Cost of medication as an inpatient is SHOCKING!!!

EmeraldNYL, BSN, RN · Jul 29, 2003

Originally posted by ainz
This is a key concept for direct patient care nurses to understand. When you know more about the financial system you are working in and understand it, you can be more effective in your communication with your managers and administration. You can also help your patients to understand how they are being charged for services and how their particular payor is going to pay for those services instead of having patients becoming needlessly anxious about their hospital bill. Nurses can actually contribute to the patient's anxiety by their lack of understanding of basic concepts of healthcare finance.

Thanks for the explanation ainz. I wish I understood more of the business and finance aspect of healthcare. I think we had less than a one hour lecture on it in school.... which is no where near enough because this crap is CONFUSING. :rolleyes:

ainz · Jul 30, 2003

I had no finance courses in my undergraduate work. What a shame. But I did not go into nursing because I was interested in finance, went into it because I liked clinical work and directing my efforts toward the PERSON that was there for healthcare, my patients. As a matter of fact, I hate finance, accounting, and everything to do with it, but in my work it is a basic tool. Kind of like reading lab values. Same for the organization, the financial reports give you a diagnostic picture of business operations.

It is quite complicated and quite absurd. The hospital pays entire departments and must buy large computer systems just to keep up with all of this mess.

My hope is that the nurses who read my posts do not think I am defending the hospital or insurance companies, it is to simply inform nurses about the financial aspects of our healthcare system. During my years as a staff nurse I was clueless about finance and didn't care. I thought the hospital was charging entirely too much (and they are) and it was confusing to keep up with.

My only reason for writing about all of this is that hopefully some nurses will gain some understanding that will help them when they face their managers and administrators with a proposal of some kind to improve nursing and advance the profession. The administrators are very, very, very financially oriented and bottom line focused. It is unfortunate that they have the power. If you want something changed or something done, you must be able to talk to these people in a way that they understand and a way that let's them know you know what you are talking about. Otherwise you will never earn any respect from them and you need that if you want a chance at things being different. The old saying "what you don't know won't hurt you" is not true in hospitals and dealing with administration.

I would not advocate sharing this kind of detail concerning finance with your patients. It is helpful if you understand it. You can bet the doctors understand it very well. It is how they get paid and they make plenty of money as well.

So the picture is like this. The hospital administration understands healthcare finance very well. The doctors understand healthcare finance very well. The other major player, the nurses, generally don't have a clue about the DETAIL of how this system works and they generally don't want to know. Therefore, nurses are kept in the dark, do not have access to financial information, just come in, clock in, take care of their patients, and go home. The administration and doctors like it this way. If nurses had full access to financial information, understood how the system works . . . . there would definitely be a revolt. Knowledge is power, this knowledge is being kept from nurses. If you don't believe me, just try asking your administration to see the hospital's financial reports year-to-date and see what kind of reaction you get. They DO NOT want you to know!!!!

Nurses are not earning their fare share of the money being made in healthcare. It generally boils down to this, hospitals provide the building and equipment (very expensive), doctors provide the medical care and general decision making as to what clinical action is to be taken, nurses carry out those orders, measure the patient's response to it, and do many other things that attend to the patient's health. These three entities, hospitals, doctors, nurses, make up the thrust of the team. Hospitals and doctors are making tons of money, nurses are not. Hospitals and doctors know the system and how to work it, nurses do not. Hospitals and doctors get together to plan strategies to increase their earnings, nurses are left out. Hospitals and doctors have a great relationship because they help each other out financially, nurses are left out of this relationship. Hospitals and doctors get huge pieces of the financial pie, nurses do not. If you look at the healthcare dollars available out their, hospitals and doctors get it all, nurses are paid by the hour and don't seem to really care.

It is not all about the money, but the money is there. Nurses do much of the work but are not compensated in relation to the amount of work that is done and their contribution to the outcome of the patient. Hospitals and doctors are raking in the money, nurse are not. Why are we left out of this loop? Why are we not asked our opinion? Why is financial information withheld, or only selected and safe "tidbits" are given to the nurses who are halfway interested? Why? Because if nurses knew the whole picture, there would certainly be a major REVOLT in healthcare.

