LeChele Mack

This is not just a saying, it is reflected in the business of healthcare. Let’s look at one of the largest healthcare corporations in the United States, HCA healthcare. Evidence of this physicians generate income, nurses cost money idea can be seen in HCA healthcare’s financial statements. Their discussion of physicians compared with nurses and ancillary staff in their 2021 financial statements when discussing labor matters perfectly illustrates this point. “Physicians are an integral part of the success of our hospitals in delivering quality care to our patients (HCA Healthcare, 2022, p. 33).” Here doctors are viewed as an asset contributing to corporate success. “In some markets, nurse and medical support personnel availability and retention have become significant operating issues to healthcare providers (HCA Healthcare, 2022, p. 33).” Here retaining and hiring nurses is not “integral to success” but an expensive labor cost and operational issue. This point is further driven home by a recent article that reports that HCA healthcare is among several hospital operators looking to increase rates to offset labor costs, especially for nurses (Lokuwithana, 2022). This drive to increase rates has little to do with any actual need or lack of funds. For HCA healthcare, revenue increased 14% from $51.533 billion in 2020 to $58.752 billion in 2021 and net income increased from $3.754 billion in 2020 to $6.956 billion in 2021 (HCA Healthcare, 2022, p. 66). As we know, in corporate, for-profit system money is the driving factor for decisions made within that system. Nurses are an expensive labor cost that corporations want to decrease, minimize, and offset. From that view, there is no motivation for any healthcare corporation to increase nursing staff. That is a problem central to the nursing shortage. Insufficient staffing is a major factor that drives nurses to leave the bedside and/or the profession. A survey conducted in November of 2021 found that 32% of respondents (a 10% increase in less than ten months) reported thinking about leaving the bedside (Berlin et al., 2022). One of the major driving factors reported was insufficient staffing (Berlin et al., 2022). While several states have adopted legislation to adopt mandatory nurse-to-patient ratios, it isn’t enough. State-by-state legislation is cumbersome and complicated. What is needed is a federal standard. This could be accomplished by tying nurse-patient ratios with either reimbursements or increased payments from the Centers for Medicare and Medicaid (CMS). This would change nurses from an expensive labor cost to a means of financial savings or income generator. Nurses already add value and decrease costs to healthcare facilities. Research has shown that increased nurse staffing improves the quality of care. Increased nurse staffing levels lead to decreased rates in healthcare-acquired infections (Mitchell, Gardner, et al). Healthcare-acquired infections (HAIs) are a significant cost to facilities. According to the CDC costs from HAIs in U.S. hospitals exceeds $28.4 billion annually. Additionally, research shows that increased nurse staffing and having higher proportions of bachelor’s degree nurses are associated with lower patient mortality (Haegdorens et. al. 2019). It is clear that nurses add value, but right now that value is not translated into dollars on a balance sheet. CMS Value-Based Programs The precedent has already been set for incentivizing quality care through reimbursement and/or increased payments. CMS value-based programs do just that. For example, one CMS value-based program, that many nurses are familiar with, is the Hospital-Acquired Condition (HAC) value reduction program. This program reduces reimbursement for such conditions as pressure ulcers, and post-operative sepsis acquired during the hospital admission ((CMS’ Value-Based Programs | CMS, n.d.)) Another, CMS value-based program, that fewer nurses may be aware of, is the Quality Payment Program. This program is designed to reward high-quality Medicare clinicians with payment increases (Quality Payment Program Overview, n.d.). If these programs are about quality care it is the logical next step to add safe nurse staffing to CMS. The evidence is available to show that increased nursing staff leads to safer, higher-quality care, and linking safe staffing ratios to reimbursement or to increased payments would incentivize healthcare corporations to increase nurse staffing levels. This would relieve one of the factors driving nurses away from the bedside. References Berlin, G., Lapointe, M., & Murphy, M. (2022, February 18). Surveyed nurses consider leaving direct patient care at elevated rates. McKinsey & Company. Retrieved June 1, 2022 CMS’ Value-Based Programs | CMS. (n.d.). CMS.Gov. Retrieved June 1, 2022, Haegdorens, F., Van Bogaert, P., De Meester, K. et al. The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC Health Serv Res 19, 864 (2019). HCA Healthcare. (2022, February). 2021 Annual Report to Shareholders. Lokuwithana, D. (2022, May 9). Hospitals seek price hikes to offset rising nursing costs - WSJ. SeekingAlpha. Retrieved June 1, 2022, Mitchell BG, Gardner A, Stone PW, Hall L, et al. Hospital staffing and healthcare-associated infections: a systematic review of the literature. Jt Comm J Qual Patient Saf. 2018;44:613–22. Quality Payment Program Overview. (n.d.). Retrieved June 1, 2022

