OPINION: A Bedside Nurse's Guide to Nursing Reimbursement
Written by: Shannon Lunn, Melissa Mills, and Katie Davis
Let's dive into the world of nursing reimbursement - something we all need to know to ensure our work as nurses doesn't go unnoticed and unappreciated. Currently, there are over 3 million nurses in the U.S. who are the backbone of patient care, yet many of us feel overworked and undervalued. A recent survey revealed that 800,000 nurses are considering leaving the profession by 2027 due to burnout and feeling unappreciated.
Why Nursing Reimbursement Matters
Why? Because the true value of nursing gets hidden as a routine overhead cost in a hospital bill. If we want a sustainable workforce, we've got to ensure nurses get the recognition they deserve by reforming how nursing care is reimbursed.
Rebecca Love, RN, MSN, FIEL, who launched the Commission for Nursing Reimbursement, explained, “As bedside nurses, we were long trained to not ask about money, reimbursement or business - we were never taught that nurses are the only healthcare professional that is a cost to healthcare systems. Unlike nurses, every other healthcare professional can bill for their services. This is why nurses are consistently staffed to the lowest costs to healthcare systems.”
The History of Nursing Reimbursement
Now, let's take a quick journey through time to understand how we got here. In the 1930s, nurses were self-employed and compensated directly for their services. Then, in 1935, the Social Security Act came along and hid nursing costs in room and board rates. Moving ahead to 1983, prospective payment entered the scene; it pushed care out of hospitals, giving rise to shorter patient stays with higher patient acuity, fewer nurses, and heightened nurse-to-patient ratios.
As our roles evolved, influential nursing leaders like Cathryne Welch, Carole Jennings, and Claire Fagin championed reimbursement reform, recognizing the need to advocate for the value of nursing services. Yet, despite their efforts, reimbursement today remains an outdated near century-old fixed cost based on the level of care that is charged the same as maintenance or housekeeping.
How Nursing Reimbursement Works
Picture this: You order a basic brew coffee, and your friend orders a fancy caramel macchiato with extra foam, and the price is the same - not fair! Well, this is how nursing reimbursement is set up. Two patients, same unit, the same bill for nursing care.
That patient admitted with a non-ST-elevation myocardial infarction (NSTEMI) that, on top of their cardiac concerns, needs to be turned Q2h, assistance with ADL’s, has memory impairment, and multiple IV medications every few hours is charged the same as the patient on the same unit with an NSTEMI who can care for themselves, takes a few oral meds, and is on the unit for cardiac monitoring, regardless of the actual nursing care needed.
Currently, there is no incentive for hospitals to improve nurse ratios. In fact, it's financially smarter for hospitals to cut nurse numbers and increase workloads. This misalignment of incentives isn't just bad for nurses; it's bad for patients too. Nursing shortages lead to more errors, higher morbidity, and increased mortality rates. It's time to stop framing nurses as a cost and start recognizing them as revenue generators. Until nursing is separated from overhead costs, our worth remains undefined.
Hospitals Don't See the Economic Value of Nurses
Why does this matter? Because hospitals don't see the economic value of nurses, and that needs to change. Rebecca explained how, “A lack of knowledge regarding nursing reimbursement has handicapped our profession from being able to effectively advocate for the changes that must be made to create a sustainable nursing workforce. Healthcare is a business, and as long as nurses remain a cost to them, there will never be investment into the nursing profession. We can change this!”
The Solution
So, what's the solution? We need to change the billing game. Let's ditch lumping nursing care into room rates and start recognizing nursing as a billable service. Billing based on nursing care provided could be the game-changer we're looking for, allowing hospitals to compare the real cost and benefits of nursing care.
Reimbursement for nursing care isn't a new concept. Services, including physical therapy and occupational therapy, are reimbursable, and it’s time we follow their path to explore new avenues for billing, like using Current Procedural Terminology (CPT) codes to bill for care in outpatient settings or adjusting for nursing time within the Diagnosis Related Group (DRG) codes for inpatient care.
What You Can Do to Help
Advocating for change won't be a walk in the park, but nurses have a powerful tool – our collective voice. It's time we unite and use our voices for change - talk with your hospital leadership about reimbursement, call your state or local officials, post about reimbursement on social media, or join the Commission of Nursing Reimbursement!
Let's break free from being hidden costs in a hospital bill – our service is not a mere expense; it's an invaluable asset. Reimbursement reform isn't just about nurses; it's about fighting for the ability to provide the best care to our patients. Together, we can make nursing visible, valued, and victorious!
