NanaPrimo

In response to the above conversation regarding whether the ACO changed patient's insurance - The insurance company changed its plan, probably in response to the ACO regs on Insurance Companies, so they could keep some or most of their profit margin.

Unfortunately in my area, lay-offs do happen, and older experienced nurses are considered too expensive, so they tend not to be hired. The hospitals would like the state to expand Medicaid, so they get a little money at least for inpatient stays on otherwise uninsured patients. There is a lot of anti-government sentiment in my area, marketplace plans are limited, and many people will self-pay before applying for those market plans in the first place. Or the people don't qualify because they are unemployed with NO income at all. So our patient visits for primary care are NOT up, ERs are full, and the hospitals are losing money. Sad situation.

I think the way your employer handled that was not really fair, but I do think a BSN should be required for certain types of nursing, such as in public health, case management, instructors - educators. However, you should have been "grandfathered in" somehow, after all those years in the unit.

My experience with status: Medicare criteria, i.e. Interqual, are listed by condition. Criteria for observation status vs. inpatient must be met for reimbursement for that stay. Also, certain surgeries are listed as to what Medicare reimburses for inpatient status vs. observation/outpatient. The observation status means less coverage, but only home medications that are administered during the Obs stay. If the patient has a Medicare replacement plan or supplemental insurance, that might cover the home po meds that are given during the stay. There seems to be a fear tactic within the general Medicare population that the ACA is causing hospitals to treat them unfairly. As CMs, we can assure them that observation is a way to reimburse less, but it also prevents fraud, and hospitals admitting patients with no need to be there. It in no way reduces the quality of care. Medicaid pays 24 hours of observation, private payers differ.