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