Proposal to incorporate nursing care into prospective payment formulas

[rwingo]

This very interesting bit of nursing news came across the CARING list from John Welton regarding the Nursing Intensity Project:

Originally Posted by John Welton, RN, PhD

I want to pass along my personal thanks for those who submitted comments to the Rulemaking site for the Medical University of South Carolina (MUSC) proposal to adjust inpatient prospective payment for nursing care. Senator John Kerry was here in Charleston on the 22nd for a health care town hall meeting and we gave him a copy of the document in the public forum (to lots of cheering MUSC nurses and nursing students). Senator Kerry said he would consider the plan. There are several other things happening at the national level that I cannot discuss at this point but there is definite momentum building to influence the new IPPS formula to include nursing care and specifically adjust hospital payment for nursing intensity. I've put together a web page on my MUSC site to put documents and other related materials:

http://jonathan.con.musc.edu/weltonj...ityProject.htm

For those of you in Massachusetts, especially members of MARN and MONE, I have been working with both organizations to keep Senator Kerry engaged as we move forward with policy and political initiative. Please consider joining that effort. Those in other states may want to consider working with their respective US Senator, especially members of the Senate Finance Committee (that writes Medicare legislation) in particular, Santorum-PA, Snowe-ME, Frist-TN. What's the informatics perspective . . . getting committment to enact the NMDS in the UHDDS and UB92 (soon to be UB04). I'm sure Harriet is smiling.

Thanks again for all your support and I hope to have more good news in the coming months.

John Welton, RN, PhD

And this is the opening paragraph of the proposal:

Enclosed is a counter proposal to CMS-1488-P to directly incorporate nursing costs and nursing intensity into the revised hospital reimbursement formula. Nursing care represents approximately 30% of all hospital expenditures and nearly half of all direct care costs. The current Part A inpatient prospective payment system (IPPS) uses the medical diagnosis as the sole determinant of payment – essentially ignoring the contribution of nurses to patient care at US hospitals. Recent studies have indicated that nursing care has both an independent outcome and cost function related to hospitalization. The enclosed nursing proposal meets the stated goals of CMS to align future hospital payment with actual costs expenditures by incorporating direct and indirect nursing costs for individual patients and uses nursing intensity for severity of illness adjustment within the APR-DRG severity weights as discussed in the proposed rule. Data from the Medical University of South Carolina are provided to map nursing intensity and nursing costs within the APR-DRG severity adjustment framework as a potential model.

Having worked on an inpatient unit as an RN, I think that this is an excellent idea! Nursing Intensity is a fascinating concept that I hope we'll be hearing more about in the coming years.

Dr Welton has an excellent collection of information on his Nursing Intensity Project web page. I highly recommend that you read through all of the documents there.