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Nursing Makes Cents

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 conditionsIncludes several conditions which are nur

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Nursing Makes Cents

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    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. Third party payers are following the lead of CMS Accreditation organizations are adopting many of the indicators of quality & safety into their requirements Pay-for Performance: The Beginning

    4. 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 Hospital-Acquired Conditions

    5. 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 Hospital-Acquired Conditions

    6. P4P: A Double-Edged Sword? Potential Positives + Potential Negatives - 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

    7. P4P: A Double-Edged Sword? Potential Positives + Potential Negatives - 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

    8. 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 business�s bottom line What Can Nurses Do?

    9. 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 What Can Nurses Do?

    10. The worth of a thing is best known by the want of it. �James Kelly (18th century) Something To Think About

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