Will the new Medicare payment revisions improve or worsen nursing working conditions?

[marie-francoise]

Does anyone think the new Medicare payment revisions (see link below) will force hospitals to improve nurse-patient ratios?

Paper by GWU on nursing implications of Medicare payment revisions:

http://www.aannet.org/policy/ippswhitepaper.pdf

(Also posted to Nursing News.)

Namely, I'm wondering if hospitals might now be "forced" to acknowledge the importance of nursing staffing through a business perspective - i.e., that they will now have to provide adequate staffing in order to avoid incurring costs from "nursing-sensitive" complications that Medicare now won't pay for, and that can be averted through adequate staffing (or their likelihood reduced).

In other words, maybe, under this new CMS policy, hospitals will learn that they can save money through adequate staffing (i.e., hiring of additional nurses), since this will help to prevent nursing-sensitive complications that Medicare is not covering.

Maybe hospitals will find that their having to "eat" the costs of these complications exceeds the cost of hiring the additional nursing staff necessary to prevent those complications in the first place. Maybe the new Medicare rule will also serve to unbundle nursing from fixed overhead (room & board!).

So, the optimist in me hopes these things will happen - i.e., that the new Medicare rule might force hospitals' hand financially, and make them acknowledge the need for adequate nursing staffing to provide quality care, esp now that $$$$ is being tied to nursing-sensitive quality outcomes.

The cynic in me, though, thinks the new rule might make nursing working conditions worse, at least in the short term (e.g., more vapid in-services, mandated hourly rounding that likely occurs anyway but has to be documented on yet another sheet of paper, staff & resource cuts, yet more charting requirements, etc.).

What do you think?

[oramar]

I will guarantee is will cause more paper work. I would bet my house on it.

[Simba&NalasMom, LPN]

Well, one can and should hope...however, I think nurses have a ways to go before they are taken that seriously by most facilities. It seems to be a general trend to blame nursing for everything in most places; now they will have even more to hold against nurses.

I do hope that eventually administrators will come to the realization that nursing is a commodity as valuable, if not more valuable, than medicine; however, I do not see it happening for a long, long, time. This is going to increase stress and help lower morale even more.

The worst part is who really pays at the end of the day? The patient. :angryfire

[EmmaG, RN]

While there may be a forward-thinking hospital administration out there that realizes adequate staffing based upon acuity actually prevents complications, saves money (and lives!), I'm betting we see something similar to what happened in the 80's. They are all too often focused on a quick fix, and won't tolerate the immediate higher costs necessary to save money down the road.

Nursing is going to suffer for this, and badly.

[OC_An Khe]

Well this will be different from the introduction of DRGs in the 80's.Because unlike the 80's when the hospital learned to game the system and low quality of care was actually rewarded with more money this time those same games will result in less money. It will definitely result in more paperwork. It will also require the MDs to document more precisely. In fact our facility is already beginning to have classes for MDs and their staffs on the changes that need to be made.

[ASSEDO]

Medicare pays for patient care. However, I have never read in the CMS manuels or transmittals that they require a nurse/patient ratio. Medicare leaves this ratio to the hospital and pays the hospital DRG and PPS, sometimes with a outlier involved and expect each patient to be taken care of...The hospital gladly takes the government money, but has a history of not providing enough worker-bees (nurses) to provide adequate patient care.

Until CMS spells out in their manuals the ratio of nursing care to the hospital, such as: 1 Registered Nurses to each 4 patient per shift for bed, then hospitals will never provider adequate patient care. Nursing staff is the last group to get staff relief, because nursing has a history of working beyond the safe ratios, to provide care for their patients. As long as the nurse works extra to care for multiple patients, then help will never arrive.

It will take CMS/OIG audits of individual hospitals to determine patients are not receiving the benefit of their money before they will slap the hospital administrations on the wrist for not giving safe patient care.

In the meantime, God help us.

[P_RN, ADN, RN]

I have like zero confidence that CMS will want to get into ratios.

Facilities will either charge uninsured/otherwise insured patients to make up the difference or try to get more work out of less expensive staff.