Should Nurses Bill Separately from Hospitals and Physicians?

Nurses General Nursing

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Susie2310

2,121 Posts

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.

Specializes in MICU, SICU, CICU.

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

Guests

Guest

0 Posts

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.

Specializes in SICU, trauma, neuro.

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.

ceebeejay

389 Posts

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.

Specializes in Pediatrics, Emergency, Trauma.
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...

PMFB-RN, RN

5,351 Posts

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

I used to be very much in favor of nurses billing for their services. Not any more. Now, with the deliberately created glut of nurses we would be our bidding each other for patients. If I am willing to provide care for an ICU patient for (let's say) $40 and hour, sure enough there is another RN who will do it for $30 and so on until that patient is getting nursing care for $10 and hour. It can't work for nurses like it does physicians because, unlike physicians, nursing doesn't control the number of nurses allowed into the market.

Quiller

38 Posts

I'm going to have to disagree but then I don't think the physician and hospital bill should be separate either. When you take your car to the mechanic, you don't get two bills. When you go to the dentist, you don't get two bills. When you go out to eat, you don't two bills. Multiple billing is one of the things that's wrong with our healthcare system; it's not something we should encourage. On that same note, there shouldn't be charges for equipment.

If you go to the ER for stitches, you get a bill from the hospital for the procedure with each item used charged separately and a bill from the physician. Who was doing the stitches and what did they use? Why can't they just have a base rate for stitches that includes everything used? Sure, add on if it requires more than X supplies but if you already know what's used for stitches, why charge for every item?

anon456, BSN, RN

3 Articles; 1,144 Posts

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???

You could base the number of hours on the acuity of the patients in your care. If you have a patient with an acuity of 700 on a scale of 1 to 1000, and your other patients are all 150's then they 700 patient could be charged more. Not sure how this works in other facilities, but where I work the nurses do an acuity worksheet every shift so the manager knows how busy some of the patients are and can spread out the work more.

anon456, BSN, RN

3 Articles; 1,144 Posts

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...

I guess I should have read the whole thread first! LOL! I just said the same thing!

Also I imagine at my facility at least, every time I chart a diaper change or oral care, the medical billing company is probably reading my notes and adding a charge to the patient. I could be wrong, but someone once told me they did that.

wooh, BSN, RN

1 Article; 4,383 Posts

I guess I should have read the whole thread first! LOL! I just said the same thing!

Also I imagine at my facility at least, every time I chart a diaper change or oral care, the medical billing company is probably reading my notes and adding a charge to the patient. I could be wrong, but someone once told me they did that.

They aren't adding charges for ANYTHING that YOU do if you're a nurse that's not working in a provider role.

wooh, BSN, RN

1 Article; 4,383 Posts

Accounting for time spent on patients isn't difficult for physicians. They add a cut and paste note at the end saying, "I spent x minutes doing blah blah blah physician stuff" at the end of their note. Which I usually find hilarious. They claim to spend hours on patients that they spent minutes on. When if you added up all their patients that day, they spent way more than 24 hours on patients that day. (Perhaps I should cut and paste this post in the charting lies thread.)

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