New health care bill..

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What does the new Health Care bill mean for Nurses?

Job wise? Finical Wise? Etc?

From what I've heard (I have not read the bill...has anyone? Including those who voted for it?) all the versions of the bill that have been floated around include cuts to both Medicare reimbursement to hospitals AND cuts to reimbursement for home health services.

IF (big IF) that's true, I can't see how that could be a good thing for either nurses or patients. Lower reimbursement means higher patient:nurse ratios in hospitals in order to stretch the $$$. Lower reimbursement for home health care may put home care nurses out of their jobs...and those who cannot be cared for at home or who run into problems at home when care is cut back to less frequent visits will end up back in the ER or readmitted.

Coming from a background of physician practice management in the past, I understand that the fee schedule is all artificial and the reimbursement to providers is set by Medicare (CMS). So if a provider charges $100 for an office visit (for example) Medicare may pay $45. Medicaid may pay $17. Private insurance companies negotiate their own rates. Then the office writes off all the rest. It's all smoke and mirrors. If a nurse practitioner sees the Medicare pt, he/she is paid at 85% of what the physician reimbursement would be...

At these rates, it's no wonder new docs are not choosing to go in to primary care -- especially when they come out of med school with triple-digit student loan debt! Let's say you see 4 patients per hour and get paid ~ $200 for that hour. Then pay your front desk and clinical staff, utilities, rent/mortgage on the office space, liability and , etc. How much of that $200/hr are you getting to keep?

Although I fully agree that the American medical system needs reform, I honestly cannot fathom how getting the Federal Gov't involved can improve much of anything...unless one is a bureaucrat looking for a job in the MASSIVE new government agency that will be formed to administer and oversee this great big beast.

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keep in mind, there will be millions of new 'customers' utilizing healthcare.

that can't be all bad.

leslie

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Can someone explain to me why this would hurt nurses? It seems like it will only hurt insurance companies but hospitals should be even busier now with patients and nurses would be in higher demand.

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Specializes in Med/Surg, Academics.

I've said it in one thread, and I'll say it in this one.

No one knows what is in that 1000-page bill because it has been cut and pasted together. For example: Did anyone know that, for some reason, one version of the bill--not sure if it's the final version that got passed--included changes to federally subsidized student loans that had NOTHING to do with education for healthcare fields? Yeah, I don't know why either!

Only when the IRS updates its tax codes and the healthcare and insurance industries align billing with the Act, will we know who is affected by cost and who is affected by expanded access.

Then, a few years out, when healthcare entities check their balance sheets, they will make changes to maintain solvency. Only then, we will see the full effect of this Act.

I support reform. I think every American should have access to quality, affordable healthcare. I have no idea if this Act will do it...no one does, but we'll see what happens in a couple years. I remain hopeful. And, if it doesn't work, I remain hopeful that continuous improvements to the Act will occur.

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Specializes in Med/Surg, Academics.
Can someone explain to me why this would hurt nurses? It seems like it will only hurt insurance companies but hospitals should be even busier now with patients and nurses would be in higher demand.

I think the assumption is that payments for services will be affected by both Medicare/Medicaid and private insurance, meaning that hospitals will have fewer dollars to pay their staff.

FYI...the total cost of one of my relative's ER visits (afterhours, directed to ER by her doctor) with a one-night stay in a med/surg unit was over $8000. (Only costly procedure in-patient was a colonscopy, labs were hgb/hct q6h, and in room-treatment was IV NS...that's it).

Medicare paid the hospital a little over $1000.

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I think the assumption is that payments for services will be affected by both Medicare/Medicaid and private insurance, meaning that hospitals will have fewer dollars to pay their staff.

FYI...the total cost of one of my relative's ER visits (afterhours, directed to ER by her doctor) with a one-night stay in a med/surg unit was over $8000. (Only costly procedure in-patient was a colonscopy, labs were hgb/hct q6h, and in room-treatment was IV NS...that's it).

Medicare paid the hospital a little over $1000.

That's exactly what I'm talking about. $1000 for an ER visit and an overnight stay would (for instance) $1000 divided by 24 hours would come to just over $41 per hour. The hospital must pay the nurses out of this $41/hour they received from Medicare... also they pay the lab techs who ran the tests, the endoscopy lab for the nurses and techs involved in that (have you ever cleaned/sterilized a colonoscope? Not a quick job!), the dietary staff, the telecommunications and IT techs/staff, etc., etc. Oh, and the utilities, , and all the other stuff I can't think of right now.

It's easy to see why patient:nurse ratios must increase to the point where the quality of care can eventually suffer. Yes, we will have LOADS more patients seeking and having access to care, but that does not equate to good conditions for nurses I'm afraid.

Of course, remember this is all theoretical since we don't really know what's in the bill.:confused:

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Specializes in ED, CTSurg, IVTeam, Oncology.
At this time private insurance is still an option. Eventually private insurance will be a thing of the past and will be replaced by a government run plan. At this time, insurance companys can deny coverage for pre-existing conditions, and place a cap on pay outs. Taking these two options away, will eventually bankrupt the private companies. We are for the most part a very unhealthy society. I'm not saying I think it's right to deny coverage, just saying it's what makes private insurance possible. Once there is no longer private health insurance, a government plan will be implemented. Like most of us here, I am confused about what's going to happen. I heard this on TV and it made sense to me. The public option that Dems wanted, but didn't get will happen. Just not as fast as they wanted.

