Friday, September 29, 2023

Nurses are the crux of repairing our healthcare system

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Shreya Christina
Shreya has been with for 3 years, writing copy for client websites, blog posts, EDMs and other mediums to engage readers and encourage action. By collaborating with clients, our SEO manager and the wider team, Shreya seeks to understand an audience before creating memorable, persuasive copy.

Rebecca Love is the Chief Clinical Officer at IntelyCarethe first nurse on and a leader in nurse workforce innovation.

If you are building a house and the foundation is not solid, your house will begin to crumble over time.

This is a perfect analogy for what is happening to our healthcare system. Nurses are the foundation of healthcare and represent the largest segment of the healthcare workforce with more than four million nurses only in the US. While there are more nurses in the US than at any time in history, they are also leaving our healthcare system in droves. In 2021 100,000 nurses left bed, the largest single exodus of nurses ever recorded, as reported by a study at health affairs. But as bad as it was in 2021, it’s getting worse.

In addition, a recent McKinsey Survey revealed that a third of nurses plan to get out of bed by the end of this year. The biggest concern nurses referred to when asked about their desire to move on was unsafe staff, followed by inadequate pay. This is a problem we can solve, but only if we address the structural failures in Medicare reimbursement models dating from the 1930s, who did not value nursing. Within this model, physician services were outlined for reimbursement, but nursing services were not.

Instead, insurance policies were created that covered a patient’s room, bed, bedding, and nursing care. Nurses were rolled into room rates and viewed simply as a cost to the health care system. This nurse reimbursement model, or lack thereof, was skewed from the start and has financially devastated our health care system. This fee model is still in effect.

The Centers for Medicare & Medicaid Services (CMS) is the standard-bearer for the reimbursement model of our healthcare ecosystem. The Center determines the policy. Other payers, healthcare facilities, hospital systems and even corporations do not have the power to directly effect change. A CEO of a healthcare system cannot simply decide to change the reimbursement model. That change has to come from the CMS.

However, because CMS is a federal agency within the US Department of Health and Human Services, policymakers can drive change. But how can companies help? By advocating for these policy makers the need for a reimbursement model for nurses. We must advocate for an economically viable model that moves nurses to the same side of the ledger as all other health care professionals. Leaders must use their visibility and position in the industry to ensure that the CMS re-directs investment into the nursing profession, help solve the nursing crisis, and ultimately stabilize our healthcare system.

Precedent for changing the compensation model

There is a precedent for changing the compensation model. CMS is constantly updating its billing structure to add new clinicians to the group, including, for example, radiologists and occupational therapists, physical therapists and respiratory therapists. The services of these clinicians are billable to the payer and/or the patient.

We know that this billing model works for all other healthcare professionals and can be applied to solve the inherent challenges of nursing. The way nurses are reimbursed for their services need not be a complex undertaking. We have the technology, such as electronic health records, that can help us determine costs and easily track the number of hours a nurse provides care, what services they provide, and what types of interventions they perform. Technology can show us the tremendous value of nurses.

If health systems cannot be reimbursed for nursing services, how can they pay for the nursing staff? The simple reality is that they can’t. Hospitals and nursing homes don’t struggle with paying doctors, physical therapists or occupational therapists because they are on the revenue side of the ledger, while nurses are on the other side of the ledger, below costs. If we don’t treat nursing like all these other clinical services, hospitals and nursing homes just won’t be able to afford the nursing staff much longer.

In addition, because nurses are treated as a cost, they are often targeted when hospitals or long-term care facilities need to cut costs. However, reducing the nursing staff has a direct negative effect on patient outcomes. We know from many years of study that the more nurses there are, the fewer complications arise in hospitals or long-term care facilities.

Nursing care is ultimately what patients are admitted to hospitals or nursing homes for; without 24/7 monitoring and care by a nurse, patients entering these facilities are at risk of death. Hospitals and nursing homes cannot function without nurses. Policy makers need to change the reimbursement model so that we can maintain our hospitals and nursing homes.

The outbreak of the current nursing crisis has little to do with the lack of trained nurses. We are short of nurses because we do not support nurses in a financially viable model that supports the profession or their employers. We can solve this by aligning nursing services to the industry standard for reimbursement along with all other clinicians. By doing so, we will stabilize the nursing staff and rebalance the finances of hospitals and nursing homes. Above all, it will lead to better results and save lives. We must act now. Business Council is the leading growth and networking organization for entrepreneurs and leaders. Am I eligible?

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