Breast cancer patients account for 40% of the general surgical ward hospitalization rate, every 2-3 weeks need to be treated with chemotherapy, often in the general surgery four wards, because the accounting is not uniform, so that patients and their families have doubts about the amount of payment, causing a reduction of trust. The purpose of this project is to improve the correctness of nursing staff's accounting for breast cancer chemotherapy patients from 88% to 100%.
There are many types of medication for breast cancer chemotherapy, and the consumable items are complicated, which leads to inconsistent accounting registration. According to the literature, the cost of common medical materials accounts for one-third of the total operating cost of the hospital. Therefore, Eisai management is closely related to the hospital's revenue. The nursing staff is the grass-roots Eisai manager, which needs to have the concept of Eisai management. If the account is not accounted for or the accounting is not uniform, it will lead to loss of hospital operation and affect the quality of service. Therefore, it is necessary to strengthen the proper management of the nursing staff to reduce the cost of the hospital and increase the trust of patients.
Methods:
We application of the plan-do-check-act (PDCA) cycle improves the accuracy rate for charging chemotherapy treatment fees.
- Plan: Analysis of the statistics of breast cancer chemotherapy patients from January 3 to 9, 2017, the accounting omission rate was 12% (15/125). According to the account statistics and survey, the main reason for the inconsistent billing is that the therapeutic treatment items are cumbersome and the medical order of each patient is different, which causes the nursing staffs to be unclear about the difference between the self-pay and health insurance chemotherapy accountings. Therefore, the main reason for doing this is to do improve and strengthen the correctness of the concept of medical valuation by nursing staffs.
- Do: First of all, our group designs a " Charging chemotherapy treatment fees jingle", which will be announced at the morning meeting of January 12 to 13, 2017, so that nursing staffs can become more familiar with the methods and principles of accounting. In addition, the printed paper is posted on the bulletin board.
- Check: The analysis of 16 breast cancer chemotherapy bills from January 13 to 26, 2017, the accounting omission rate was 7% (12/171). Among them, the self- pay items in chemotherapy and target therapy were mostly missed.
- Act: In order to improve the accounting accuracy rate, the second phase of the group decided to use the concept of casing pricing. We design the health insurance and self-pay, chemotherapy and target treatment separately in color blocks. Use visual effects to redesign a " new form for chemotherapy treatment fee ". Analysis of charging fee for 17 breast cancer chemotherapy patients from February 12 to 18, 2017, the omission rate of charging chemotherapy treatment fees was 1.1% (2/181).
Result:
The analysis data of charging fee for breast cancer chemotherapy patients from January 3 to 9, 2017, the accuracy rate was 88%. Therefore our group make " Charging chemotherapy treatment fees jingle " to deepen the memory of nursing staffs. Then redesign the sheet of "new form for chemotherapy treatment fee " to separate the chemotherapy and target therapy from the health insurance and self-pay to facilitate the accounting to improve the correctness of chemotherapy treatment fee. In February 2017, the accuracy rate of charging chemotherapy treatment fee was improved from 88% to 98.9%. Compared with before improvement, the correctness of charging fees increased was 12.4%.
Progress rate % = (98.9–88)/88 x 100% = 12.4%.
Conclusion:
According to the total number of breast cancer chemotherapy patients in the general surgical ward in 2016, there are 2,230 person-times. If the analysis time is lengthened, the amount and level of impact will be wider. The unified accounting standards can reduce the burden of doubts, the need to spend manpower, time to check the account. In this project, we build the set of bills, as the basis for upcoming information system’s automatically roll account of reference by the medical orders.
Charging chemotherapy treatment fees jingle:
Needle in and out of the two joints, precision infusion with 3way.
Use iv set to take pump, health insurance and self-pay need to separate.
The target therapy should also note the fluid fee.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters