great job at explaining the risks
and complications that come with smoking. Patients are more likely to quit if they are given
medical advice from a doctor than from a nurse (Evidence-Based Best Practices for Promoting
Smoking Cessation, 2012). Another example would be using nicotine patches. They are fairly
expensive but can aid the patient in quitting, which again would decrease the number of
hospitalizations. These patches are usually covered by insurance both in the hospital and in the
pharmacy if the patient uses them after discharge. I have also researched resources the client can
use to better her condition. In the Handbook of Depression it states that one of the most
successful interventions for depression is cognitive-behavior therapy. This focuses on modifying
dysfunctional automatic thoughts that lead to depression. Minimizing these dysfunctional
thoughts or learning to cope with them could rid the patient of her depression. If the depression
was lifted, she’d have more motivation to eat and wouldn’t be hospitalized again for failure to
thrive or nutrition imbalances. A psychiatrist consult and follow ups could also assist with this
9. DISCHARGE COSTANALYSIS 9
issue. The patient could also use a consult with a nutritionist to help get her nutritional status
back to normal. They could assess and determine which nutrients and vitamins she needs most.
I’d also like to address a few ways nurses can improve assess to healthcare. A literature resource
I found stated that the way nurses treat patients with depression can great affect them and their
outcomes. Some nurses disregard the depression and don’t assess the patients’ signs and
symptoms. They need more affection than non-depressed patients. If these patients feel like
they’re a bother or feel hopeless, they won’t seek healthcare. We need them to feel comfortable
enough to come for us for help and support. Preventative care is one of the most important
factors in decreasing health problems in our community. We need to be more proactive in
educating our community on how to stay healthy. This can be done simply by doing our job;
educating everyone as much as possible. My patient was a smoker and she told me that a nurse
she’d had the day before, didn’t want to give her her pain medication. I understand that everyone
has their beliefs and opinions in healthcare but we don’t have the right to make decisions for our
patients; they make their own decisions. I always have my values and beliefs but I don’t let it get
in the way of treating my patient. We are there to help them get better and fulfill their healthcare
wishes. These different strategies can make us better nurses overall and decrease preventable
hospitalizations.
Summary & Personal Reflection
This paper seemed like it was going to be such a hassle when we were first told about the
assignment. It was a lot of work! I spent extensive hours doing research and I was exhausted
once I finally finished. Every resource I found online gave me different information. They all
had different fees for each procedure. I attempted to speak with the billing department at WilMed
and they couldn’t give me much information before they said they were too busy. They’re not
10. DISCHARGE COSTANALYSIS 10
like a doctor’s office; offices usually have codes paired with costs. I found an article discussing
the difficulties in making a very closely estimated cost analysis
(http://economix.blogs.nytimes.com/2009/03/13/cost-effectiveness-analysis-and-us-health-
care/?_r=0).It was kind of a headache but once I was done, I was glad I had done this paper for
the purposes it was meant for. I feel like I’m more capable of explaining costs to my patients
now. I know procedure costs and hospital bills are very important when dealing with healthcare.
This assignment made me more compassionate to how much every little thing in one
hospitalization can affect a person’s life. I was dreading this assignment to begin with, but the
further I got into it made me realize how much this really affects each individual I come across. I
also got a view on how it affects our states and country as a whole. Patients without insurance
can’t afford to go to the hospital with hospital expenses rising every year. But in change, the
prices are rising because insurance companies are having to pay for these expenses. It’s all a
cycle in order for everyone to get paid. Our instructors really do have a great idea of how to care
for our patients and have compassion towards what they deal with once they go home. Albarran,
2015
11. DISCHARGE COSTANALYSIS 11
References
CPT Codes and Fees. (2015). Retrieved October 28, 2015, from
http://www.ic.nc.gov/ncic/pages/80000.htm
Drug Cost Estimates - Generics. (n.d.). Retrieved October 24, 2015, from
http://www.bcbsil.com/aon/pdf/aon_top50generics.pdf
Gotlib, I. (2002). Handbook of depression (3rd ed.). New York: Guilford Press.
