Abstract
Purpose
The purpose of this study was to perform an economic analysis and estimate the fee for the practices that carried out by Emergency Nurse Practitioner (ENP) using relative value scale (RVS) and its conversion factor.
Methods
First, we developed ENP's RVS for 25 advanced nursing services based on ENP's workload and its time spent by survey. A cost analysis was performed to evaluate the conversion factor of ENP's RVS. The share of ENP's contribution to fee-for-service in emergency setting was also analyzed.
Results
Calculation of the RVS of 25 advanced nursing practices showed a range of points from 73.4 to 296.3 and an average of 145.1 points. The relevant conversion factor for advanced nursing practices among ENP was estimated at 12.2~15.9 won. The contribution rate of ENP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 13.1~17.0%.
Conclusion
The practices of ENP are not compensated separately and its reimbursement is usually included in physician fee. An estimation of nursing fee and an independent fee related to ENP's services shows the contribution rate to total revenue. It suggests that emergency nurse practitioners be considered as a revenue source the in emergency room.
REFERENCES
American Nurse Association. 2007. Barriers to the practice of advanced practice registered nurses. Nursing's Legislative and Regulatory Initiatives for the 110th Congress: Workplace Rights. Retrieved September 9, 2011, from the ANA Web site:. http://nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/APRN/PracticeofAPRN.pdf.
Barr M.., Johnston D.., McConnell D.2000. Patient satisfaction with a new nurse practitioner service. Accident and Emergency Nursing. 8(3):144–147. http:/dx.doi.org/10.1054/aaen.2000.0139.
Cardello D. M.1992. Implementation of a one-hour fast-track service: one hospital's experience. Journal of Emergency Nursing. 18(3):239–243.
Cole F.., Ramirez E.2005. Nurse practitioners in emergency care. Topics in Emergency Medicine. 27(2):95–100.
Greenfield S.., Komaroff T. M.., Pass H.., Anderson H.., Nessim S.1978. Efficiency and cost of primary care by nurses and physician assistants. New England Journal of Medicine. 298(6):305–309. http:/dx.doi.org/10.1056/NEJM197802092980604.
Health Insurance Review & Assessment Service. 2006, December. Study on revised relative value scale. Seoul: Author.
Hong M. H.2012. Increase in emergency patients annually. Without lack of emergency specialist. Retrieved July 17, 2012, from Digital Doctorstimes. Web site:. http://www.doctorstimes.com/news/articleView.html?idxno=151849.
Hsiao W.., Brauns P.., Becker E.., Causino N.., DeNicola M.., Dunn D., et al. 1988. A National study of resource-based relative value scales for physician services. Final Report. Department of Health Policy and Management, Harvard School of Public Health & Department of Psychology, Harvard University.
Jang H. S.., Yoo S. J.., Hwang J. I.., Jin Y. L.2004. Demand and supply planning for the advanced practice nurses. Korea Health Industry Development Institute;Seoul:
Jung G. Y.., Im K. S.., Min Y. I.., Lee S. B.., Kim S. K.1997. The present status of emergency care in emergency centers. The Korean Society of Emergency Medicine. 8(3):441–459.
Kang C. W.., Kim Y.., Lee P. S.., Kwon Y. D.., Kim C. Y.., Shin Y. S.1997. Performance evaluation of emergency medical center. The Korean Journal of Preventive Medicine. 30(4):884–892.
Kim E. J.., Lim J. Y.2010. Evaluation of Shortening the stay time of patients in and Emergency Medical Ecnter (EMC). The Journal of Korean Academic Society of Home Care Nursing. 17(1):21–27.
Kim J. H.., Kim M. A.., Kim M. W.., Kim K. S.., Yoo C. S.2011. Development of a resource-based relative value scale and its conversion factor for advanced nursing practices in the national health insurance corporation. Journal of Korean Academy of Nursing. 41(3):302–312. http://dx.doi.org/10.4040/jkan.2011.41.3.302.
