Reimbursement for what we do?

[RNSue]

I think I have figured out one important aspect of the whole nursing shortage issue. What we do everyday on the floors is not reimburseable. Every little task a doctor does has an ICD-9 code attached to it. These codes are then sent into the insurance company or Medicare and the doctor gets money back for what was done. Physical therapist's, respiratory therapist's and lab tech's duties are reimburseable also. I say this because recently, I have worked in a couple hospitals that discovered that checking an O2 sats was reimburseable, so they took that duty away from nurses and now we have to call Resp Rx for every O2 sat. Same way with Hemoccult stools( the little cards and reagent), they now have to be sent to the lab, because they are reimburseable items. If nurses perform those duties, they can't get reimbursement. Nurses are seen as something that sucks up the profits. We are included with the room charge that has to pay for building and grounds, housekeeping, dietary, furniture, wallpaper, etc. In other words, what we do does not generate any income. This explains why, when a hospital wants to cut costs, the people to go first are nurses and ancillary staff. Now, what if we could change this? What if every time we did a patient assessment or started an IV or ran a code, we could send the task to the coders who send it in and the hospital gets money back for what we did? We would be generating income and the hospitals would bend over backward to come work for them. We could have a say-so in how things were run, call some of our own shots. I have worked as a nurse in an environment where what I did directly determined how much money came into the practice and let me tell you , things were MUCH nicer; better work environment, real input into how things were done, and some great perks. So what do we need to do to make this happen?

[Jenny P]

I have been a strong advocate of getting nursing care costs out of the hospital bed charges for years. Over the years there have been times when it looked like it might be feasible (at least in my institution), but then these ideas were thrown to the wayside as different people used the data in different ways. The same data that could track fees for nursing have been used to calculate staffing patterns and needs, and charge for materials' usage. It all depended on who was doing the figure crunching and how they used the data.

We had these lovely little "bingo sheets" where we circled how many minutes (documented as points) we spent doing different activities throughout our shift. And we also had "stickie labels" for each and every dressing, med, syringe, etc. we used. Working in ICU, the management had to come down and tell us we could only use so many points per 8 hour shift (I can't remember exactly, but so many minutes[maybe 5?] equaled 1 point, and the total number of points [96] could not equal more than 480 minutes- or 8 hours). They could not understand that we could both give cares and give emotional support (both got points) at the same time, and both were nursing duties, so both should be included the points and charged for.

Anyway, they ended up using that system to figure out staffing needs according to census.

I do think the same type of system could work for charging for nursing care and suggested that to the director of nursing (who initially thought it was a good idea!), but it was never done due to the next restructuring program. The paper work was increased, and the "bingo sheets" got tossed out of the system (because "nurses complained about too much paper work" I was told).