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Kim, Kim, Kim, and Lee: Economic Analysis and Fee Development by Relative Value Scale of Nursing Practices by Emergency Nurse Practitioner
Original Research

Korean J Adult Nurs 2013;25(3):275-288.

Published online: 18 June 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.3.275

Economic Analysis and Fee Development by Relative Value Scale of Nursing Practices by Emergency Nurse Practitioner

Jin Hyun Kim1, Kyung Sook Kim2, Mi Won Kim3, Kyoung-A Lee1

1College of Nursing, Seoul National University, Seoul

2Department of Nursing, Namseoul National University, Cheonan

3Department of Nursing, Sangmyung University, Cheonan, Korea

Corresponding author: Kim, Kyung Sook Department of Nursing, Namseoul University, 충남 천안시 성환읍 대학로 91, Cheonan 331-707, Korea Tel: +82-41-580-2712, Fax: +82-41-580-2931, E-mail: kgs4321@nsu.ac.kr

Received 17 January 201315 May 2013       Accepted 18 June 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Nurse practitioner, Advanced nursing practice, Relative value scale, Nursing fee, Emergency nurse practitioner

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Figure 1.
Fee development by relative value scale of ENP's practices.
kjan-25-275f1.tif
Table 1.
General Characteristics (N=30)
Characteristics Categories n (%) M±SD Min Max
Gender Male 2 (6.7)      
Female 28 (93.3)
Age (year) ＜30 9 (30.0) 33.73±4.40 27 42
30~39 18 (60.0)
≥40 3 (10.0)
Marital status Single 12 (40.0)      
Married 18 (60.0)
Clinical career (year) ≤10 12 (40.0) 11.37±4.39 5 19
11~15 10 (33.3)
≥16 8 (26.7)
Clinical career in ED (year) ＜3 18 (60.0) 6.44±4.21 1.7 8.0
3~5 8 (26.7)
＞5 4 (13.3)

ED=emergency department.

Table 2.
Relative Value Scale, Time, Frequency in Emergency Nurse Practitioner
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

ENP=emergency nurse practitioner; ABGA=arterial blood gas analysis. POCT=point of care test; CPR=cardio-pulmonary resuscitation, NIV=non-invasive ventilation. GI=gastric intestine.

† Reporting data in Kim et al. (2010).

Table 3.
Costs of Advanced Nursing Practice in Emergency Nurse Practitioner
Advanced practice Health insurance Health insurance fee Cost by indirect cost rate
0% 10% 20% 30%
ABGA with POCT Blood gas study 11,545 1,586 1,742 1,898 2,067
Sampling in blood culture Microorganism culture identification and antibiotics sensitivity test 1,7766 3,948 4,336 4,724 5,145
Sampling and irrigation from tube Natural drainage and care after operation (per day) 9,778 1,140 1,252 1,364 1,486
Electrocardiogram EKG tracing and interpretation 5,907 778 852 929 1,011
Simple dressing Simple dressing 4,908 1,162 1,276 1,391 1,51
Bed sore dressing Infectious wound dressing (per day) 9,618 2,788 3063 3,337 3,634
Cervical immobilization Cervical immobilization with cervical collar, etc. 11,976 1,060 1,164 1,268 1,381
Spinal board immobilization Spine immobilization 39,454 2,081 2.286 2,491 2,713
Emergency patient. transfer Involved admission care 25,000 3,392 3,725 4,059 4,421
Defibrillation∗ Defibrillation, cardioversion (per day) 69,414 2,978 3,270 3,564 3,881
CPR Cardiopulmonary resuscitation (15min) 68,887 23,059 25,327 27,595 30,052
Bag valve mask ventilation Mechanical ventilation : within 3hr 29,333 5,521 6,064 6,607 7,196
NIV care BIPAP treatment (per day) 103,187 6,748 7,411 8,075 8,794
Care of patient with ventilator Mechanical ventilation: within 3hr 47,484 6,031 6,624 7,218 7,861
Chemoport needle insertion -   6,307 6,927 7,547 8,219
Arterial catheter insertion -   5,517 6,059 6,602 7,190
Intravenous catheter insertion -   1,588 1,745 1,901 2,071
Nasogastric tube insertion Nasogastric tube insertion 14,494 2,209 2,426 2,644 2,879
Gastric lavage Gastric lavage: GI bleeding 30,873 6,366 6.992 7,618 8,296
Transcutaneous pacing Transcutaneous cardiac pacing 10,222 4,759 5,227 5,694 6,202
Chest bottle change Natural drainage and care after operation (per day) 4,081 1,508 1,657 1,805 1,966
Retention enema Retention enema 7,679 2,951 3,241 3,531 3,846
Supervised medication of emergency drug Involved admission care   1,688 1,854 2,020 2,200
Hemodynamic monitoring -   3,430 3,764 4,101 4,466
Triage Involved admission care   1,513 1,661 1,810 1,971

EKG=electrokardiogram; BIPAP=Bi-level positive airway pressure.

† Multiply one defibrillation by three.

Table 4.
Contribution Rate of Advanced Nursing Practice in Relative Value Scale
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)

CR=contribution rate.

† Applied 50% additional charge for emergency practice.

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