Kim J. H.., Kim M. A.., Kim M. W.., Kim K. S.., Yoo C. S.., Lee E. H.2009. Analysis on advanced practice performance by emergency nurse practitioners. Journal of Korean Data Analysis Society. 12(2):781–796.
Kim K. H.., Han S. T.., Kang H.2006. A study on finding of hospitalization at obstetrics and gynecology emergency center by using health information. Journal of the Korean Data Analysis Society. 8(3):989–996.
Korean Accreditation Board of Nursing. 2005. Core competencies of advanced practice nurse and job performance of each branches of Advanced Practice Nurses. Seoul: Author.
Korean Hospital Nurses Association. 2008, 2012. Hospital nurse staffing status survey. Seoul: Author.
Korean Accreditation Board of Nursing. 2013. The Statistics of Certified Nurse Examination. Retrieved March 1, 2013 from the KABON web site:. http://kabon.or.kr/kabon04/index02.php.
Korean Accreditation Board of Nursing. 2005. Core competencies of advanced practice nurse and job performance of each branches of Advanced Practice Nurses. Seoul Moon, S. Y. (2002). Estimation of nursing cost for each nursing behavior in neonatal intensive care unit using resource-based relative value scale. Unpublished Master's thesis, Ewha Womans University, Seoul.
McGee L. A.., Kaplan L.2007. Factors influencing the decision to use nurse practitioners in the emergency department. Journal of Emergency Nursing. 33(5):441–446.
National Emergency Medical Center. 2012. . Result of evaluation of emergency medical institution. Retrieved April 1, 2012 from. http://www.nemc.or.kr/infor/board_view.jsp?boardLeftMenuFlag=10&num=10.
National Health Insurance Corporation. 2012, January. 2012 Health insurance fee schedule. Seoul: Korea.
O'Brien J. M.2003. How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health-System Pharmacy. 60(22):2301–2307.
Park K. J.2008 February. Present and challenge in system of advanced practice nurses. Workshop presented at the meeting of Korean Nurses Association and Korean Accreditation Board of Nursing on how to obtain methods of application of Advanced Practice Nurses. Seoul, Korea.
Park S. G.., Lee S. H.., Jwa Y. K.., Myung H. B.., Lee J. Y.2011. Evaluation of the midterm outcome of the plan to advance a emergency medicine. Korea Health Industry Development Institute;Seoul: Korea:
Shin T. G.., Song J. W.., Song H. G.., Hong C. K.2011. Characteristics of frequent users of emergency department. Journal of The Korean Society of Emergency Medicine. 22(1):86–92.
Song K.., Kim Y. S.., Lee Y. H.2008. Legalistic study of the subrogation payment system in emergency medicine. The Korean Society of Law and Medicine. 9(2):139–179.
The National Council of State Boards of Nursing. 2012. NCSBN Model Act. Retrieved April 1, 2013 from. https://www.ncsbn.org/12_Model_Act_090512.pdf.
Yoo I. S.2010. What to do to improve emergency care. Health and Welfare Policy Forum. 169:45–57.
Wood C.., Hurley C.., Wettlaufer J.., Pengue M.., Shaha S.., Lillis K.2007. Retrospective comparison of emergency department length of stay for procedural sedation and analgesia by nurse practitioners and physicians. Pediatric Emergency Care. 23(10):709–712. http://dx.doi.org/10.1097/PEC.0b013e318155ade4.
Table 1.
Table 2.
