Guest Author - Colleen Moore, RN
DRG’s Versus Healthcare
I wish nursing schools would teach about reimbursement and how it works. Nurses don't like to think about money, and nobly so, but today it is important to understand why so many hospitals have gone out of business and how much it actually costs to give adequate patient care. Nurses need to take a care management approach to the treatment they supply. They should be looking at the length of stay and facilitate a speedy recovery through care planning. Nurses should have some understanding of DRG’s and the impact they have on reimbursement.
It is not the fault of healthcare providers that patients are going home far too early. Hospitals need money to run effectively, which comes from reimbursement. If a patient comes in to the hospital with pneumonia, the hospital gets reimbursed, say 7,000 dollars. It doesn’t matter if the patient is compromised in some way causing them to take a longer time to recover such as an Oncology patient who is immunosuppressant. It doesn’t matter if the patient came in Friday night through the ER and doesn’t receive any new orders until Monday because the on-call physician forgot to see the patient and nursing didn’t take the initiative to call anyone. Three days in the hospital is 7,000 dollars worth of care, every day the patient spends in the hospital after that, the hospital looses money. If every pneumonia patient leaves in the three days the hospital will make money to pay their bills and pay their staff. For every day over, the hospital looses money and it has a much harder time paying the bills and people that take care of the patients. If they can get patients out in two days, everyone is happy because the hospital does well, they can pay their staff more and purchase new equipment to better care for their patients.
Insurance companies force patients to leave the hospital far too early. Whether the patient had surgery or pneumonia, they are going home when they still need treatment. Reimbursement for Home Health agencies is becoming as limited as the inpatient arena. Community healthcare is driven by funds just like all of health care. If they are not getting paid, it is difficult to supply the healthcare that many individuals require after they are released from the hospital. The insurance companies are the problem and this country is in such a dire need of health care reform. Where does it stop? This is when knowing your local and state representatives, as well as choosing the next presidential candidate, are so very important. Vote responsibly.