NURS 523 Week 7 Discussion Board Forum 3 on a Business Case for a Nursing Program Example

Fifteen Readmissions to Break Even: A Business Case for Nurse-Led Post-Discharge Calls

NURS 523 Financial and Resource Management for Nurse Leaders, Discussion Board Forum 3

Thread by [Student Name]

The hospital, its volumes and the cost assumptions are composites written for a model discussion; check every assumption against your own organization's data.

Our hospital's medicine service discharges about 2,400 patients a year, and roughly 15% of them are back within 30 days. Each of those readmissions costs the hospital money it often is not paid for and adds to its penalty exposure under Medicare's readmission program. My unit has proposed a simple response: one registered nurse who calls every medicine patient within 72 hours of discharge to review symptoms, medications, appointments and support at home. The question for this forum is whether that position pays for itself, and building the business case is the way to answer it. A nursing proposal that arrives at the finance committee with numbers already worked out is treated very differently from one that arrives with only a description of good intentions.

Jones et al. (2019) describe a business plan as a structured argument that a new program is worth its cost, built on a clear statement of costs, expected benefits and the assumptions behind them. The costs here are straightforward. One full-time registered nurse at $42 an hour for 2,080 hours, with benefits at 28%, costs $111,821 a year. Adding $6,000 for a phone system license and call-tracking software brings the total to about $117,800.

The benefit depends on how many readmissions the calls prevent. The evidence for calls is encouraging. In a 200-bed urban medical center, Wright (2026) had registered nurses use a standardized script based on the federal Re-Engineered Discharge toolkit to call patients within 24 to 72 hours of discharge for 12 weeks; 3.5% of 112 patients who received calls were readmitted within 30 days, compared with 17% of 287 who received standard care. An integrative review of 12 studies found that early follow-up with a primary care provider, especially within seven days of discharge, was consistently associated with fewer readmissions (Foley et al., 2026), and our calls would also schedule those visits.

Because a single 12-week project is not enough to forecast a year, I used a far smaller effect: a 2-percentage-point drop in readmissions, from 15% to 13%, which means 48 fewer readmissions a year. If each avoided readmission saves the hospital an estimated $8,000 in unreimbursed cost and penalty exposure, an assumption finance would need to confirm, the annual benefit is $384,000.

Break-even = program cost divided by savings per avoided readmission = $117,800 divided by $8,000 = 14.7, or 15 readmissions avoided.

Return on investment = (benefit minus cost) divided by cost = ($384,000 minus $117,800) divided by $117,800 = 2.26, or 226%.

Even if the calls achieve less than a third of the reduction I assumed, the program still covers its cost, which is the kind of margin of safety a finance committee looks for. I would propose a one-year pilot, with the readmission rate for called and uncalled patients tracked monthly, so the assumption is replaced with our own data. The parable of the builder who first counts the cost (English Standard Version Bible, 2001/2016, Luke 14:28-30) is usually read as a warning against starting what we cannot finish; here, counting the cost shows a program we cannot afford to skip.

Reply to Monique

Monique, your business case for a nurse-run heart failure clinic is persuasive, and I especially liked that you included a full year of space and equipment costs instead of only the nurse practitioner's salary. My one suggestion concerns your volume assumption. You projected 1,800 visits in the first year, which assumes the clinic fills from the first month. New programs usually ramp up as referrals build, and if the first six months run at half capacity, the first-year revenue in your plan would be overstated by about a quarter. Jones et al. (2019) recommend that business plans show the expected ramp-up period and the point at which the program becomes self-supporting, because finance committees are more likely to approve a plan that admits a slow start than one that is later shown to be optimistic. The evidence still supports the clinic's purpose. An integrative review of 12 studies found that follow-up with a primary care provider within seven days of discharge was consistently associated with fewer readmissions (Foley et al., 2026), and your clinic could offer that visit to every heart failure discharge, which may be the strongest selling point in your plan. Could you add a month-by-month volume table for the first year and show when the clinic reaches break-even? That single table might answer the first question your finance committee will ask, and it would make your case harder to dismiss. It would also give you a target for each month of the pilot, so you could show the committee early whether the clinic is on track.

Reply to Terrence

Terrence, I agree with your point that the strongest part of your proposal for a sepsis nurse navigator is not its effect on your unit's budget but its effect on the hospital as a whole. That raises a challenge many nursing business cases face: the costs land in the nursing budget while most of the savings land elsewhere, in shorter intensive care stays, fewer readmissions and lower penalty exposure. Jones et al. (2019) note that programs should be evaluated from the perspective of the organization, not only the department that pays for them, and your case would be stronger if it said so explicitly and asked finance to credit the savings across departments. Recent evidence on follow-up after discharge shows how large the downstream effect can be. In the quality improvement project reported by Wright (2026), patients who received structured nurse calls after discharge were readmitted at a rate of 3.5%, compared with 17% for those who did not, a difference that would never appear in the nursing budget that paid for the calls. Sepsis survivors are at high risk of readmission, so your navigator's post-discharge calls might produce similar savings. Have you asked your finance partner whether the hospital uses a shared savings method to credit programs like yours? If it does, your proposal might qualify, and if it does not, your case could be the reason to start one. Either way, putting the cross-department savings in writing, with the assumptions labeled, would make the navigator role much easier to defend at the next budget cycle.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Foley, S., McClamrock, G., Watts, L., Strickland, M., & Smith, C. M. (2026). Impact of early primary care follow-up on hospital readmissions: An integrative review. Journal of the American Association of Nurse Practitioners, 38(8), 592-601. https://doi.org/10.1097/JXX.0000000000001269

Jones, C. B., Finkler, S. A., Kovner, C. T., & Mose, J. N. (2019). Financial management for nurse managers and executives (5th ed.). Elsevier.

Wright, M. R. (2026). Structured, nurse-led post-discharge follow-up calls to reduce 30-day hospital readmissions: A quality improvement initiative. Worldviews on Evidence-Based Nursing, 23(3), Article e70142. https://doi.org/10.1111/wvn.70142