Will travel nursing survive Obamacare?

Sage1111 · Nov 16, 2012

With the current Medicaid/ Medicare reimbursement surgery, which is usually a money maker for hospitals, loses money in most cases. This money is made up on private insurance procedures. I have strong concerns regarding what effect this will have on our healthcare system. I am hoping for the best possible outcome for all.

NedRN · Nov 16, 2012

This is how Medicare, Medicaid, and private insurance works right now. Capitation per procedure code. What is changing, but has nothing to do with ACA, is reducing payments for complications. So eventually hospitals will only get paid for original diagnoses, not for hospital acquired infections or adhesions etc. I've seen very positive changes in hospitals right now to provide better care and reduce complications of many kinds. They will have to to survive, and everyone will be better off. I'm not sure who initiated that change but it has been in the works for a number of years.

If anyone tells you they know what will happen in 5 years because of the ACA, well, they are just making educated guess (to be tactful).

Sage1111 · Nov 18, 2012

Time will tell I guess. I am hoping you are right Ned! After almost 40 years of patient care, I have a bad feeling about ObamaCare. Do we really want to head towards socialized medical care?? I appreciate any and all discussion regarding this level of government control.

Sage1111 · Nov 18, 2012

Do we really have any control over adhesions in a post surgical patient? The answer is NO!!!

NedRN · Nov 18, 2012

No (although there are some techniques and products that can reduce incidence, Interceed for example), but it is completely predictable how many patients will have such complications as a percentage of the total. Bed sores may be a better example of preventable complications, as are medication errors. Do you want to debate every item? Pointless as this is how the government and insurance companies will reimburse in the future. That is a good thing for patient care ultimately. That should be our focus.

Sage1111 · Nov 20, 2012

Percentage of the total having complications? Where are you from?? We have always focused on preventing post-op complications. You seemed to have missed my main point. The private insurance companies will no longer pay for the deficits in Medicare/Medicaid reimbursement. The entire payment system is going to change and nursing may get the short end of the stick, as well as patients in the long run. You and I are now going to help pay for those 30 million patients coming into the system. Those are tax dollars, not money off the money tree. No point in continuing as this topic can be discussed for days. Bottom line -- travel nursing will flourish, at least in the short term. Just my opinion. See you all on the road.

NedRN · Nov 20, 2012

I think the whole point of insurance is that we all cover one another. You are coming up with some bizarre concepts: insurance has never covered Medicare's "deficits", it is actually the other way around. Medicare/Medicaid covers the holes in private insurance coverage. The ACA is meant to cover more Americans with private insurance, not in small part to relieve the taxpayers of doing so.

Sage1111 · Nov 21, 2012

You couldn't be more wrong.

NedRN · Nov 21, 2012

So please enlighten us. For what purpose was Medicare and Medicaid enacted for?

Sage1111 · Nov 21, 2012

Maybe an example will be more clear. Most cataract surgeries are elderly patients on Medicare. We lose money on every single case. We make up revenue on say the private insurance ortho case in the OR next door. This is the point I was trying to convey.

NedRN · Nov 21, 2012

Who might we be? You are working for free? Is the ophthalmologist working for free? Perhaps you mean the hospital is telling you they are losing money? Ask them to quantify it. How do they stay in business? They don't have to take Medicare patients, perhaps they make money overall taking Medicare patients. Otherwise they would be foolish to do so unless there are other compelling business reasons they are not telling you about.

For example, the hospital I'm at right now has a big losing cardiac surgery program. I'm estimating they lose well over one million a year, perhaps as much as two million (I'm a team member). At one point, the hospital actually told us that they were losing $40,000 per case. However, they are supporting a large cath lab that makes far more money than cardiac surgery loses.

I hear hospitals all over complaining about how they are losing money. But if you look at their financials, they are posting record breaking profits. A lot of it is a big act to keep employee wages down, and fight for higher reimbursement levels. Yes, some hospitals are going out of business, and they should. If they can't make a profit, or their leverage is too high, that is what happens.

bubblejet50 · Nov 21, 2012

Obamacare, if you read the entire things states that hospitals will get flat fees for hospitalization. So if you get complications or if you use more supplies the hospital still only gets the flat fee. This flat fee will include reimbursement for all medical staff including doctors and nurses and therapists. More people will be proactive in their health, yes, but this type of fees will reduce difference in wages and favor the cheaper paid nurses IMO.