The way the United States pays for nurses is broken
The pandemic made a long-simmering problem in hospitals impossible to ignore: We desperately depend on nurses to deliver quality health care, but the American health system does not properly value the work that they do — in the most literal sense.
Most US hospitals run under a fee-for-service system: They make money by billing for individual services. Doctors, in this universe, are a revenue generator. They order tests to be run, imaging to be taken, medication to be administered. They conduct surgeries and exams. The hospital can charge for each of those individual services, and patients see them on their bills.
Nurses are essential to each of those services. But because hospitals don’t bill insurers for the care that nurses provide to support a doctor’s orders, they end up on the other side of the balance sheet as a labor cost. Patients end up charged for nurses’ work in the same way they are for housekeeping or Jell-O, as part of the cost of a hospital room.
The work that they do — checking on patients, inserting an IV line, assessing patients for infections, teaching patients how to care for themselves — is not considered a billable service under the current fee-for-service payment model.
“All of that work is invisible, except for maybe the supplies that I used,” Matthew McHugh, professor of nursing at the University of Pennsylvania, told me. “The invisibility of nursing work, the inability to put a value on it ... is not in line with how any other kind of professional service would operate.”
This means hospital systems have an economic incentive to keep their nursing staff as small as possible. US hospitals, on average, employ fewer health care staff per capita compared to hospitals in other wealthy countries, most of which have universal health systems that do not rely upon fee-for-service reimbursement.
And when their finances become tight — such as when a global pandemic forces them to cancel moneymaking elective services — nursing and other labor costs are often targeted for cuts. That’s why US hospitals were furloughing nursing staff shortly before they became flooded by Covid-19 patients.
https://www.vox.com/policy-and-politics/23076581/us-covid-health-care-nurses-pay-salary
Brothers and sisters, this is the fcuking TRUTH!
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