I have the privilege of studying for my MSN in Informatics in an entirely online format with Capella University. An interesting line of analysis arose, during a discussion of universal nursing terminology. There are a number of universal terminologies, perhaps the best known being NANDA, NIC and NOC. The Omaha System is integrated within SNOMED, perhaps making it the most likely candidate for eventual universal utilization.
Be that as it may, the question arose: would the use of standardized nursing terminology ultimately lead to billing separately for nursing services. Why or why not? Would nursing be perceived differently if their departments were revenue-earning? My reply is below:
I think the key lies in re-framing both the public and the industry’s perception of nursing as ‘revenue draining’, and instead creating a ‘value added’ perception.
Increasingly numerous studies are indicating that better nursing environments lead to nurses’ ability to perform their job better and subsequently better patient outcomes. Because of my passionate belief in advocacy and the use of social media to change perception, I would like to refer you to my blog post in in this regard which can be found here:
This post refers to a study authored by Jeffrey H. Silber, MD, PhD, from the Perelman School of Medicine at the University of Pennsylvania. Dr. Silber found that the higher the acuity of the patient, the more difference the nursing environment made. Perhaps most germane to this discussion was Dr. Silber’s conclusion:
Hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients.
Simply put, more nurses working in a better environment result in better patient care and lower mortality with similar costs. On a systemic level, more nurses and better working conditions for nurses actually results in decreased cost relative to outcomes, and increased value. The abstract is accessible from the reference citation below. I was made aware of it through the ANA’s news outlet for members, ANA SmartBrief. Members can subscribe at the ANA member website to read the most current news about nursing.
Whether or not the government – driver of reimbursement reform and change – will pick up on this and ultimately require nursing services to be unbundled and tracked for outcomes will probably be the determining factor as to whether floor nursing services will be separately reimbursable. Hospitals, however, could conceivably offer a ‘tiered’ service. OK, that sounds terrible but it is the way this county works. We are definitely a health care industry, not a socialistic system where everyone gets the same. As such, market forces prevail. Hospitals could offer patients Cadillac services at a higher price, which the patient/family would pay out of pocket. Sort of like staying at the Hilton as opposed to the Red Roof Inn…
It is a fascinating discussion (here comes the soap box), but unless we as individuals and as a profession advocate for such a change, it is highly unlikely. Unless, perhaps, President Sanders is elected. (Where is my unicorn?).
Silber J., Rosenbaum P., McHugh MD, et al. (2016). Comparison of the value of nursing work environments in hospitals across different levels of patient risk. JAMASurg. Advance online publication. doi:10.1001/jamasurg.2015.4908.