Nursing Makes Cents

1
Nursing Makes Cents

• Pay-for-Performance A Double-Edged Sword for
  Nursing?

2
Pay-for Performance The Beginning

• CMS Reporting Hospital Quality Data for Annual
  Payment Update (RHQDAPU)
• Hospitals failing to report receive reduced
  payments (2 less)
• As of October 1, 2008, CMS stopped paying for
  certain hospital-acquired conditions
• Includes several conditions which are
  nurse-sensitive

3
Pay-for Performance The Beginning

• Third party payers are following the lead of CMS
• Accreditation organizations are adopting many of
  the indicators of quality safety into their
  requirements

4
Hospital-Acquired Conditions

• CMS identified no pay conditions
• Pressure ulcers
• Falls associated trauma
• Catheter-associated urinary tract infections
• Vascular catheter-associated infections
• Objects left inside surgical patients
• Surgical site infection in some cases
• Deep vein thrombosis/pulmonary embolism following
  certain surgeries
• Air emboli
• Blood incompatibility reactions
• Nursing sensitive conditions

5
Hospital-Acquired Conditions

• May be added in the future
• Legionnaires disease
• Poor glycemic control
• Delirium
• Ventilator-associated pneumonia
• Staph aureus septicemia
• Clostridium difficile disease
• Surgical site infection post specified elective
  procedures
• Iatrogenic pneumothorax

6
P4P A Double-Edged Sword?

• Recognizes nursing contributions to quality which
  may stimulate investment in nursing
• Ties nursing to measures which impact the
  financial profitability of the institution

• If reduction in reimbursement is anticipated,
  resources may be cut
• Culture of blame
• Increased dissatisfaction, intention to leave,
  and turnover

• Potential Positives

• Potential Negatives -

7
P4P A Double-Edged Sword?

• Recognition of nursing impact may propel addition
  of nursing to quality management teams
• Staffing could be ruled by patient need, not
  numbers

• May focus on only those quality goals which are
  subject to P4P
• Does not quantify nursing intensity by individual
  patient
• Does not separate nursing services from room
  board or per diem rates

• Potential Positives

• Potential Negatives -

8
What Can Nurses Do?

• Become familiar with measured outcomes, public
  reporting, and financial incentives tied to
  nursing
• Analyze financial impact of nursing on healthcare
  institutions
• Demonstrate nursing contributions to quality care
  safety
• Remember that not all nursing measures contribute
  to a businesss bottom line

9
What Can Nurses Do?

• Educate staff on how to detect document
  conditions present on admission
• Participate in quality safety research
• Advocate for nursing participation in financial
  decisions
• Advocate for research that addresses nursing
  contributions, payment systems that account for
  nursing intensity, and integration of nursing
  information into clinical support decisions

10
Something To Think About

• The worth of a thing is best known by the want of
  it.
• James Kelly (18th century)