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?

[LadyFree28, BSN, LPN, RN]

You are assuming that the nurses who work basic cases would work on trach/vent cases.

I know lots of basic nurses who do not want to work with vents at my agency,and it is a sizable number of nurses who do not work with high tech cases.

I really do not blame them,as they get paid the same amount per hr as the nurses who work high tech cases.

Why work harder making the same amount of money for something easier?

I got paid MORE as a trach/vent nurse; I enjoyed the complexity, as well as the increase in pay.

We are in the same area from previous threads.

There are too many agencies in your area that pay more.

I also negotiated more at certain places my rate for complex cases as well.

To answer the question of the thread, I would change the policy that nurses would be paid closer to the amount that is allotted for nursing; most agencies do the 60/40 split, instead of giving the full amount to nurses; across the board it would be illegal to pay nurses less than the funded amount; I would also makes sure DME were tailored to what the pt needs, as well as have emergency supply prorated for a minimum fee.

[SDALPN]

How would the agencies make money if they don't pay less than the funded amount? If they are getting $40/hr for a case, they can't pay us $40/hr or they wouldn't stay in business. But I'm sure they could afford to pay us more if they weren't so greedy. That's why I think they should take the middleman out. Both the nurses and the gov come out better. And the families have more choices.

[LadyFree28, BSN, LPN, RN]

How would the agencies make money if they don't pay less than the funded amount? If they are getting $40/hr for a case, they can't pay us $40/hr or they wouldn't stay in business. But I'm sure they could afford to pay us more if they weren't so greedy. That's why I think they should take the middleman out. Both the nurses and the gov come out better. And the families have more choices.

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.

[SDALPN]

I've never seem that in the paperwork. I've only seen a specific number per hour paid. Maybe it's different in different states? Do they leave that other amount off the paperwork where the state says what they pay?

[LadyFree28, BSN, LPN, RN]

I've never seem that in the paperwork. I've only seen a specific number per hour paid. Maybe it's different in different states? Do they leave that other amount off the paperwork where the state says what they pay?

CMS has specific funding and prices related to reimbursement for payment through diagnosis; they have separate reimbursement for DME, and they bill separately for nursing, HHA, nurse visits, and even provider visits.

Once the agency accepts a pt; CMS (federal or state, and insurance companies usually follow CMS guidelines with some adjustments but very little difference) bills the company directly based on pt diagnosis, then pays them directly for nursing staff, and approves the hours; they pay the amount monthly, do agencies can make enough to cover operations in terms of the amount of cases they have, per office; if they have 500 cases per office (including home visits) and have 20 offices, they can make a nice profit.

Most home care agencies I worked for had Peds, Adults, and Skilled visits; they get enough money to cover operations, lol.

I also worked at a medical daycare; they would get 300-500 dollars per child, depending on their specific diagnosis; the more acute, the better; however, if the child didn't show up, they couldn't get paid.

[SDALPN]

CMS has specific funding and prices related to reimbursement for payment through diagnosis; they have separate reimbursement for DME, and they bill separately for nursing, HHA, nurse visits, and even provider visits.

Once the agency accepts a pt; CMS (federal or state, and insurance companies usually follow CMS guidelines with some adjustments but very little difference) bills the company directly based on pt diagnosis, then pays them directly for nursing staff, and approves the hours; they pay the amount monthly, do agencies can make enough to cover operations in terms of the amount of cases they have, per office; if they have 500 cases per office (including home visits) and have 20 offices, they can make a nice profit.

Most home care agencies I worked for had Peds, Adults, and Skilled visits; they get enough money to cover operations, lol.

I also worked at a medical daycare; they would get 300-500 dollars per child, depending on their specific diagnosis; the more acute, the better; however, if the child didn't show up, they couldn't get paid.

Exactly but I've never seen a separate fee for operations, just a rate for hourly nursing which covers nurses and operations.

[LadyFree28, BSN, LPN, RN]

Exactly but I've never seen a separate fee for operations, just a rate for hourly nursing which covers nurses and operations.

Like I stated in the previous post, the reimbursement for the client as well as hourly rate (60 percent) is covering for operations; they are getting ones from the client itself due to diagnosis AND funding for nursing care; the money for nursing hours is separate, it is NOT included in the rate for diagnosis paid; nursing hours alone is about 3,000-5,000 per month; the reimbursement for which home health insurance reimbursement is a SEPARATE charge which is charged at a different rate, which can be at a higher or lower amount of the nursing rate.

Believe me, most of the major home health agencies are taking both-reimbursement based on diagnosis or coverage rate and nursing care funding-and making money....they can go 40/60 if they wanted to, but then again, the CEOs would have to take a pay cut.

[LadyFree28, BSN, LPN, RN]

And the current rate for nursing care is 70 dollars, not 40 dollars; it went up from 68 dollars.

[SDALPN]

And the current rate for nursing care is 70 dollars, not 40 dollars; it went up from 68 dollars.

That depends on the state. I threw out a random number on that one for example. But the reimbursement rate depends on many things in my state. It isn't a set rate.

[LadyFree28, BSN, LPN, RN]

That depends on the state. I threw out a random number on that one for example. But the reimbursement rate depends on many things in my state. It isn't a set rate.

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.

[SDALPN]

Hmm, I've seen basic cases at 36/hr on the paperwork. I've seen other cases up from that number based on acuity and other things. So that's why I wonder if it's by state.

[LadyFree28, BSN, LPN, RN]

It can be by state, or better yet the "overhead" has already been taken out, federally, meaning Medicaid, it's 70 dollars without "overhead"; I'm not keen on medicaid's charges, however, CMS usually sets the rates.

As fare as in my state, one of the agencies I used to work for put out a petition to help increase the rate to increase pay to nurses; their reasoning is that the state is taking the money, instead of alloying what CMS proposes.