Testing an inpatient nursing intensity billing model

The Value of Nursing Care: A Concept Analysis

AIM

To report an analysis of the concept of value of nursing care.

BACKGROUND

Value-based health care delivery and reimbursement models are focused on value as a product of quality and cost. Nursing care provides tangible and intangible contributions to patient and organizational outcomes. The nursing profession must be able to proactively and effectively communicate the value of nursing care.

DESIGN

Concept analysis.

DATA SOURCES

Thirty-five separate sources were chosen from database searches of CINAHL Complete and ABI/INFORM Complete. Key terms utilized for the search were "nursing value" OR "nursing care value" OR "value of nursing".

METHODS

Caron and Bowers' (2000) dimensional analysis method was used as a guide for the project.

RESULTS

Dimensions identified from this concept analysis included: (a) economic, (b) relational, and (c) societal.

CONCLUSION

Direct care nurses experience the relational and societal dimensions of the value of nursing care. Patients and/or families experience the relational dimension of value in nursing care. Health care administrators, third-party payers, and nurse researchers interpret value from the economic dimension. Future nursing research should better quantify the economic value of nursing care. Qualitative research which focuses on how patients and families experience the value of nursing care would also contribute to further refinement of this concept.

The Zebra index: one method for comparing units in terms of nursing care

AIM

To describe an approach for developing a nursing index that is based on the patients' needs of nursing care and enables nursing costs to be calculated.

BACKGROUND

Usually staffing resources are calculated as the ratio between the number of staff and the number of occupied beds per unit.

METHOD

The index was developed from two parts of the Zebra method. The index factor per patient category of care was calculated first. The patient days per category of care was multiplied next with the index factor for the category, which gives the same value in terms of nursing care given for all the patient days. The third step was the calculation of the Zebra index (ZI).

RESULTS

The ZI shows 'the intensity of nursing care' given. The index makes it possible to follow changes in the nursing care given over a period of time and it can also explain why two similar units with the same number of staff per patient can have a totally different workload situation.

CONCLUSION

The ZI obtains reliable information about the changing nursing situations over a period of time.

IMPLICATIONS FOR NURSING MANAGEMENT

The approach described can be used in different settings and is not bound to Sweden but can be looked upon as a general method. The index is useful for comparing different units and clinics in terms of nursing care and staffing.

Paying hospitals on the basis of nursing intensity: policy and political considerations

Some believe that explicit incorporation of nursing intensity into hospital payment systems would lead hospitals to increase the use of nursing resources. But 25 years of Medicare provider payment policies, followed increasingly by Medicaid programs and private insurers, means that any incorporation of measures of nursing intensity into payment systems needs to be consistent with concepts of prospective payment. But the main impact of such a step would be to increase equity among hospitals with different case mixes and blunt incentives to specialize in diagnosis-related groups with relatively low nursing intensity. Issues of the role of nurses in hospitals and the intensity of nursing resources used in care are more likely to be influenced by quality reporting and pay for performance than by incorporating nursing intensity into a prospective payment system.

Lessons learned from advanced practice nursing payment

For more than 25 years, advanced practice nurses have been incrementally included as a part of the health care financing structure. Following physician payment revisions at the federal level, advanced practice nurses were overtly recognized as Medicare providers and have participated in the establishment of current procedural terminology codes and the subsequent relative work values associated with payment. Success in this regard has been the result of business, political, and policy savvy that has important lessons for moving forward in any health care restructuring for both nurses and advanced practice nurses. Principles of valuing nurse work, time, and intensity in the Resource-Based Relative Value Scale are discussed with implications for future opportunities of measuring nursing work and any potential relationship to quality outcomes of care.

Measuring and accounting for the intensity of nursing care: is it worthwhile?

In June 2007, the Robert Wood Johnson Foundation sponsored a conference titled "The Economics of Nursing: Paying for Quality Nursing Care." The second topic at the conference was "the appropriateness and feasibility of measuring and accounting for the intensity of nursing care." Drs. Welton and Sermeus presented papers on that topic. This response to those papers focuses on why the hospital industry has not always accounted for and measured nursing intensity. Then it asks, "Why do we want more accurate information about nursing resources used by different patients?" It is not sufficient to say the data regarding nursing costs are not accurate. Nor is it sufficient to say that we now can improve the accuracy of the data. To move forward in this area, we need to develop compelling evidence and arguments that indicate that nursing-cost data of greater accuracy have a benefit that will exceed the costs of that data collection.