Hospital union votes in St. Louis set stage for tense talks

allnurses Guide · Aug 15, 2012

Thank you Karen. I wish the nurses well.

What the hospital's consultant said in the linked article jumped out at me. He admitted hospitals have been billing for unnecessary care?

... Walter Kopp, an independent hospital consultant based in San Anselmo, CA., said the nurses union likely will face tough talks.

"There are huge cuts coming for hospitals with health care reform. The revenue for hospitals is going to drop dramatically as unnecessary care is dropped," Kopp said. "That's going to be the background of these negotiations." ...
Hospital union votes in St. Louis set stage for tense talks : Stltoday

Home Health Columnist / Guide · Aug 15, 2012

Nothing in his comments about billing.

My interpretation is that there is a big push by medical society and health insurers to stop doing unnecessary care: not repeating tests done at one hospital cause you don't have access to results and patient now in your ER (shared under HIE); appropriate age related testing recomendations by medical groups (no mamogram for 25yo); lab tests now require diagnosis codes to be approved for payment; unable to bill for wrong test/procedures; Medicare patients in hospital 3 days under OBERSVATION status, thus not admitted and will have lower payment due to otpatient level care etc... thus income will drop. Already seening this in SE PA.

allnurses Guide · Aug 16, 2012

Nothing in his comments about billing.
My interpretation is that there is a big push by medical society and health insurers to stop doing unnecessary care: not repeating tests done at one hospital cause you don't have access to results and patient now in your ER (shared under HIE); appropriate age related testing recomendations by medical groups (no mamogram for 25yo); lab tests now require diagnosis codes to be approved for payment; unable to bill for wrong test/procedures; Medicare patients in hospital 3 days under OBERSVATION status, thus not admitted and will have lower payment due to otpatient level care etc... thus income will drop. Already seening this in SE PA.

Thank you. I didn't know what "unnecessary care' is.

NayRN · Aug 16, 2012

Also included in unnecessary care would be the rate of unnecessary admissions-the 25 year old with the flu and no co-morbidities on medicaid could probably take their tamiflu and home and get plenty of rest and fluids rather than staying in the hospital for a week.

We have seen admissions like this drop at my hospital lately, and although it means some staffing changes, it is overall a good thing for healthcare as a whole.

Maybe unionization with improved patient ratios would serve to keep some nurses employed when there are less patients to go around.

But then again, with less money coming in, will an expensive union contract be sustainable?

They (hospitals) always manage to find money somewhere when they want to donate to something and get their names in the paper.

Maybe with the health insurance mandate contained in Obamacare hospitals will also provide less uncompensated care and the burden will not fall squarely on them anymore. I think this may serve to offset some of the financial issues caused by unionized nurses and less "unnecessary care." Also, since Medicare (and probably private insurance companies) have begun reimbursing based on quality indicators, rather than fee for service, wouldn't improved patient ratios and the better care that should result serve to bring in the maximum Medicare reimbursement, offsetting this further?