Will nursing change w/ Nonpayment for Performance (Medicare)

[Gr8Dane]

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.

[elkpark]

I agree with the posters who have commented that they think the new Medicare reimbursement rules will (ultimately) benefit nurses. I don't have any sources to quote, but it is my personal opinion/observation (from almost 25 years in nursing) that the best way to avoid/prevent the kinds of common negative outcomes/side effects Medicare is going to stop paying for treatment of is increased attention and care from nurses. I think that a big part of why there are so many of these problems in hospitals now is because nurses have been stretched so thin. Hospital and nursing administrators with any sense will realize (even if it takes a while ... ) that it will (now) be cost effective to increase nursing staff and decrease individual nurses' workloads. Up to now, administrators didn't really have to care about outcomes that kept people in the hospital longer or increased the care they required (unless, of course it was something serious enough to get sued over), because they were going to get paid for having the person in the hospital longer, and whatever additional treatment was required, regardless. Hospital care is suddenly, in a very concrete way, going to be about "quality, not quantity." To continue with the now-common minimal staffing and heavy reliance on CNAs (instead of nurses) will suddenly become, under the new Medicare rules (and remember, where Medicare goes, the private insurance companies always follow -- the next thing that will happen is that all the insurance companies will announce they are instituting the same requirements), "penny wise and pound foolish" for hospitals.

[RedZeppelinRN]

I agree with the posters who have commented that they think the new Medicare reimbursement rules will (ultimately) benefit nurses. I don't have any sources to quote, but it is my personal opinion/observation (from almost 25 years in nursing) that the best way to avoid/prevent the kinds of common negative outcomes/side effects Medicare is going to stop paying for treatment of is increased attention and care from nurses. I think that a big part of why there are so many of these problems in hospitals now is because nurses have been stretched so thin. Hospital and nursing administrators with any sense will realize (even if it takes a while ... ) that it will (now) be cost effective to increase nursing staff and decrease individual nurses' workloads. Up to now, administrators didn't really have to care about outcomes that kept people in the hospital longer or increased the care they required (unless, of course it was something serious enough to get sued over), because they were going to get paid for having the person in the hospital longer, and whatever additional treatment was required, regardless. Hospital care is suddenly, in a very concrete way, going to be about "quality, not quantity." To continue with the now-common minimal staffing and heavy reliance on CNAs (instead of nurses) will suddenly become, under the new Medicare rules (and remember, where Medicare goes, the private insurance companies always follow -- the next thing that will happen is that all the insurance companies will announce they are instituting the same requirements), "penny wise and pound foolish" for hospitals.

Great post. This I do agree with! In a hospital I worked at, a patient developed a huge decubitus on his coccyx. The daughters continually complained that he was not being turned. He weighed well over 200 lbs. I don't know how it was managed, but the hospital had to pay for the surgery. must have had a good lawyer.

Red

[fins]

Everybody is looking at the big picture. I want to look at my tiny slice of the world.

I'm going to be doing a LOT more linen changes, because the doctors aren't going to want foleys in patients who need them. Hey, a UTI will cost them money, but my spending my shift changing beds full of pee is free, as far as they're concerned.

Also, if you think you've been verbally abused by a doctor because you annoyed him, just wait until he thinks that you've cost him MONEY.

[elkpark]

Everybody is looking at the big picture. I want to look at my tiny slice of the world.

I'm going to be doing a LOT more linen changes, because the doctors aren't going to want foleys in patients who need them. Hey, a UTI will cost them money, but my spending my shift changing beds full of pee is free, as far as they're concerned.

Also, if you think you've been verbally abused by a doctor because you annoyed him, just wait until he thinks that you've cost him MONEY.

Touché! :chuckle

[RosalindRN]

pts can get UTIs whether or not they have foleys. Most docs will probably go for the foley instead b/c they know that urine on the skin and frequent changes will lead to skin breakdown fast. Which leads me to my next point. What about the patients who come in that are basically here to die and dont get better. If they hadnt been eating and come in with bones purtruding and wasting away, bedsores are almost inevitable. Same goes for UTIs. If pt was incontinent at home and doc didnt order a UA/U micro then when we put the foley in, who is to say it wasnt already festering? Anyway, just my two cents.

[Miami NightNurse]

Everybody is looking at the big picture. I want to look at my tiny slice of the world.

I'm going to be doing a LOT more linen changes, because the doctors aren't going to want foleys in patients who need them. Hey, a UTI will cost them money, but my spending my shift changing beds full of pee is free, as far as they're concerned.

Also, if you think you've been verbally abused by a doctor because you annoyed him, just wait until he thinks that you've cost him MONEY.

I don't think it will cost the doctor money, just the hospital. And I don't take flack from Doctors any way

[HeartsOpenWide, RN]

I do not know if this will improve nursing or not long term. But what I foresee is more cost for the uninsured as well as privately insurance companies. I have friends that work in billing, I understand how it goes...those that pay out of pocket pay a lot more than those with insurance, the insurance only pays so much for specific procedures and they right off the rest (so what a cash payer forks out is a lot more than not only an insurance payer but what the insurance itself pays). I foresee the hospitals pushing off these costs to cash payers as well as private insurance plans such as 80/20...a procedure that normally cost 1000 (200 out of your pocket) will then cost 2000 (400 out of your pocket). private insurance itself (which is already almost unatailable to some) will probably go up do to rising medical costs. I foresee the nursing shortage only getting worse, which is part of the problem of those preventable falls and infections; over worked nurses are going to quit and make it even harder on the ones that stick around, bring down the patient care....a downward spiral is what I see.