Burden Calculation

Burden Calculation.LTCH Monitoring. 09.05.13.docx

Long Term Care Hospitals Quality Reporting Program: Program Evaluation

Burden Calculation

OMB: 0938-1242

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ACA 3004 LTCH Quality Reporting Program:

Program Evaluation

Burden Calculation Worksheet


  1. Time Burden Calculation

  • Number of LTCHs to Participate in Evaluation Process Each Cycle: 30

  • Data Collection Method to be Used: Interview (In Person or Telephone Interview)

  • Number of Staff at Each LTCH to be Interviewed: 2 persons

  • Job Titles of Staff to be Interviewed:

    1. Nursing Administrator (Director of Nursing / Nurse Manager of LTCH Unit)

    2. Infection Control / Quality Assurance Registered Nurse


Estimated Time Required per Each Interview = 63 minutes or 1.05 hours

  • Number of Questions Used in Interview = 9

  • Estimated Average Time Required to Complete Each Question = 7 minutes

  • 9 questions x 7 minutes = 63 minutes per interview

  • 63 minutes / 60 minutes per hour = 1.05 hours



Estimated Time per 2 Staff Interviews = 126 minutes or 2.1 hours

9 questions per interview x 7 minutes per question = 63 minutes

63 minutes per interview x 2 staff members = 126 minutes

126 minutes / 60 minutes per hour = 2.1 hours


Estimated time required for onsite preparation for Interviews = 15 minutes

(i.e. – prepare for CMS arrival at facility, Introductions to staff, explanations of interview, preparations, time between interviews, etc.)



Burden to Each Facility for Participation in LTCH Monitoring Program:

126 minutes 2 staff interviews

15 minutes time spent by LTCH staff to prepare for interview

141 minutesTotal estimated time required to prepare for and perform interviews



Burden to All LTCHs Participating in Monitoring Program:

141minutes / 60 minutes per hour = 2.35 hours

2.35 hours per each LTCH x 30 LTCHs = 70.5 hours for a total of 30 LTCHs




2. Wage Calculation

Nurse Administrator:

Interview by CMS representative 63 minutes



Infection Control/ Quality Assurance Nurse:

Time required for onsite preparation 15 minutes

Interview by CMS representative 63 minutes

Total estimated time: 78 minutes



According to Salary.com and the U.S. Bureau of Labor Statistic, the average hourly wages for the nurses that CMS plans to interview are as follows:


Job Title Average Hourly Estimated Yearly

Wage Wage___________

Nurse Administrator $40.52 $84,281 per year1

Infection Control Nurse $34.78 $72,351 per year 2



Nurse Administrator Wages:


  1. Wages Per Each LTCH:

63minutes / 60 minutes per hour = 1.05 hours

1.05 hours x $40.52 per hour = $42.55


  1. Across all 30 LTCHs

1.05 hours x 30 LTCH = 31.5 hours

31.5 hours x $40.52 per hour = $1,276.38






Infection Control / Quality Assurance Nurse Wages:


  1. Wages Per Each LTCH:

78 minutes / 60 minutes per hour = 1.3 hours

1.3 hours x $34.78 per hour = $48.83


  1. Across all 30 LTCHs:

1.3 hours x 30 LTCH = 39 hours

39 hours x $34.78 per hour = $1,356.42



Total Estimated Wages to be Incurred by Each LTCH:

$42.55 Nurse Administrator Wages

$45.21 Infection Control /Quality Assurance Nurse Wages

$87.76 TOTAL



Total Estimated Wages to be incurred across 30 Participating LTCHs:

$1,276.38 Nurse Administrator Wages

$1,356.42 Infection Control Nurse Wages

$2,632.80 TOTAL





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCAROLINE GALLAHER
File Modified0000-00-00
File Created2021-01-27

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