Advanced practice | Relative Value Scale | Time | (RVS∗T) | Frequency (1 person/yr) | |||
---|---|---|---|---|---|---|---|
Technical skill | Mental effort | Stress | Mean | ||||
ABGA with POCT | 100.0 | 100.0 | 100.0 | 100.0 | 7:03 | 703.0 | 1,584 |
Sampling in Blood culture | 130.7 | 119.8 | 138.1 | 129.5 | 13:51 | 1,750.0 | 528 |
Sampling and irrigation from tube | 100.4 | 90.2 | 98.1 | 96.2 | 5:25 | 505.2 | 48 |
Electrocardiogram | 82.3 | 85 | 82.7 | 96.2 | 4:13 | 344.2 | 2,640 |
Simple dressing | 76.2 | 72.4 | 71.6 | 73.4 | 7:02 | 515.3 | 112.8 |
Bed sore dressing | 130.5 | 132.8 | 131.6 | 131.6 | 9:39† | 1,236.0 | 51.6 |
Cervical immobilization | 91.3 | 97.4 | 93.2 | 94.0 | 5:00† | 469.8 | 24 |
Spinal board immobilization | 93.3 | 93.0 | 86.4 | 90.9 | 10:15† | 922.6 | 5 |
Emergency patient. transfer | 159.0 | 170.0 | 156.0 | 161.7 | 9:30 | 1,503.5 | 7 |
Defibrillation | 160.1 | 205.9 | 207.9 | 191.3 | 2:30† | 440.0 | 2 |
CPR | 322.9 | 274.4 | 291.7 | 296.3 | 11:50† | 3,407.8 | 64.8 |
Bag valve mask ventilation | 174.8 | 189.1 | 195.7 | 186.5 | 13:12† | 2447.3 | 36 |
NIV care | 172.4 | 182.1 | 189.3 | 181.3 | 5:50 | 997.0 | 18 |
Care of patient with ventilator | 236.3 | 243.3 | 242.3 | 240.6 | 11:11 | 2,673.4 | 55 |
Chemoport needle insertion | 111.1 | 210.7 | 115.9 | 145.9 | 19:16 | 2,795.4 | 12 |
Arterial catheter insertion | 157.2 | 168.6 | 163.3 | 163.0 | 15:00 | 2,445.5 | 42 |
Intravenous catheter insertion | 110.1 | 79.8 | 99.9 | 96.6 | 7:29 | 704.2 | 396 |
Nasogastric tube insertion | 106.2 | 97.8 | 106.2 | 103.4 | 9:47† | 979.2 | 6 |
Gastric lavage (GI bleeding) | 137.1 | 97.2 | 112.2 | 115.5 | 24:43 | 2,821.7 | 5 |
Transcutaneous pacing | 150.1 | 175.2 | 187.9 | 171.1 | 12:33 | 2,109.3 | 8 |
Chest bottle change | 112.7 | 106.7 | 111.6 | 110.3 | 6:06 | 668.6 | 7 |
Retention enema | 140.0 | 115.9 | 160.2 | 138.7 | 9:43† | 1,307.9 | 1 |
Supervised medication of emergency drug | 162.3 | 195.1 | 198.2 | 185.2 | 4:04 | 748.2 | 240 |
Hemodynamic monitoring | 143.7 | 160.4 | 151.6 | 151.9 | 10:00 | 1,519.0 | 84 |
Triage | 153.1 | 203.8 | 208.1 | 188.3 | 3:56 | 670.5 | 1,533 |
Mean | 140.6 | 146.7 | 147.9 | 145.1 | 9:40 | 1,774.9 | 300.4 |
Proportion of indirect cost in ENP'S total cost | |||||||
Conversion factor | 0% | 10% | 20% | 30% | |||
12.21 | 13.43 | 14.65 | 15.90 |
Table 3.
Table 4.
