Nursing reimbursement
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Nursing reimbursement: Commission founded to improve model of payment

A Commission was founded to create an economic model for nursing reimbursement and to create a sustainable model for the nursing profession.

The Commission for Nurse Reimbursement has recently launched in response to the nationwide concerns of nursing staffing shortages and will be working to change the way healthcare systems are reimbursed for the valuable care nurses provide. 

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The Commission is comprised of national nurse leaders, healthcare executives, policy experts and academics. Together they aim to vet, validate and create sustainable solutions that can be adopted by the Center for Medicare and Medicaid Services and insurance providers.

The Commission believes that this will improve the current model of payment for nursing services within hospital and healthcare systems. 

Nursing reimbursement model from 1930s

Dr John Welton, Professor Emeritus, University of Colorado, states, “The current financial model for nursing dates back to the 1930s, one that rolled nursing services into ‘room rates’ for insurance reimbursement and placed nursing services as a cost to healthcare systems.” 

Historical perspective helps to explain why nurses were rolled into room rates, and why their services were denied a nursing reimbursement model. In the late 19th and early 20th century, families would hire private nurses to go into the hospitals, and patient outcomes improved. Hospitals saw the value in this and started to train and employ nurses.

At that time, nursing services were listed as billable. But by the 1930s, as hospitals established a payment model, they looked to hotels and realised maids were rolled into room rates, so they did the same with nurses—forever hiding the value of nursing services.

This differs from how any other healthcare professionals are treated. For example, occupational therapy, physical therapy, respiratory therapy, podiatry all have billable services, while nursing has remained without. 

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Nursing reimbursement model is sunk cost to healthcare systems

Rebecca Love, Co-Chair of the Commission, states, “The way the nursing reimbursement model is constructed contrasts starkly to any other reimbursement model for healthcare professionals. All other healthcare professionals bill for their services, except for nurses. The reimbursement model today positions nurses as the only healthcare profession that is a sunk cost to healthcare systems.”

She continues, “In business, we know one does not invest in costs, you cut costs—and we have seen this failed economic model create an unsustainable and misaligned model where nurses and healthcare systems are in constant conflict that can be solved by allowing nurses to be a billable service.”   

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Time to fix nursing reimbursement model

Sharon Pearce, Co-Chair of the Commission, stated, “For decades, nurses have worked to bring this issue forward and create a more sustainable reimbursement model. Today, we are formalising this initiative with the Commission.” 

She continues, “The reimbursement models for all other healthcare professionals are successful—we never hear that we can’t support more doctors or physical therapists—but we constantly hear there is no money for nurses. It is time we fix this. Healthcare cannot function without nurses.”

Nursing care is backbone of patient care

Dr Olga Yakusheva, a health and labour economist and Professor of Nursing and Public Health at the University of Michigan, states, “Nursing care is the backbone of high-quality, affordable patient care. It is in the public’s interest to have a strong and thriving nursing workforce, and so our government and public payers, acting on behalf of the public, must step in and improve the economic drivers of organisational decisions to invest in their nursing employees.” 

The Commission will be working alongside nursing organisations and partnering with healthcare groups nationwide to propose a solution to Congress that considers the needs of the more than 5 million nurses in America today and seeks to improve the quality and reduce the high cost of healthcare.


– Globe Newswire, Boston


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