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Tips for Successful
Budget Management
Deborah Herring MHA, BSN, RN Director of Nursing
Kimberly B. Hardy, MSN, FNP-BC
Pitt County Health Department
Learning Objectives
At the end of this session, participants will be able to:
1. Describe the relationship between budget and strategic
planning.
2. State at least two aspects of budget management
3. Identify the importance of an interdisciplinary approach to
budget management.
4. Develop a budget or budget tracking template.
What is a Budget:
A budget is:
• an annual plan
• includes the organization’s goals and objectives (strategic
plan)
• lists all planned expenses and revenues
• guides the organization on the best use of human and
material resources.
Types of Budgets
• An Incremental Budget:• Use previous years actual costs as a starting point for building the
next years budget, adjusting for inflation
• Projecting revenues: Divide current by number of months and
then multiply by twelve
• Monitor budget throughout the year to assure it is on target
Types of Budgets
• An Add-on budget
• Is the budget based on the previous years’ budgets adjusted for
current information.
• Add-on budgets can be adjusted for new levels of inflation,
employee wage rates, or new requirements.
Types of Budgets
• Supplemental budget Is the budget for an area that is not
included in the main (base) budget
Budget examples
• Annual operating
• Special Projects/Grants
• Contracts
• Productivity
• Personnel
Maternal Health Budget
Family Planning Budget
STD/HIV Budget
Why Do I Care?
• I did not go to school to be a finance person
• The Affordable Care Act – How will Public Health navigate?
• We are asked to do more with less and to be more
self sufficient (Sherman,2012)
Budget Time Line
• All departments, other than the public schools, are required to
submit to the County Manager their budget requests and
revenue estimates for the next fiscal year by April 30.
• Generally, the finance officer will ask for budget request
usually mid February. The Board of Health must approve the
budget before the budget is presented to the County
Manager.
• The County Manager submits the recommended budget,
including a budget message, to the Board of County
Commissioners not later than June 1. G.S. 159-11 requires that
the recommended budget be balanced unless the Board of
County Commissioners insists that an unbalanced budget be
submitted.http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_159/A
rticle_3.pdf
Budget Amendments
• During the course of the year, departments can amend their
budget due to an increase/decrease in revenues (i.e., receipt
of a new grant, change in State or Federal funding, etc.); a
request for use of contingency funds; or the transfer of funds
between appropriation units (i.e., personnel, operating or
capital expenditures) or between other departments and
funds. A department is required to submit a budget revision
form which states why the revision is needed along with the
appropriate revenue and/or expenditure account information.
A budget revision that increases salaries, changes a
department’s “bottom line”, or requires transfers between
departments and funds must be approved by the
Commissioners. All other revisions are approved by the
County Manager.http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_159/Article_3.pdf
Steps of the Budget Process
1. Building the budget
• Gather your capital requests
• Communicating expectations, avoid assumptions
• Set time to meet with responsible staff to review
confirm budget proposals
• Get input from stakeholders
• Are you in need of an additional employee
• Is there a position you wish to upgrade
• Don’t forget about computers
• Don’t forget to look at your notes
Steps of the Budget Process
2. Use budget worksheets (templates). The finance officer
usually develops these and communicates how to complete
3. Review the Agreement Addendum to identify new needs for
the coming year. Strategic planning is key!
4. Communicating the adopted budget
a. Share the outcome of the approved budget to stakeholders and
team members.
5. Tracking expenditures
a. Tools for tracking- Excel, notebook, photocopy
Business Measurements
Other Measurements
• Review your revenues verses expenditures monthly
• If reports are available review clinic productivity
• Review your Medicaid, third party and self pay
• If numbers are up but money is low, may be a billing issue (analyze denials)
• Have your consultants review your coding
• Include billing as a part of routine chart audits
Monitoring Clinic Reports
0200400600800
10001200140016001800
Nu
mb
er
pa
tie
nts
se
en
Month
Clinic Attendance 2013-2014
TB TB BC MLP FP AH PN A PN PN PN CH
W/U Meds
Method
s Cnslt FP Proce Scrn PT Pre Rtn f/u labs flu NSC BCCCP Total
3 10 160 8 252 21 12 82 49 308 9 2 11 4 1287
10 14 206 10 225 33 3 69 32 296 3 1 14 3 1322
6 13 149 7 209 24 4 49 31 259 1 1 14 5 1168
3 12 166 9 236 29 12 85 46 287 2 0 5 0 1326
3 9 170 5 196 35 4 71 26 263 2 2 0 7 1191
3 4 181 4 158 30 3 67 29 191 4 0 447 0 0 1439
3 5 212 0 203 56 7 82 31 207 1 3 440 0 8 1672
July 1287
August 1322
September 1168
October 1326
November 1191
December 1439
January 1672
Clinical Productivity and Efficiency
• We are asked to see more patients with less staff
• Check your cycle times quarterly
• If possible ensure your higher level employees are
busy with billable activities
• Work through your processes to improve
efficiencies and remove road blocks
• Utilize Quality Improve Process to measurable outcome goals
(develop acuity measures to determine number of staff
needed)
Things to remember
• Don’t wait until the last minute – include budget reviews in
annual work plans
• Set aside uninterrupted time – schedule meeting times
• Have your calculator handy
• Careful descriptions can make a difference
Things to Remember
• Budgets are logic, justification and politics
• Don’t take the politics personally
• Most things can be fixed
• It’s all about teamwork
Questions ?
Thank you
References
• Bradley, L. S. (2008). Budgeting-or refusing to budge? how budget
workshops can reduce the pain. Healthcare Financial Management, 62(3),
56-9. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/196387163?accoun
tid=10639
• Issel, L. M., Olorunsaiye, C., M.P.H., Snebold, L., M.P.H., & Handler, A., DrP.H.
(2015). Relationships among providing maternal, child, and adolescent
health services; implementing various financial strategy responses; and
performance of local health departments. American Journal of Public
Health, 105, S244-S251. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/1667326083?accou
ntid=10639
• Jensen, S. (2005). Budgeting concepts for nurse managers. Association of
Operating Room Nurses.AORN Journal, 82(4), 691-691,693. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/200846960?accoun
tid=10639
References
• McLarty, J., & McCartney, D. (2009). The nurse manager the neglected
middle. Healthcare Financial Management, 63(8), 74-8, 80. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/196360813?accoun
tid=10639
• Northcutt, A. C. (1991). Master the budget, line by line. Security
Management, 35(7), 54. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/231141520?accoun
tid=10639
• Thornbory, G., & Farley, L. (2007). Budget basics. Occupational Health, 59(8),
20-21. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/207321185?accoun
tid=10639