Advanced practice | Health insurance | Health insurance RVS | Adjusted RVS of ENP | |||
---|---|---|---|---|---|---|
0% (CR) | 10% (CR) | ) 20% (CR) | 30% (CR) | |||
ABGA with POCT | Blood gas study | 134.54 | 18.48 | 20.30 | 22.12 | 24.09 |
(13.74) | (15.09) | (16.44) | (17.91) | |||
Sampling in blood culture | Microorganism culture, identification and antibiotics sensitivity test | 207.06 | 46.01 | 50.54 | 55.07 | 59.97 |
(22.22) | (24.41) | (26.59) | (28.96) | |||
Sampling and irrigation from tube | Natural drainage and care after operation (per day) | 113.96 | 13.28 | 14.59 | 15.90 | 17.31 |
(11.66) | (12.80) | (13.95) | (15.19) | |||
Electrocardiogram | EKG tracing and interpretation | 68.85 | 9.05 | 9.94 | 10.83 | 11.79 |
(13.14) | (14.44) | (15.73) | (17.13) | |||
Simple dressing | Simple dressing | 58.04 | 13.55 | 14.88 | 16.21 | 17.66 |
(23.34) | (25.64) | (27.94) | (30.42) | |||
Bed sore dressing | Infectious wound dressing (per day) | 112.10 | 32.50 | 35.70 | 38.89 | 42.36 |
(28.99) | (31.84) | (34.70) | (37.79) | |||
Cervical immobilization | Cervical immobilization with cervical collar, etc. | 209.37† | 12.35 | 13.57 | 14.78 | 16.10 |
(5.90) | (6.48) | (7.06) | (7.69) | |||
Spinal board immobilization | Spine immobilization | 689.76† | 24.26 | 26.65 | 29.03 | 31.62 |
(3.52) | (3.86) | (4.21) | (4.58) | |||
Emergency patient. transfer | - | - | 39.53 | 43.42 | 47.31 | 51.52 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Defibrillation | Defibrillation, cardioversion (per day) | 1,213.53† | 34.71 | 38.12 | 41.54 | 45.23 |
(2.86) | (3.14) | (3.42) | (3.73) | |||
Cardiopulmonary resuscitation | Cardiopulmonary resuscitation (15min) | 1,204.32† | 268.75 | 295.19 | 321.62 | 350.26 |
(22.32) | (24.51) | (26.71) | (29.08) | |||
Bag valve mask ventilation | Mechanical ventilation: within 3hr | 512.82† | 64.35 | 70.68 | 77.01 | 83.87 |
(12.55) | (13.78) | (15.02) | (16.35) | |||
Non-invasive ventilation care | BIPAP treatment (per day) | 1,202.65 | 78.65 | 86.38 | 94.12 | 102.50 |
(6.54) | (7.18) | (7.83) | (8.52) | |||
Care of pt with ventilator | Mechanical ventilation: within 3hr | 830.15† | 70.30 | 77.21 | 84.12 | 91.62 |
(8.47) | (9.30) | (10.13) | (11.04) | |||
Chemoport needle insertion | - | - | 73.50 | 80.73 | 87.96 | 95.80 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Arterial catheter insertion | - | - | 64.30 | 70.63 | 76.95 | 83.80 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Intravenous catheter insertion | - | - | 18.52 | 20.34 | 22.16 | 24.13 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Nasogastric tube insertion | Nasogastric tube insertion | 168.09 | 25.75 | 28.28 | 30.81 | 33.56 |
(15.24) | (16.74) | (18.24) | (19.86) | |||
Gastric lavage | Gastric lavage: GI bleeding | 539.70† | 74.19 | 81.49 | 88.791 | 96.69 |
(13.75) | (15.10) | (16.45) | (17.52) | |||
Transcutaneous pacing | Transcutaneous cardiac pacing | 119.14 | 55.46 | 60.92 | 66.37 | 72.28 |
(46.55) | (51.13) | (55.71) | (60.67) | |||
Chest bottle change | Natural drainage and care after operation (per day) | 47.57 | 17.58 | 19.31 | 21.04 | 22.91 |
(36.96) | (40.59) | (44.23) | (48.17) | |||
Retention enema | Retention enema | 89.50 | 34.39 | 37.77 | 41.16 | 44.82 |
(38.43) | (42.21) | (45.99) | (50.08) | |||
Supervised medication of emergency drug | - | - | 19.67 | 21.61 | 23.54 | 25.64 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Hemodynamic monitoring | - | - | 39.94 | 43.87 | 47.80 | 52.05 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Triage | - | - | 17.63 | 19.36 | 21.10 | 22.98 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Mean | 46.67 | 51.26 | 55.85 | 60.82 | ||
(13.05) | (14.33) | (15.61) | (17.00) |