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Should Nurses Bill Separately from Hospitals and Physicians?

Posted

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

I read a letter in the Baltimore Sun this morning that mentioned this interesting idea.

Nurses should bill separately from hospitals and physicians.......

The dean of the Johns Hopkins School of Nursing recently claimed that "today, nurses are full partners and leaders in the heath care process" ("This is not crazy; this is nursing," Aug. 18).

But if that's so, why are nurses (primarily a female workforce) still being paid at a flat per diem rate out of their hospital's room and board line item?

During the 1920's, patients received a separate bill from nurses in addition to the hospital and physician bills. Of course this practice was short-lived as hospitals grew and hired the private duty nurses as employees. Now, nurses' expenses are rolled in with the room and board rates.

Currently there isn't a way to capture the actual number of hours that nurses spend with individual patients. Of course, that hasn't stopped physicians and other healthcare providers from charging exorbitant rates for the limited minutes they spend in a patient's room. Imagine, if nurses were compensated half the amount of the physician's fee for their hours spent in patient care???

The separation of nursing from room and board would provide real time data to show the actual value of nursing, very much like the profession operated in the early 1900s when nurses were hired directly by patients and billed separately from the physicians and hospitals

The author suggests that an opportunity for this was missed during the creation of the ACA. "It certainly would've added to the spirit of this legislation which encourages quality of care and measurable outcomes that provide value."

Interesting idea. How do you think this would go over?????? As the largest sector of employees in the healthcare industry, nurses could be a real force to be reckoned with.

http://www.bristolpost.co.uk/news?page=2&listName=channelActivity&orderByOption=

http://www.bls.gov/spotlight/2009/health_care/home.htm#chart_oes

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

consider this: nurses would have to hire people to do the paperwork, make sure the coding is corect, and monitor the federal and state requirements. I feel sure Liability Insurance would be required to cover any financial losses. In the end, nurses might net less and be paying to some organization to do all the administrative stuff. You would be a private contractor. As things stand now, I am not for it. Sounds like jobs would be a lot less secure.

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience.

I think with proper documentation and technology, nurses can be paid better; they base nursing care for hours worked; If CMS institutes that nursing have a specific rate (like they do for home health PDN and home visits and the like), we may end up with a higher compensation; controlling that organizations can't take more than 30% of the assigned rate; then the facilities and agencies can continue to institute pay differentials and raises and scales as well, but won't have to think of us as a "room and board" commodity because most of the pay is paid by CMS and insurance money.

I'm sure my ideal is pretty lofty and probably I'll conceived at best, but oh well, at least it's an idea to start with. :cheeky:

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience.

consider this: nurses would have to hire people to do the paperwork, make sure the coding is corect, and monitor the federal and state requirements. I feel sure liability insurance would be required to cover any financial losses. In the end, nurses might net less and be paying to some organization to do all the administrative stuff. You would be a private contractor. As things stand now, I am not for it. Sounds like jobs would be a lot less secure.

I have been an IC; I found myself having more money than being a W-2'er; I paid my taxes and got some really great breaks; I also understand the frustration of doing taxes and paperwork; but it's do-able. :yes:

If nurses end up being contractors, I think we would have more money. I have been an independent contractor, and it's not too bad; however the tax involvement can give people a headache, and that could be the crux of the issue for many nurse who want to work and leave work at work.

RNperdiem, RN

Has 14 years experience.

In life there are trade-offs. It is easy to take for granted the perks of being an employee: the paid time off, retirement contributions and steady paycheck every two weeks etc. There will always be a trade-off.

I grew up with self-employed parents who never had any paid time off, are still working because not enough was left over retirement, no matching funds and the insecure realization that a business can fail easily.

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

consider this: nurses would have to hire people to do the paperwork, make sure the coding is corect, and monitor the federal and state requirements. I feel sure liability insurance would be required to cover any financial losses. In the end, nurses might net less and be paying to some organization to do all the administrative stuff. You would be a private contractor. As things stand now, I am not for it. Sounds like jobs would be a lot less secure.

Reality. Darn. I was having such nice thoughts of charging that nasty patient for fluffing the pillows, and topping off that cup of coffee.

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

We bill 1:1 nursing hours, but other than that it is just in the unit cost.

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience.

Reality. Darn. I was having such nice thoughts of charging that nasty patient for fluffing the pillows, and topping off that cup of coffee.

