Will nursing change w/ Nonpayment for Performance (Medicare)

Crocuta, RN · Mar 10, 2008

What is your opinion on the new Medicare rules? Sorry if this is a repost of the same topic.

Personally, I think that Medicare will usher in the end of health care in the US as we know it. As all forms of "free" healthcare increase, users will require more and more free services. Medicare and other public forms of payment will decrease reimbursement to try and contain costs, which will result in a loss of primary care as doctors stop accepting Medicare as payment in an attempt to survive. This will push more people into our ER's as their primary route of care. Since ER's and hospitals can't turn people away regardless of whether those patients result in a net loss to the hospital, shortages in ability to meet capacity will result.

Soon after, someone will pass some form of "universal" healthcare offering "free" healthcare to a vast number more people. In trying to fix the healthcare mess, politicians will pile on even more of what didn't work already. In the end, there won't be a large enough supply of medical care (doctors, nurses, beds) to meet the demand for more "free" care, and we'll end up with some form of rationed healthcare. Americans will have a giant hissy fit when they are told for the first time in generations that they are not entitled to all the free healthcare they can consume. I don't know what will happen at that point. Either the entire system will collapse, or someone wise will make people come to their senses.

Ginger35 · Mar 10, 2008

Personally, I think that Medicare will usher in the end of health care in the US as we know it. As all forms of "free" healthcare increase, users will require more and more free services. Medicare and other public forms of payment will decrease reimbursement to try and contain costs, which will result in a loss of primary care as doctors stop accepting Medicare as payment in an attempt to survive. This will push more people into our ER's as their primary route of care. Since ER's and hospitals can't turn people away regardless of whether those patients result in a net loss to the hospital, shortages in ability to meet capacity will result.
Soon after, someone will pass some form of "universal" healthcare offering "free" healthcare to a vast number more people. In trying to fix the healthcare mess, politicians will pile on even more of what didn't work already. In the end, there won't be a large enough supply of medical care (doctors, nurses, beds) to meet the demand for more "free" care, and we'll end up with some form of rationed healthcare. Americans will have a giant hissy fit when they are told for the first time in generations that they are not entitled to all the free healthcare they can consume. I don't know what will happen at that point. Either the entire system will collapse, or someone wise will make people come to their senses.

OMG!!! That is what I see too!!!

OC_An Khe · Mar 10, 2008

First of all medicare is not free, never has been and never will be.

Yes the changes in medicare reimbursement will change how nursing is practised, and I believe for the better. In the past providers were rewarded for care no matter how poor/good. IN fact complications and falls actually increased their profits so they had no reaqson to provide quality care. Poor quality of care brought in more money.

TINSTAAFL

RedZeppelinRN · Mar 10, 2008

Of course Medicare is not free. I see it deducted from every paycheck although I receive medicare. Share of costs can be expensive also.

Red

banditrn · Mar 10, 2008

First of all medicare is not free, never has been and never will be.
Yes the changes in medicare reimbursement will change how nursing is practised, and I believe for the better. In the past providers were rewarded for care no matter how poor/good. IN fact complications and falls actually increased their profits so they had no reaqson to provide quality care. Poor quality of care brought in more money.
TINSTAAFL

Do you REALLY think this will bring about a higher quality of care?! And HOW will this change nursing practice?

Do you work in a hospital now? Do you not see that, as usual, nursing will be the ones to suffer from this stupidity.

If a hospital suffers a money pinch, it's not going to affect the salaries of top-heavy management - it will affect staffing, supplies and services.

HealthyRN · Mar 10, 2008

I don't believe this is a good thing at all.
Some falls are preventable yes but not all. Infections are preventable to only an extent, Patients going downstars to smoke or leaving the floor, Its beyond our control if they catch an infection doing these activities.
The only thing I forsee with these new Medicare rules are more abuse on the nursing staff and further shortages.
I am just finishing my nursing orientation, and I already have 6-7 patients on a good day. Generally after the first part of my shift (7-3), the 3-7 section I have 8 patients to look forward to due to shortages and the hospital being loaded (ER Keepers). In order to save money, they are refusing to call in Agency, yet their elder staff is leaving at an alarming rate and none of the current staff wishes to work overtime due to bonuses being taken away (to save money) for working extra shifts).
All this contributes to more falls due to overwhelmed staff unable to keepup and provide adequate care.
What is your opinion on the new Medicare rules? Sorry if this is a repost of the same topic. It has me very alarmed.

