If you could change medicare/medicaid...

[SDALPN]

Ok, so I've thought about this in all the years I've done this job. Then I started wondering about what others think. Finally, I thought maybe the decision makers might run across this thread one day.

So, how would you change things if you could?

I'll start. I think the way the equipment and supply system works, really doesn't work. How is it that insurance will supply 50 bottles of peroxide, but only 12 trach ties in a month? Wouldn't it make more sense to give each family a certain amount to spend each month? Then the families could have the 30 ties they need instead of reusing nasty ties. And they wouldn't be getting 50 bottles of peroxide a month that they don't use anyway.

Another issue is nursing. I think it would be better if there were a database of nurses and patients/parents. Like a matchmaking service, where nurses and families find each other based on availability, nursing skills, education, pet friendly, smoker/nonsmoker, etc. The state runs the site and provides RNs/case managers to oversee the cases. No more agencies. Private scheduling makes families happier. And even an area in the database for last minute nurses to cover call outs for families and to supplement the nurse that has a pt in the hospital. Wider selection of nurses for the families and better chance of cases closer to home for nurses. The state could pay us more per hour and still save money because they wouldn't be paying so much to the agencies. Even better if we got state benefits out of it. The states want to save on their budget and I think they could save by doing this. And we could get paid what we deserve.

I think better rules should be in place for pt/family boundaries as well. We are nurses, not babysitters and not maids.

I think the foster program for medically fragile children could be improved. Instead of the kids being in homes where the parent is barely trained, the state should consider nurses first. This again would save the state money and provide better care for the children. Nurses could work from home, minimizing expenses for the state because of the cost of a facility.

The state could also open a few medically fragile daycares. The state would save because each nurse could have 2 or 3 total care patients each. Some parents just want care while they are at work and want to do the rest themselves. Plus the kids that are capable, could learn socialization skills and interact with others like them without fear of judgment or bullying.

Any other ideas, thoughts?

[SDALPN]

I've seen a few agencies fight for increases. *sarcasm* which I'm sure, as the agencies say, it's for the nurses. :-\

[smartnurse1982]

Medicaid may not, but Medicare does have a set rate, and that may change each fiscal year, depending on funding, and healthcare costs; the Medicare/CMS rate is 70 dollars.

Wait a minute...

Medicare reimburses all the states the same amount for Pdn/hr?

If that is the case,i wonder why the difference in pay in different states?

Agencies cannot use the excuse of "cost of living" if everyone gets paid the same

[smartnurse1982]

They still get funding for operations; they get an approved monetary amount for the child as well; most of the time these agencies are scooping up nursing money and patient money.

I'm hesitant about removing the middleman, meaning that alloyed money for diagnosis would be left to the parents; meaning, they would take the money and not be able to pay us.

I rather deal with CMS directly.

If i am not mistaken,don't nurses who do Pdn independently bill Medicare and Medicaid directly?

[LadyFree28, BSN, LPN, RN]

If i am not mistaken,don't nurses who do Pdn independently bill Medicare and Medicaid directly?

Yes, they can and get the direct rate.

[LadyFree28, BSN, LPN, RN]

Wait a minute...

Medicare reimburses all the states the same amount for Pdn/hr?

If that is the case,i wonder why the difference in pay in different states?

Agencies cannot use the excuse of "cost of living" if everyone gets paid the same

Basically, CMS has pay per visit as well as PDN rates; as I explained the rate for Medicaid and Medicare is set at specific coverage; however, Medicaid operation funding is sent to the states; and they have to make up whatever is needed for the rest, and they have an algorithm for that since the states have the power to decide, that's where the rate changes and what is given to the home health companies are then cut at an additional rate; the 60/40 split.