Getting help with the mental part of addiction. (2014, February 6). Retrieved October 28, 2015,
from http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-
quitting-smoking-help-mental
HCPCS 2015 Index. (2014, October 8). Retrieved October 23, 2015, from
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/2015-Alpha-
Numeric-Index-.pdf
ICD-10 Version:2015. (n.d.). Retrieved October 26, 2015, from
http://apps.who.int/classifications/icd10/browse/2015/en#/R62.9
Medicare 2015 costs at a glance. (n.d.). Retrieved October 22, 2015, from
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-
4808
North Carolina Hospital Association. (n.d.). Retrieved October 20, 2015, from
https://www.ncha.org/healthcare-topics/finance/top-35-drgs
Reinhardt, U. (2009, March 13). 'Cost-Effectiveness Analysis' and U.S. Health Care. Retrieved
October 23, 2015, from http://economix.blogs.nytimes.com/2009/03/13/cost-effectiveness-
analysis-and-us-health-care/?_r=0
VHA Chief Business Office. (n.d.). Retrieved October 22, 2015, from
http://www1.va.gov/cbo/apps/rates/disclaimer/viewFile.asp?tbl_ID=191&ver_ID=36&mode=1&
CFID=77698&CFTOKEN=de24f1b765819b0d-AD154A4C-C021-62C9-2B65235FB520BA68
Your Medicare Coverage. (n.d.). Retrieved October 22, 2015, from
https://www.medicare.gov/coverage/ekg-screenings.html
2015 Medicare Costs. (n.d.). Retrieved October 21, 2015, from
https://www.medicare.gov/Pubs/pdf/11579.pdf
12. DISCHARGE COSTANALYSIS 12
Tables
Table 1: ED, Room and Board, & Imaging Charges
Total Cost Medicare Pays BCBS Pays Patient Pays
Med/Surg Room per Day (estimate
from a different hospital)
$651.00 x 2 $1041.60 $260.40 $0.00
ED Level 2 (different hospital) $325.00 $260.00 $65 $0.00
EKG (estimate) $168.00 $134.40 $33.60 $0.00
ABG’s (estimate) $119.00 $95.20 $23.80 $0.00
Chest x-ray portable 1 view $192.00 $153.60 $38.40 $0.00
Chest CT with contrast $1638.00 $1310.40 $327.60 $0.00
TOTALS: $3744.00 $2995.20 $748.80 $0.00
Table 2: Laboratory Charges during Hospitalization
Total Cost Medicare Pays BCBS Pays Patient Pays
CBC $74.00 $59.20 $14.80 $0.00
CMP $196.00 $156.80 $39.20 $0.00
PTT (estimate) $39.00 $31.20 $7.80 $0.00
Urinalysis $52.00 $41.60 $10.40 $0.00
Sedimentation rate $33.00 $26.40 $6.60 $0.00
Creatinine $61.00 $48.80 $12.20 $0.00
TOTALS: $455.00 $364.00 $91.00 $0.00
13. DISCHARGE COSTANALYSIS 13
Table 3: Medications Given in Hospital
Total Cost Medicare Pays BCBS Pays Patient Pays
Acetaminophen tablet $3.32 x 4 $10.62 $2.66 $0
Azithromycin injection (estimate) $15.57 $12.46 $3.11 $0
Vitamin B12 $1.23 x 4 $3.94 $0.98 $0
5% dextrose /0.45% NS 1000 mL $21.96 $17.57 $4.39 $0
Enoxaparin sodium injection $15.57 x 2 $24.91 $6.23 $0
PPD test (estimate) $12.74 $10.19 $2.55 $0
Ciprofloxacin injection $3.68 $2.94 $0.74 $0
Heparin IV 20000 u (estimate) $1.23 x 20 $19.68 $4.92 $0
Nicotine patch $29.71 x 2 $47.54 $11.88 $0
Nicotine gum $63.29 x 4 $202.53 $50.63 $0
IV Tubing 10 gtt $12.32 $9.86 $2.46 $0
TOTALS: $452.79 $362.23 $90.59 $0
Table 4: Costs Incurred for 2 Months after Discharge
Total Cost Medicare Pays BCBS Pays Patient Pays
Standard wheelchair (varies) $112.89 $90.31 $22.58 $0
Celexa 30 day supply $12.04 $9.63 $2.41 $0
Nicotine patch 1 wk supply $21.99 $17.59 $4.40 $0
Nicotine gum pack 170 pcs $32.98 $26.38 $6.60 $0
Multivitamin 180 capsules $37.99 $30.39 $7.60 $0