How can we help stop the spread of COVID-19? The question isn’t so much about what we need to stop the spread, we know we need people to get vaccinated, wear masks, and practice social distance, but how do we convince people whose minds seem to be made up against doing any of these things? The misinformation and political rhetoric have made this feel like an impossible task. We need our patients to listen to us, and we can feel defeated when they would rather believe a radio host than their health care providers. Giving up is not the answer. We need to change the way we speak about COVID-19 and the benefits of getting vaccinated. The messaging everyone has heard over and over again has been about full hospitals and ICU’s. We have talked about overworked and exhausted healthcare providers and the danger for patients this creates. We have begged people to wear masks to stop the spread and protect their community. We have told the heartbreaking stories of people who are asking for the vaccine just before they are intubated, and of the COVID-19 deniers that reverse their stance when they become seriously ill. It baffles us that, with all this information, people continue to deny that COVID-19 is a problem, or refuse to follow public health guidelines. It’s not personal to them, it doesn’t affect them, and it’s not a problem until it becomes personal. When we talk to our patients we need to make it personal. Research on messaging to increase COVID-19 vaccination rates found that emphasizing personal benefits of vaccination increased participants' intention to get vaccinated more than any other type of messaging1. One way we can make the message personal is by talking about the long-term consequences of COVID-19 infection. There is more than ICU’s, and ventilators to talk about with our patients. How many times have you heard someone say they don’t have to worry about COVID because they are young, or healthy? In the context of severe illness and hospitalization, they are probably right. The majority of people infected with COVID-19 experience mild illness. Of course anyone can experience severe illness, but for younger people, people without pre-existing conditions the threat of hospitalization or death is not personal. We need to educate our patients about the long-term effects of COVID-19 on their personal health. A study completed by the University of Arizona Health Sciences found that 68% of patients with mild or moderate covid experienced long COVID, only slightly less than those hospitalized with COVID2. Long COVID or Post COVID is defined as experiencing one or more symptoms lasting four or more weeks3. The most commonly reported symptoms from the University of Arizona study were: fatigue, shortness of breath, brain fog, and stress or anxiety4. The following is a list of the most common post-COVID symptoms5: Difficulty breathing or shortness of breath Tiredness or fatigue Symptoms that get worse after physical or mental activities (also known as post-exertional malaise) Difficulty thinking or concentrating (sometimes referred to as “brain fog”) Cough Chest or stomach pain Headache Fast-beating or pounding heart (also known as heart palpitations) Joint or muscle pain Pins-and-needles feeling Diarrhea Sleep problems Fever Dizziness on standing (lightheadedness) Rash Mood changes Change in smell or taste Changes in menstrual period cycles While there are limitations to the data, it seems the prevalence of these symptoms is high and may affect a large number of people. It remains to be seen how long these symptoms may last and how COVID-19 infection may impact a person’s overall health. It is important for healthcare providers to relay this information to patients who may not know that COVID 19 may have a long-term impact on their health or cause disability. Perhaps then we can change some people’s minds about getting vaccinated to protect themselves from infection and the long-term consequences of that infection. References 1Emphasize personal health benefits to boost COVID-19 vaccination rates. Proceedings of the National Academy of Sciences of the United States of America 2,4Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT 3,5COVID-19 and Your Health. Centers for Disease Control and Prevention