P_RN, ADN, RN · Jul 30, 2003

I got sent to the ER once after pulling a groin muscle. The doc checked me out and said to the nurse "give her a Motrin." I said "don't bother, I have Motrin here in my pocket." I took my motrin and went on my way. It was worker's comp, but I got an itemized bill also, and right there was a charge for ONE 800MG MOTRIN. It didn't cost them a cent or did it. Wonder how much that one Motrin cost by the time the insurance claim was settled.

jjjoy, LPN · Jul 30, 2003

Isn't the premise that nurses (and other ancillary staff) are like the factory workers while the hospitals and doctors are the owners and engineers? The hospitals (owners) provide the materials and facilities that require lots of financial investment and the doctors (engineers) provide the know-how and determine the best way to meet the owners' goals (here to make money from providing medical services - or at least to be able to cover costs to continue providing such services). The nurses (factory workers) tend to be considered as interchangeable and relatively easy to train.

The original idea does seem to make sense in the traditional capitalist system. However, there are real problems with this idea.

1) Nurses and other nursing staff cannot all be lumped together as interchangeable factory workers. Basic tasks can be taught and carried out routinely on stable patients and these workers don't demand high salaries - aides, techs, etc. But we run into trouble trying to determine how to assign tasks to different job roles while still providing quality care and being financially sound - which tasks can be assigned the "factory worker" and which tasks require more extensive education. With sicker patients and busier doctors, nurses need more than basic skills - they regularly need to exercise judgement on unique individual patients as opposed to working with standard equipment.

2) Healthcare is unique. Ethical issues abound as do regulations; providers don't have so much choice over what services to provide and how to provide them. In industry, if a product line isn't turning a profit they can eat their losses and try something else. If industry makes a substandard product, they simply lose out on the profit. If a healthcare facility offers substandard care, people's very lives are affected. Yet, if the facilities cannot recoup expenses, they can't continue to provide service - no matter how great the service. Sicker patients also need a lower patient-nurse ratio yet don't seem to provide a proportional monetary return.

What to do? I don't have any easy answers. I don't have any answers, really, but I do want to learn more so that I can where I fit into influencing the future of healthcare.

ainz · Jul 30, 2003

great post jjjoy!!

There are real problems with this model/idea!! You are exactly correct. The problems you mentioned are absolutely correct.

The way the charge and payment structures are set up in healthcare is the way it is set up. Like it or not, right or wrong, it is the system we are working in, the environment we are working in, we need to understand it so that we can begin to generate ideas to change it.

I do not write stuff like this because I am for it or like it, I write it because it is our reality, whether we like it or whether we think our patients will like it or whatever.

Nurses need to understand the environment we are working in, the people who are running healthcare, and how to effective communicate our ideas to advance our profession. We can stick our head in the sand and issue statements of morality, lack of integrity, and so on 'til the cows come home. That will never change a thing, it will only keep things as they are and nurses will continue to leave the profession.

flowerchild · Jul 30, 2003

Here's an idea! Get all your patients to refuse non essential items and complete their questionaires with references to the high costs of individual items and as the reason they refused b/c of high cost. The hospital will see a decrease in billing and reimbursement revenues for private payors and insurance on those items. Then, we nurses can solve the problem by charging fee for service to allow for billing that reflects a seperation of costs for the nursing services, thus reducing the cost of each pill or item to the pateint and allowing the patient to see exactly where the $$ is applied. Things like utilities, maintnance, and housekeeping should be kept in the room charge fee, same as a hotel or rental and not part of the cost of a Tylenol or the nursing. JMO. You know, the hospitals could even charge rental on the equipment being used by the patient. Don't let them fool you, they know exactly what they are doing when they roll all those things into the cost of a Tylenol

I know, I know, I can dream though, can't I?

live4today, RN · Jul 31, 2003

Better yet, let the patients be responsible for bringing their own linen, bath towels/face cloths, pajamas and over the counter meds to the hospital with them. If they are on scheduled meds at home, let them bring them, too. When they run out, let them get refilled at their chosen pharmacy.

