Demonstrating APN value in a capitated market.

To be acknowledged as powerful resources in health care reform, APNs must demonstrate their capability to discern and implement cost-effective care. APNs are typically associated with services that do not generate revenue. Therefore, they need to document their value in terms of improved outcomes, reduced costs, improved patient satisfaction, enhanced institutional image, and better health care team efficiency. The savings generated by APN consultation and followup for patients referred for home TPN was examined in Rochester, NY, using a simplified cost analysis and forms. Collection of data does not need to be elaborate. Costs can be bundled and examined within the period, simple data collection methods can be constructed for details of consultations, and community surveys can provide market prices. It is suggested that the analysis follow basic steps: list items, examine costs, collect or estimate costs, list all assumptions, then calculate total month and daily costs.