On July 8, vice president Joe Biden announced that in striving to gain support for its health reform plan, the White House reached an agreement with the key hospital groups, including the American Hospital Association, the Federation of American Hospitals, and the Catholic Health Association of the United States.
The deal is a quid pro quo deal: according to the AHA Web site, the associations agreed they will not fight $155 billion in cuts in Medicare and Medicaid payments, in return for assurances that the cuts are linked to expanded coverage. Additionally, if health reform legislation turns out to include a public insurance plan, then hospitals will receive payments higher than the traditional Medicare and Medicaid rates. The idea is that losses from the reduced payments would be offset by insurance payments from the increased numbers of patients who will be covered. Hospitals will have fewer “pro bono” patients to deal with.
So how will this affect patient care and nursing services? Well, some think that things may get worse before they get better. Hospitals have long complained that the current reimbursements are already woefully inadequate to fund quality care. We see this in barely-able-to-do-basic-care staffing (never mind quality care or patient teaching) and lack of resources for staff development, to name two areas.
Sean Clarke, PhD, RN, FAAN, RBC, chair in cardiovascular nursing research at Toronto General Hospital, says that “at least in the short term, shortfalls in reimbursements would lead some hospitals to try to further decrease operating costs . . . and nurses and other types of nursing staff would be a place that they’d turn fast (as they did in the 1980s and 1990s).”
Already, many hospitals have stopped hiring and some have begun layoffs, including nurses. In June, the Association for Professionals in Infection Control and Epidemiology released the results of an online survey in which respondents linked hospital cuts of people and resources to decreasing surveillance to track hospital infections.
It’s only a matter of time before the indicators that measure the quality of nursing care—to name a few: numbers of pressure ulcers, falls, and pneumonia (fewer nurses means fewer nurses available to assist with ambulating and turning patients); rate of failure to rescue; number of hospital-acquired infections—begin to get worse. And throw into the mix the Medicare regulations that won’t reimburse for hospital-acquired complications. The end result could be further cuts in payments unless hospitals truly “get it” that nurses are the key to reducing complications, length of stay, and hospital readmissions.
Linda Burnes Bolton, Dr PH, RN, FAAN, vice-president and chief nursing officer at Cedars-Sinai Medical Center in Los Angeles, agrees, noting that nurses “make significant contributions to patient care quality and could make more if they are provided the opportunity to spend more time with their patients. . . . When nurses are used to adequately educate patients and their families and provide transitional care, hospital readmission rates decrease.
Sean Clarke adds that, with many nurses forestalling retirement because of the poor economy, there are fewer jobs for new graduates:
“If new graduates in the next few years do not find work and leave, we will lose them to the profession–and we’ll need them once retirements really start in. Also, if word gets out to the high school graduates and career changers who have been coming to nursing school in such high numbers recently, we may watch enrollments start to dry up all over again.”
Nurses need to carefully monitor how this deal for hospitals unfolds—it may be no deal for nurses or patients.
Shawn Kennedy, AJN editorial director
(A follow-up note/update, on March 22, 2010: It looks like a version of health care reform is going to pass. None of us like all the deals that were made to get this done–like the one described above–but it’s also pretty hard to say such deals weren’t necessary to achieve this very narrow victory. The cost-cutting issue remains largely unresolved, but it’s something we’ll have to address in the future. There’s no way around it, now that we’re expanding the rolls of the insured so drastically. This means some of these temporary deals with hospitals and pharmaceutical makers will be revisited. To see a list of the benefits to nurses from this legislation, read my more recent post here.)