Pay-For-Performance Model Of Hospital Reimbursement

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In recent years there has been a marked change in the inpatient hospital experience. Many of these changes are related to funding and payment. Hospitals are no longer reimbursed by insurance companies as a fee-for-service. There has been a move to a pay-for-performance model (Knudson, 2013, C8). Insurance companies have instituted performance measures that hospitals must attain for reimbursement. Adverse events that occur during a patient’s stay now leads to financial loss. Hospitals have to absorb the additional treatment cost of “never events” such as injuries from falls, infections from urinary catheters, and pressure ulcers that are acquired during a patient’s admission (Agency for Healthcare Administration, 2012). The nurses providing …show more content…
As professional nurses, it is up to us to provide leadership with evidence based practice that supports the assertion that staffing is related to improved patient outcomes and satisfaction and this directly affects hospital profit and revenue. Improving patient safety and outcomes can be as simple as the addition of one RN full time equivalent per day. With this addition, there is a 9% decrease in the odds of death in the intensive care unit, 16% decrease in surgical units and a 6% decrease in medical units. There is also a decrease in hospital acquired pneumonia, pulmonary failure, failure to rescue, and blood stream infections related to this staffing increase. (Shekelle, 2013, p.405). In contrast, patient mortality increased by 7% for additional patient added to a nurse’s workload (Kerfoot & Douglas, 2013, p.274). California has enacted legislation to ensure safe staffing ratios. Medical/surgical units are staffed five patients per nurse on medical/surgical units and two patients per nurse on intensive care units. Two years after passage of the bill, Aiken and colleagues were able to show statistical significance between nurse patient ratio and 30 day mortality rates and failure to rescue (Shekelle, 2013, p. 407). California is not alone in legislation related to nurse staffing levels. Legislation exists in 15 states and the District of Columbia which either mandate ratios or require staffing committees that include direct care nurses to develop safe staffing strategies (Knudson, 2013,
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