please see attachment
Financial Considerations in Nursing
Currently, nursing services are considered an expense for which healthcare organizations cannot bill separately. Respond to the following questions and, if appropriate, include personal experience as part of your answers:
· Why are healthcare organizations unable to bill separately for nursing services, and what is the impact on nurse leaders?
· What can the nursing profession, and specifically nursing leaders, do to change this issue?
· Why are nursing services considered an expense and not an income generator?
Discussion response instructions:
Ask questions of the other students that promote further thinking and discussion on the topic. Consider the changes to billing identified by the other students. Do you agree or disagree that these changes can make an impact on nursing services? Why or why not?
Use your personal experience, if it’s relevant, to support or debate other students’ posts. If differences of opinion occur, debate the issues professionally and provide examples to support opinions.
Discussion response #1
Currently healthcare organizations are unable to bill for individual nursing services. After a hospitalization, the patient is presented with a bill that highlights the services that the patient received during their hospitalization. These services often include specific tests completed and specific nursing interventions required such as the need for a blood transfusion or medications. In addition to these services, the physician or specialist visit is billed at a set rate depending on the diagnosis-related group which the patient is admitted under (Lasater, 2014). However, the nurses and patient care technicians who provide a majority of the services that the patient is billed for do not get a set rate for the patient to be billed. Lasater (2014) highlights the although the nurses are not a part of the inpatient billing system the patient is billed for room and board in which the nursing care is embedded. This means that no matter the nursing care that the patient received during their hospitalization they have a set rate for room and board (Lasater, 2014). Unfortunately, this leads to the conclusion that most healthcare organizations are under the impression that nursing care is an added expense to the hospital system due to the way that they are not directly compensated for nursing care as they are for physician care (Lasater, 2014). This impacts nurse leaders by creating a void in nursing care. With hospital organizations viewing nursing care as an added expense for them, the nurse leaders must be able to advocate for the nursing staff and the need for nursing staff within the organization.
One way that nursing leaders can advocate to change the financial standstill within the nursing profession is to create a plan to highlight the amount of nursing care that the patient is receiving during their hospitalization. This can be done by creating an acuity tool designated to show the amount of nursing care required for the patient. This acuity tool designated a set number to assign the patient depending on the acuity of the patient. For example, a patient who is deemed as a 4 on the acuity scale doesn’t require as much nursing and clinical care as a patient deemed an 8 on the acuity scale. This scale can be in place to highlight the importance of nurses and the amount of care that the patients require during their hospitalization. This is important because this tool can be transformed into financial freedom for nurses to prove to the healthcare organization that they are an important part of the team (Bayram et al., 2022).
Laskowski-Jones (2023) highlights that nurses are the largest labor expense in healthcare, nursing positions are often budgeted as a cost as opposed to a revenue generator. This is due to the simple fact that physicians are able to charge for their services and are viewed as a revenue generator for the organization. The nursing profession is the one profession within healthcare that provides care for the patient (Laskowski-Jones, 2023). This is because the nurse implements the doctor’s orders and is face-to-face assessing the patient on a daily basis. Hopefully in the future nurses will be recognized for the difference they make in the healthcare field and not viewed as an added expense to the organization.
References
Bayram, A., Pokorná, A., Ličen, S., Beharková, N., Saibertová, S., Wilhelmová, R., Prosen, M., Karnjus, I., Buchtová, B., & Palese, A. (2022). Financial competencies as investigated in the nursing field: Findings of a scoping review.
Journal of Nursing Management,
30(7), 2801–2810.
Lasater, K. B. (2013). Invisible economics of nursing: Analysis of a hospital bill through a Foucauldian Perspective.
Nursing Philosophy,
15(3), 221–224.
Laskowski-Jones, L. (2023). Classifying nursing as a cost comes at a high price.
Nursing,
53(1), 6–6.
Discussion#2
Healthcare organizations cannot bill separately for nursing services mainly because nursing care is bundled into the cost of patient care. “Nursing care has been bundled into the hospital charge since the inception of hospital care” (Hooper, 2022, para. 5). This bundling approach is rooted in the structure of healthcare financing and reimbursement systems, where services provided by nurses are not itemized separately but are rather part of the larger bill for hospital or medical services. This approach has a significant impact on nurse leaders as it affects resource allocation, budgeting, and staffing decisions within healthcare organizations. Nurse leaders must navigate the challenge of providing high-quality nursing care within limited financial resources, often balancing patient needs with budgetary constraints.
Nursing services are often considered an expense rather than an income generator because they are viewed as a cost center within healthcare organizations. According to an article by Vallire Hooper, “Nursing is not a cost center…..nursing is THE ONLY revenue center that keeps hospitals open. Patients are admitted to the hospital for one, and only one reason: the need for 24/7 nursing care” (2020, para. 5). While nursing care is essential for delivering high-quality patient care and achieving positive outcomes, it is not typically billed as a separate service that generates revenue. Instead, nursing services are part of the overhead costs associated with providing healthcare services, including salaries, benefits, and other operational expenses, therefore considering nursing care an expense rather than an income generator.
Nursing leaders can advocate for changes in healthcare policy and reimbursement structures. They can collaborate with policymakers, professional organizations, and other stakeholders to promote recognition of the value of nursing services and advocate for reforms that allow for separate billing or reimbursement mechanisms for nursing care. Nursing leaders can also demonstrate the impact of nursing services on patient outcomes, quality of care, and overall healthcare costs through research, data analysis, and advocacy efforts. By highlighting the unique contributions of nursing to patient care and outcomes, nursing leaders can work towards achieving greater recognition and financial support for nursing services.
Reference:
Hooper V. D. (2022). The Future of Nursing 2022: It Is Time for Us to Take the Lead.
Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses,
37(1), 1–2.