So what is your suggestion then? That we should save the insurance industry and tell the people with pre-existing illnesses they should just drop dead? LOL...

If we bankrupt the insurance companies, GOOD! Then we could take every dime that would have gone into profit, dividends, corporate salaries, lobbyists and scary TV ads, and put it all back into patient care instead. With the size of the participant pool, we would be able to get lower costs from suppliers. And guess what that's called? Socialized medicine. Which is what we needed all along. Canada and the UK get along fine with it. People in those countries with the extra money can pay to get more if they want, but everyone has at least a basic service. It's by no means perfect, but it's a lot better than what we have with over 30 million uninsured.

This is sort of like socialized education; the government gives your kids free basic education (k-12). If you want them to have more, then you can pay for it, ie. college or private schools. But everyone has a basic education. We have another similar socialized system that pays for retirement (social security) so why not for health care too. The younger pays in, so that those that went before them can retire. When their turn comes, their children will finance their social security. It's not perfect, but that is the plan. The point is, when we live in a society, and want our society to be functional and productive, we can't conduct ourselves with the law of the jungle, where only the most fit (education, financial, physical) can survive.

Why has this become so hard for so many Americans to follow? I'll tell you why; the insurance companies have gotten so rich and because of the money, they don't want to give any of it back. After they successfully derailed Clinton's attempt with dire images of people having to choose between health care or scraps of food, they're trying to do the same again. Now that they've lost, they're still working hard to try to derail it from being implemented with back door legal maneuvers and challenges. Maybe if they had spent their money on patients instead of lobbyists and paying off congressmen, we wouldn't have found ourselves at this juncture after nearly 20 years of their HMOs, in the first place.

:twocents:

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Specializes in Med Surg.

There seems to be an assumption that everyone is going to be lining up to get insurance because if they don't they will have to pay a fine of a whopping $750. Even with coverage purchased through an employer, the cost will most likely be way more than the amount of the fine. Under the Law OF Unintended Consequences, I am willing to go out on a limb and say that a whole bunch of folks will choose to take a piddling reduction in their income tax refund over paying 10X that amount for insurance. Even with government subsidies, the cost of coverage will still most likely be higher than any proposed fine.

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Cannot wait to see how it will change healthcare workers & pts care! Keep on posting!

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Specializes in Med/Surg, Academics.
There seems to be an assumption that everyone is going to be lining up to get insurance because if they don't they will have to pay a fine of a whopping $750. Even with coverage purchased through an employer, the cost will most likely be way more than the amount of the fine. Under the Law OF Unintended Consequences, I am willing to go out on a limb and say that a whole bunch of folks will choose to take a piddling reduction in their income tax refund over paying 10X that amount for insurance. Even with government subsidies, the cost of coverage will still most likely be higher than any proposed fine.

You're looking at it as a balance sheet without taking into account the value that people place on health insurance. If all purchasing decisions were just a balance sheet, no one would spend any money for anything but the bare necessities. However, we buy more than the bare necessities because we value certain products beyond the necessities.

My husband doesn't have to use the health insurance benefits at his work, but he does because we value the product to protect us from financial ruin for even the smallest of healthcare needs. The people this is targeted to are those who want insurance, but can't afford it. The gov't is saying, "Ok, we will help make it affordable for you, and if you don't take advantage of it, then you'll be fined."

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Specializes in ICU/ER/TRANSPORT.
Cannot wait to see how it will change healthcare workers & pts care! Keep on posting!

Well ERMindy when your hospital starts feeling the sting from a massive drop in reinbursements (some 500billion nationwide) you and others on this board will see the change as in reduced hrs, bennifits, pay and incresed time at the house.

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Specializes in Med Surg.
You're looking at it as a balance sheet without taking into account the value that people place on health insurance. If all purchasing decisions were just a balance sheet, no one would spend any money for anything but the bare necessities. However, we buy more than the bare necessities because we value certain products beyond the necessities.

My husband doesn't have to use the health insurance benefits at his work, but he does because we value the product to protect us from financial ruin for even the smallest of healthcare needs. The people this is targeted to are those who want insurance, but can't afford it. The gov't is saying, "Ok, we will help make it affordable for you, and if you don't take advantage of it, then you'll be fined."

As I posted in another thread, my previous employer paid the FULL premium for each employee's health coverage. They also offered a $1000 buyout to anyone who didn't want or need insurance. At one facility that had 1450+ workers, 678 opted out for a least two years straight and took the $1000. 436 of these people were NOT covered under someone elses plan, meaning the $1000 meant more to them than 100% paid for health insurance. That was the value they placed on the coverage. The percentages were about the same throughout the whole corporation (over 18000 employees). I might add that the average HOURLY wage in this company was around $16 per hour. Sorry I can't provide more exact figures but for some reason or another my access to the corporate mainframe got canceled just because I didn't work there anymore. I really doubt that this attitude was unique to this company.

Not everyone shares your high standards and values. I spent most of my life hanging out with blue collar workers from the oil field to the factory floor. I still predict that the plotters and planners of this bill will be surprised at how many individuals will choose to pay a relatively minor fine rather than cough up a much larger amount for health coverage.

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