Patients take their own meds where I work at times. They bring the meds, and the nurses pass them out when they are due by keeping them locked until scheduled or needed prn.

To cut out the hospital linen bill, patient's family can take their dirty linen home, and bring them clean linen as they need it.

For that matter, let the family be responsible for the trash can by the patients bedside, too. Like taking it to a central dumping place in the hospital once or twice a day when it is full.

That would cut out a lot of revenue for the hospital where the TRUE FOCUS can REALLY be about NURSES HELPING PATIENTS and PATIENT CARE. Isn't that what they boast about anyway...patient care???

ainz · Jul 31, 2003

Great idea flowerchild. Separate out nursing and bill nursing care on a fee-for-service basis, just like the doctors get paid. Now that is a step toward professionalism. It also takes away the power the hospital has over nurses.

Don't you see, this way nurses are not an expense to the hospital, they are necessary and cost the hospital nothing!!!

BuffaloLPN · Jul 31, 2003

How does billing work if we aren't scanning or listing items used? On my floor, we just go into supply room and use whatever. If a nurse uses one or fifteen pulse ox probes on a pt it's not recorded anywhere, so how would that affect pt billing? I'd assume that comes out of our 'floor budget'?

Just a rant here- this billing issue is make me so mad when we keep pts who don't

need to be hospitalized, but are anyway. I like to think of us a VERY VERY expensive hotel-happens all the time:(

ainz · Jul 31, 2003

Can't imagine anyone doing that these days, just taking supplies and not charging for them. At any rate, in a DRG or per diem situation, it really doesn't matter. The hospital is paid on fee for the hospitalization regardless of the number and type of supplies, procedures, tests, number of days in the hospital, etc. It is all in how the diagnosis is coded and that depends on how well the doctors and nurses document. Putting it all together in one fee paid to the hospital is called "bundling," meaning all of this stuff is bundled together in one package. It is illegal to unbundle charges for Medicare patients for example.

However as the federal government continues to spend more on healthcare through the Medicare program and supplementing or matching the states' Medicaid program, we will see more and more copay required from the recipients.

Hospitals are the absolute worst business I have ever seen in getting their customers' bill correct, all the way from charging for items used and the correct number to charging the correct dollar amount. The systems and processes used are awful. The automated medication dispensing systems help and the supply towers. If hospitals invested in a system that works well they would not lose so much revenue from pure waste and inefficiency. Nurses have a responsibility in this as well by making sure they charge for the supplies they use and use them efficiently.

If we claim to have a holistic approach to human health, what good are we doing for someone who is hospitalized when we get them better but then contribute to devastating them with a huge hospital bill they will be paying on for the next 20 years. What kind of effect do you think that has on their life, their family, their ability to "self-actualize?"

Burnt Out, ASN, RN · Jul 31, 2003

saw this and had to share:

my best friend had a lady partsl delivery in december. in the 2 days she was there, she took 8 vicodin due to a deep perineal laceration....and her grand total for those 8 vicodin was....

$700.00 :eek:

i kid you not....... :rolleyes:

debyan · Jul 31, 2003

My husband has recently had some lab-work done they are checking out his PSA d/t prostatitis well when the bill came back from Blue Cross Blue Shield the charge from the lab was $385.04 BC-BS paid them $70.81 which was the eligible amt for those tests. Now get this, which the provider accepted as payment in full!! OK now I am not complaining I can't afford to, but what if I didn't have the insurance? I mean would they have accepted less than 1/4 the amt charged. The same thing happened with my bill for my heart procedure BC-BS paid them about 1/5 of what the bill was and they accepted it. Am I just stupid or would some poor uninsured person be totally out of luck. This has to be the same with the Tylenol they charged the $25.00 knowing that the insurance would only pay a small amount of the bill anyway. Seeing the amazing difference in the amounts charged and what the hospitals actually get, well it confuses me. I could never balance my checkbook that way. deb