Not all falls or infections are preventable, but the idea is that the system must be designed to help prevent as many as possible. It should not be the fault of the individual nurse, but the system itself (like medication errors). The type of conditions that hospitals will not be reimbursed for are urinary-catheter infections, intravenous catheter infections, pressure ulcers, etc. These are things that good nursing care can prevent in many cases. But the correct conditions must be in place so that nurses are able to provide adequate care.

I'm sure that some hospitals are going to react by trying to place blame on the nurses, when it fact it should be viewed as a system problem. In order to fix these things, education must be provided for nursing staff and floors must be adequately staffed. Overall, I think this may be a good thing for nursing, because hospitals are finally going to have to recognize the importance of good nursing care. I just don't know how long it will take for them to figure it out.

banditrn · Mar 10, 2008

Not all falls or infections are preventable, but the idea is that the system must be designed to help prevent as many as possible. It should not be the fault of the individual nurse, but the system itself (like medication errors). The type of conditions that hospitals will not be reimbursed for are urinary-catheter infections, intravenous catheter infections, pressure ulcers, etc. These are things that good nursing care can prevent in many cases. But the correct conditions must be in place so that nurses are able to provide adequate care.
I'm sure that some hospitals are going to react by trying to place blame on the nurses, when it fact it should be viewed as a system problem. In order to fix these things, education must be provided for nursing staff and floors must be adequately staffed. Overall, I think this may be a good thing for nursing, because hospitals are finally going to have to recognize the importance of good nursing care. I just don't know how long it will take for them to figure it out.

Probably not in my lifetime.

Gr8Dane · Mar 10, 2008

Not all are preventable, Prime example of this occured to me today. I started out with 5 patients this morning. I had one pt who was a definate fall risk, confused, trying to get up. Had a bed alarm and all but still a risk. I moved this pt to a room next to the nurses station.

Less than 45 minutes later I am overheaded to the room stat. THe bed alarm is blaring, water/ice all over the floor and a wiggly patient on the floor...

Luckily no major injuries. Just a small abrasion and there will prob be some bruising.

Just goes to show not all falls are preventable, unless we plan to restrain everyone with chemicals or possees, and even then accidents can happen! Is that the future of nursing? Doctors wont risk their paycheck, nor will hospitals. Im just scared the brunt force of it is going to hit the nursing staff. The forms I have to fill out already begin to point blame at nursing.

Miami NightNurse · Mar 10, 2008

Not all Falls are preventable. My hospital has started paying for private sitters for the people who like to jump over the rails. That has got to be a big financial burden

OC_An Khe · Mar 11, 2008

Some nurses work in hospitals, as I do, that are very much concerned with patient safety, quality of care and evidence based health care. Although the hospitals are not necessarily pleased about the changes in reimbursement they realize that it is the RN who will be the lynch pin in successfully dealing with these changes. I have seen nurse staffing and ancillary staffing increase as a result of these changes.( As other posters have also commented on). I have seen RN gaining more autonomy and control of practice at the bedside. Is it perfect, no, but it is heading in the right direction.

Granted there are a lot (probably a majority) of hospitals that will react differently and try and blame the RN. But they to will eventually see that the only way to compete will be to meet the guidelines CMS is putting out. They will no longer be rewarded for low quality of care as the have been in the past. In fact the less quality of care they gave the more they were rewarded. The incentive will be changed to reward quality of care and not just any care as in the past. Quality of care will require more care givers at the bedside. And the evidence has shown that in acute care hospitals it is RN staffing that has the impact on patient morbidity/mortality and quality of care.

OC_An Khe · Mar 11, 2008

Some RNs work in hospitals, as I do, that are very concerned about quality of patient care, patient safety and implementing evidence based health care. This concern has already resulted in increased RN staffing, a lowering of patient to nurse ratios, and increased ancillary staff. RNs have gained greater autonomy and control of nursing practice and how it is implemented at the bedside. Some hospital recognize that it is the RNs that will be the lynch pin in successfully dealing with CMS changes in reimbursement and non coverage of some situations/ acquired conditions. Quality of care will be rewarded and mediocre care will not be rewarded.

Sadly some hospitals will see it in the opposite vane and will try and blame the nurses (as this has always been a successful strategy in the past), try and put political pressure on to have these guidelines reversed, or they will just try and ring out the highest profits then can then just leave or close.

The most successful hospitals will those that embrace these changes. The patients will win and the employees of these hospitals will also win.