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Many patients’ groups and state legislators have pushed for higher nurse-to-patient ratios in the United States. Patient safety is at risk due to understaffing, which is understandable given the severity of the disease and the difficulty of the treatment. The minimum nurse-to-patient ratios are being considered in order to address this issue. Even if mandatory ratios were implemented nationwide, there is no guarantee that they would improve hospital quality or outcomes. Increased hospital reimbursements will not cover the additional number of registered nurses needed to meet the new, higher patient-to-nurse ratios. Individual patients could be paid for the amount of time they spend in the care of a nurse, rather than being bundled into the current room and board pricing model.
Revenue code data, which is used to charge for treatment, can be used to evaluate and analyze the case mix among hospitals. There has been previous support from national nursing organizations for hospitals paying for nursing intensity. In the coming years, there are plans to implement this concept across the country.
The current level of nursing care does not meet the needs of patients. As a rule, patients were admitted to the hospital when they were sick and discharged when they were well enough to return home. As soon as a patient’s most critical medical needs are met, they can be discharged from the hospital. Soon, patients with more serious conditions will take up residence in the beds that the recently discharged ones vacated. Hospital beds will be taken up by patients with extremely high levels of acuity. Patients’ demands for ever-higher levels of acuity care are straining hospitals’ resources.
Disparity in the quality and safety of contemporary hospital nursing care has led to controversies. Invasive surgeries, harsher medications, and an increase in the number of patients with long-term acute conditions need a higher degree of care from nurses. An older patient population with an increased demand for help with everyday activities has compounded the lack of inpatient nursing care. One of the consequences of mandatory staffing ratios is the cost of hiring more nurses. You may have an average of 100 adult patients at a medium-sized hospital. There would be an additional $4,000 in daily costs and $1.4 million in annual costs for an additional hour of RN care at the rate of $40 per hour added every day. The institution’s revenue will not be impacted by this new level of patient care. Acute care facilities are now billing and receiving payment for nursing services in an inefficient way, as seen above.
A single mean cost of nursing care per patient day is all that is recorded for individual patients, and there is no indication in the billing or payment system that different patients need different levels of nursing care. Hospital groups are opposing these bills in statehouses around the nation because of the lack of additional money that a hospital gets when it employs more staff.
Mandatory nurse-to-patient staffing ratios are intended to address the apparent imbalance between patient demands and nursing resources, but they fail to address the extremely variable degrees of treatment complexity and nursing intensity among patients in a given unit. A recent study discovered that the average time required to care for patients with a given condition varied significantly across each DRG category. When comparing patients on different units within the same hospital, or even across hospitals, it is important to remember that the intensity and costs of nursing care can vary greatly depending on a variety of factors such as the patients’ age, disability, expected level of self-care, and cognitive ability.
By incorporating acuity into the hiring process, adequate staffing levels can be achieved while also lowering costs and improving patient and employee satisfaction Some facilities use nursing intensity billing instead of requiring nurses to have a one-to-one ratio with their patients. As more states enact laws that address the symptom rather than the cause of understaffing, it may be time to consider an alternative to required ratios that addresses the source of understaffing by taking into account the intensity of a patient’s nursing care needs. If nursing is reclassified as a revenue center rather than a cost center, the relationship between nurses and hospitals may change. A cost center is the sum of a unit’s direct and indirect costs, such as nurse salaries and the cost of electricity and laundry. The Medicare Cost Report divides expenditures for routine and intensive care units into two categories. Revenue codes are used to classify medications, lab tests, and other medical products and services. These charges are frequently classified as lodging and auxiliary services and are organized into revenue centers that correspond to cost centers. Nursing care is not considered a source of revenue for the hospital because nursing services are not directly assigned to a billing code.
Simply put, hospitals would benefit from a more equitable payment system if Medicare and other health insurance providers reimbursed them directly for the nursing care they provide to individual patients instead of bundling this care into a fixed room and board cost center based on average hospital nursing time and costs. An alternative nursing care payment system, as well as its benefits and potential impact on health care policy, will be proposed. In the following section, it will be compared to the current system.
The price tag is what is causing the most concern about this shift. Laws requiring a low nurse-to-patient ratio impose a significant financial burden on hospitals, and they have little influence over staffing decisions. This means that funding for nursing education, as well as the pay and benefits offered by hospitals, must be increased in order to recruit enough nurses to fill the roles required. The transition in California was unquestionably a financial investment, and no other government is in a position to make such a financial commitment.
If ratio regulations are followed, patients may have to wait longer for treatment. Because of the ratio requirement rule, nurses cannot visit patients who are waiting to be admitted even if a bed is available and there is little activity on the ward. Furthermore, such rules fail to account for more serious emergencies that may occur within the hospital or city and necessitate immediate action and adjustments to staffing levels.
Though some studies have shown that lower nurse-patient ratios improve patient outcomes, other studies show inconsistencies in some states minimum requirement on adverse events in hospitals and mixed quality outcomes. While this legislation clearly benefits nurses, it is less clear how it benefits patients. Regardless of whether everyone agrees on how strict nursing-to-patient ratios should be, this issue isn’t going away anytime soon. In this ever-changing political, economic, and social environment, there will always be a need to develop better methods of caring for both nurses and patients.
