Two key objectives of the push for sweeping health care reform are holding down costs and driving up quality. “Pay for performance,” a demonstrated approach to accomplishing both of those goals, has gained significant traction among policy-makers and some payers. But according to the latest publication in the Robert Wood Johnson Foundation’s Charting Nursing’s Future series, “pay-for-performance initiatives related to nursing care are just emerging, largely because—while nurses are central to patient safety and quality of care—their work remains invisible to payment systems.”
The brief, Perspectives on Pay for Performance in Nursing: Key Considerations in Shaping Payment Systems to Drive Better Patient Care Outcomes, cites a 2007 literature review in which Ellen T. Kurtzman, M.P.H., R.N., assistant research professor, Department of Nursing Education, The George Washington University, found not a single example of nursing-focused incentive programs in the United States. By contrast, Kurtzman’s research identified more than 100 such programs focused on hospitals and physician practices.
“Payers recognize nurses’ importance to quality and safety,” Kurtzman explains. “The problem is that nurses are invisible in the payment system. In hospitals, for example, their work is bundled into room-and-board charges. And any change in how nurses’ time is billed would require a major overhaul of the hospital payment system.”
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