I think the though is still nice; just because you are a contractor does not mean you have to hire someone to do your billing, and etc; it has been done; there are plenty of nurses who have the experience of being billed directly in this business. :)

Billing for services doesn't necessarily mean becoming independent contractors. PT, RT, etc. is billed for instead of rolled into the room rate. And yet physical therapists and respiratory therapists are still usually hospital employees.

Caffeine_IV

Specializes in LTC, med/surg, hospice. Has 7 years experience.

I don't understand how it would work. Would we end up with an increased workload and more complaints?

Self employment works better, when one spouse is at least a part time employee with access to benefits and a retirement plan. However, if your parents were not motivated to plan for their future inevitable retirement, that does not mean that working as an Independent Contractor is a bad deal.

Self employment allows you access to all of the tax write-offs, etc, not available to the general employee individuals. They probably needed a better accountant, who specializes in the self employed, to exploit all of the tax benefits that they are allowed by our present tax laws.

Nurses would make out much better as Independent Contractors, than as employees. You can take inexpensive Business Class at your local community college. They often provide classes on how to start businesses, Self Employment, etc. Also, the local group of business owners, can offer a wealth of advice on business set ups, and keeping records, etc.

My take is that the nurse who would not want to be independent contractors, are also the ones who are risk avoiders in their personal lives, and would be happy to starve, than step out of their comfort zone.

Remember, as long as nursings' professional practice remains as part of the room rate, housekeeping, and the complementary roll of toilet paper, we will never have the recognition, respect, and compensation that we deserve.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Good points! ^^

Nurses would make out much better as Independent Contractors, than as employees. You can take inexpensive Business Class at your local community college. They often provide classes on how to start businesses, Self Employment, etc. Also, the local group of business owners, can offer a wealth of advice on business set ups, and keeping records, etc.

My take is that the nurse who would not want to be independent contractors, are also the ones who are risk avoiders in their personal lives, and would be happy to starve, than step out of their comfort zone.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

In reply to your first paragraph, while this may be true for some nurses, there are good reasons for many nurses not wishing to become independent contractors, versus being employees. The vast majority of nurses are women, and a large part of many women's lives involves taking care of ill/elderly family members, raising children, and supporting significant other's in their careers. Male or female, starting one's own business is not a good option for the majority of people. Starting a business and running it successfully usually involves a large amount of financial risk, huge demands on one's time, unpredictable income (especially at first), legal obligations and risks, very hard work, and personal sacrifices. Understandably, the majority of nurses choose to work as employees.

Your second paragraph is simply insulting.

Edited by Susie2310

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

My dream would be for all of the ICU nurses to form an LLC and sell their services to the hospital.

Billing for services doesn't necessarily mean becoming independent contractors. PT, RT, etc. is billed for instead of rolled into the room rate. And yet physical therapists and respiratory therapists are still usually hospital employees.

Though at my hospital, RT and PT are both paid less than nurses. Pharm doesn't bill for services and yet they make much more than we do.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

I get it in theory, that we are so much more than part of the room.

In practice, ain't nobody got time for that. At least I don't. ;) It's hard enough to cram all the actual nursing that I'd like to do into every shift, plus document my pt care, make sure I get to eat lunch, etc...without having to do my work of billing. I don't take work home either. If that makes me an avoider, eh. Life is short, I'll prioritize what works.

Many medical professions do this and survive quite nicely, so I think billing, as an issue, is a non-starter. The real issue is it will never be allowed to happen because insurance companies do not want to reimburse for everything a RN does in a day with multiple patients. And, that is the key with facility care - you have relatively few nurses caring for many patients over extended periods of time. They can get away with that because they can put a flat value for that care and adjust it down as they need/want to.

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience.

Many medical professions do this and survive quite nicely, so I think billing, as an issue, is a non-starter. The real issue is it will never be allowed to happen because insurance companies do not want to reimburse for everything a RN does in a day with multiple patients. And, that is the key with facility care - you have relatively few nurses caring for many patients over extended periods of time. They can get away with that because they can put a flat value for that care and adjust it down as they need/want to.

A possibility is a rate based on acuity; nurses document acuity and per ratio of pts; per the rate; now, the negotiation of rate would be, for me probably astronomical; but the starting rate 100-150/pt; then go up as acuity goes up; so in theory one could at least make 600 dollars a day; now, that can be adjusted for inflation, but 600-1000/day for starters is out of the hospital/facility billing's hands.

Granted, again, this is purely a dream and in all gravity not even happening; however it is nice to dream, yet again...