This is a refreshing dialogue about the evolution of access to HC and our place in it.
I had a discussion with my fellow colleagues about healthcare in general, including how our wages are factored in our line of work. One colleague took a course in hospital economics during her nursing studies, one did case management with our home care division (we work at an extended day pedi facility) and I have done Medicare chart reviews (payments were confirmed, denied, or reduced due to DOCUMENTATION-it's ALL about the documentation
) as well as worked in home care with shift work and skilled visits ...We have found that MOST insurances, especially Medicare and Medicaid give a set rate on the pt population, acuity and if the pt's condition has a history of a long-standing or potential
long-standing condition and the severity (that's where ICD-9 comes in...guess its ICD-10 now). That rate is assigned, with a portion of the rate going to nursing care. The HC companies, if nice enough, can add or negotiate the rate per unit or nurse...in hospitals, units get a set budget per pt care flow, acuity, education, skill mix needs, etc. In community health, such as home health, you get a set rate due to acuity of the pt...for example, if a pt is on a vent=higher acuity=specialized skills=higher pay...again, the business MAY give the set rate by the government, OR negotiate for a higher salary...At a HH agency that I worked with for about 5 years, they have a range of pay for nurses. They do negotiate raises, etc...most of the ranges are based, according to their theory, that the rates on based on government reimbursements, aka, state and local governments.
It seems to me there is a MYTH that our wages are NOT counted, in which, they are...government has an algorithm on what is to be used on nursing care...Even insurance companies separate nursing care payments from medication and durable equipment...regardless whether it is state run, federally ran, or private insurance...nursing services are in a class by itself. However, the organization that employs nurses has the due diligence to use the money as they see fit, where the issue lies...they just use the song and dance on either cutting costs and put the burden on us...or continuing to be innovative, boosting nursing education, and finding creative ways to care for undeserved pts-either through research studies, or education projects-they are viable healthcare organizations, keep most of their nurses happy, good benefits, upward wages and growth. This is where the ACA comes in regards to nursing and our "worth". I have been fortunate to know a few people who were on the committee for the ACA...one was my nursing instructor-my research nursing instructor. She and her colleague put together a report on a correlation on pt economics and nursing outcomes involving nursing economics (skill mix, hours involved in pt care, and how the nursing team produces a more favorable outcome. I do like the bill, and it IS pro Healthcare pro pt and PRO nursing-they want nurses to be higher reimbursed because we do see the pts more...NPs are going to be more included...our "worth" has been noticed...but when the political powers (1-800-MALPRACTICE, board members and investors of Suck ya dry Insurance Co) and the Drs and hospitals that thrive off the money (extra CT scan anyone?) complain about Medicare cuts-the reason is the WASTE...why WASTE when the resources should be going to the patients and the NURSES who care for them??? Yes, they can expand more options, but the best things about our government process is that things can be added, tweaked, etc. There is great information out there, free conferences, even a FREE class about the ACA...I believed it is sponsored by the University of Pennsylvania...it is free online.
A lot of companies are using the ACA to cut wages, not give out raises, not reimburse for schooling, and continuing education. I work at a non-profit, and I JUST got a wage adjustment, six months after I obtained my licensure. My manager found a way not to give me a 3% raise...go figure...healthcare plan is soo outrageously priced...400 dollars a month, including a big deductible...told a lot of my colleagues to get private insurance, which is 50% cheaper, no huge deductible, and can't raise rates anymore (thanks to the ACA). I'm just glad I obtained employment elsewhere, where I will not be "short changed" anymore...I hope that the ACA will benefit us, from wages to insurance for us as well and for the...we can take care if ourselves better while taking care of our pts, as long as we keep getting the facts, and making sure we stay informed and involved.