New JAMA Study Underscores Why the Business Case for Nursing Is Problematic

A new study to be published tomorrow in the Journal of the American Medical Association (JAMA) finds that hospitals profit when patients have complications during surgery. According to a report in the Washington Post's Wonkblog, this counter-intuitive finding is a function of the payment structure in our nation's health care system. Hospitals earn money for every procedure done, even if that procedure is necessary to correct an error that occurs during surgery.

It's for just this reason,according to Olga Yakusheva, Douglas Wholey and Kevin Frick, that it has been so difficult to make a business case for investing in nursing care. In their article in the INQRI Medical Care supplement published last month, the INQRI researchers point out that because investments in nursing care improve patient outcomes, they hurt hospitals' bottom line. The authors go on to suggest that the roll out of the Affordable Care Act, which includes penalties for high rates of hospital acquired infections among, will help to address this confounding issue. They, like the authors of the JAMA study, also encourage taking more aggressive steps to make health care payments outcome-based, rather than service-based.

According to the Post blog, the JAMA study found that a hospital's profit margin jumped from $16,936 to $55,953 when there was a surgical complication.

New Health Affairs/RWJF Brief on P4P

The Affordable Care Act expands the use of pay-for-performance (P4P) programs, which reward medical providers for achieving better patient outcomes, rather than paying them solely on the volume of services they provide. The theory behind these programs is that they will ultimately improve quality of care and save money. According to a new brief from Health Affairs and the Robert Wood Johnson Foundation, however, early demonstrations of this model yield mixed results.

Click here to read the brief.

Ohio Medicaid Program Incentivizes High Quality Care For Nursing Homes

Starting last month, Ohio' Medicaid program altered its payment procedures to reflect the current trend of moving slowly away from a fee-for-service scheme to adapt to pay-for-performance reimbursement schemes. Ohio's new payment policy links approximately 10% of all Medicaid reimbursements for nursing homes to a wide range of quality measures including, patient satisfaction, rate of errors and nurse staffing levels.

To read more about this initiative, head over to Kaiser Health News for a more thorough explanation of this, and similar programs.

Performance-Based Payment Incentives May Harm Nursing Conditions

Highly touted as a way in which to improve patient outcomes, pay-for-performance incentives have been gaining steam in hospitals nationwide. However, as reported on endnurse.com, a recent study published in Health Affairs suggests that linking reimbursement to quality of care goals could undermine the nursing workforce and shake up the nursing practice environment. The study, conducted by Ellen Kurtzman, RN, MPH, FAAN, assistant research professor in the GW School of Nursing, suggests that while payment incentives do have favorable effects on patient outcomes, they have little to no positive effect on nurse staffing and turnover rates.

Click here to read the article.

Click here to directly access the study, login credentials are necessary to access Health Affairs articles.

Pay for Performance in Nursing is Topic of New Brief from RWJF's Charting Nursing's Future

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.”

Click here to read more.

Nursing Care Quality in Acute Care Hospitals: New Linkages to Patient Outcomes

Dr. Arlyss Anderson Rothman and Dr. R. Adams Dudley present their INQRI project: "Nursing Care Quality in Acute Care Hospitals: New Linkages to Patient Outcomes" at the 4th Annual INQRI meeting.





Project Description: Increased public reporting of hospital performance and the emergence of hospital pay-for-performance initiatives provide new impetus to defining and maximizing all aspects of hospital care. This interdisciplinary team has examined whether increases in nurse staffing and skill mix improve hospital performance on a subset of JCAHO core measures, enhance patient perceptions of nursing performance, and improve overall nursing performance as measured by composite indicators that capture patients' perceptions of care and other selected outcomes of care such as complication rates.