Should Nurses Bill Separately from Hospitals and Physicians?

[tnbutterfly - Mary]

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

[APRN., DNP, RN, APRN, NP]

When I saw this post - the thought came to mind of what my old agency used to bill the hospital per hour versus what I got paid by the agency per hour.

There was at LEAST a $50 gap between the two amounts.

The idea is intriguing - take whatever you make per hour now, and tack on an extra 50 dollars on top of that.

In addition to that - you would be able to claim mileage to and from your place of work to the tune of ???? is it .54 cents per mile now? .....all year long. There are a number of lovely tax deductions that come to mind the more I think about it.

Of course, the hospital may retaliate and charge up the wazoo for any required training specific to their hospital. I'm just not really sure how that would work. If the hospital is currently required to show that the nurses have yearly competency training in all things and sundry, how would the onus of that requirement fall if the nurse was no longer an employee of the hospital.

How would floating work? If you set up your contract to only work ICU, and the hospital said that you were going to float to another floor, would you be blacklisted if you refused to float?

There would be a whole market of people who could write up contracts for independent nurses.

__________________

On the flip side, I'm not sure how that would really work if nurses were employees of the hospital, but billed out their time separately. Maybe we could get some Physical, Occupational, and Speech Therapists to give us an inservice on how that would all work. They seem pretty happy doing what they do. Of course, if I could do what I do and then look for someone else to take over whenever there's poop, vomit or urine involved, I would be a lot happier too.

[icuRNmaggie, BSN, RN]

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.

I think the contract for specialty areas would go to the best qualified people, like it does in travel nursing.

[PMFB-RN, RN]

I think the contract for specialty areas would go to the best qualified people, like it does in travel nursing.

I think travel nursing exactly makes my point. When I was a travler I noticed that if you wanted a contract in Hawaii or San Diego in winter the pay was very low. A summer contract in Alaska paid abserdly low. However a winter contract in Alaska would pay quite well. The point I am making is that the better jobs and shifts would have a lot of competition for them from a large number of well qualfied nurses and the pay for them would get lower and lower all the time. There would likely still be some high paying gigs if you are willing to work in BFE, or some place that is undesirable for one reason or another.

[Sidnetra23]

so true!!

[Jagriner71]

I think the idea of getting out of room and board isn't about private billing. It is about being seen as revenue rather than being seen as cost. That is how pharmacists are paid hospital employees but they make so much more money. Nurses as cost to the hospital are paid poorly and treated poorly. We are powerless in this position.

[KatieMI, BSN, MSN, RN]

It is not about being paid much, as it is unlikely that even the best vein whisperer RN would be compensated as much as a surgeon MD, or even as assistant PA.It is about bringing revenue in place.

Every time I go to my PCP, she goes through motions. I do not smoke (yes), my asthma under control (it depens), etc. She sure bills for all that, and now I even know how she does it. It doesn't come in my bill, but insurance somewhere checks the marks and pays for "smoking assessment", "asthma control assessment", etc., although this PCP does not actually treat it all, that's for specialist. Why, then, if I spend whole hour teaching family and document it, this time cannot be billed?

Half of the problem modern US nursing faces is that nurses are not seen as element bringing the money in by any mean except catering for patients' whims, aka "prowiding excellent customer service", whether the said service is actually safe and beneficial or not. We do not bring money, instead we're something on what money need to be spent - hense is disrespect toward RNs and refusing to spent more money on glowing issues like understaffing, lack of lifting/moving devices, lack of equipment, lack of opportunities for rest and relaxation, etc. If nursing services would start to be billed, it would help some of The Powers to wake up and see what nurses really do and how they can REALLY contribute to the agency's success.