NEW YORK NURSE: January 2008
by Nancy Webber
The Centers for Medicare and Medicaid Services (CMS) announced in August that, starting in April 2009, it would no longer reimburse hospitals for what it terms “serious preventable events.”
Government regulators said that the move would force hospitals to work harder to prevent hospital-acquired infections, patient falls, and pressure ulcers. Nurses are concerned, however, that the move will put even more pressure on overworked nursing staff.
“There already are guidelines to prevent these conditions,” said Renée Gecsedi, director of NYSNA’s Education, Practice & Research Program. “Everyone knows them and tries to follow them. The underlying problem is that nurses are being required to care for too many patients. Research has shown that inadequate RN staffing is the root cause of preventable patient complications.”
CMS listed eight conditions for which hospitals would no longer receive money from Medicare. They were chosen because of their high cost or high frequency:
CMS said it plans to add another three conditions to the list next year. Since Oct. 1, hospitals have been required to report so-called “secondary diagnoses” to the federal government. A state law requiring hospitals to report nosocomial infections goes into effect in 2009.
Unfortunately, none of the laws or regulations require hospitals to report or disclose their nurse-to-patient staffing ratios, despite ample evidence of a connection between staffing and patient complication rates.
A study published in the New England Journal of Medicine showed a strong relationship between RN staffing levels and five “preventable events,” including urinary tract infections, hospital-acquired pneumonia, shock, upper gastrointenstinal bleeding, and longer hospital stays. Higher numbers of RNs on staff resulted in a 3% to 12% reduction in rates of adverse outcomes.
The Joint Commission has found that inadequate nurse staffing was related to 24% of patient deaths and injuries. According to its report, Healthcare at the Crossroads, “higher acuity patients plus fewer nurses to care for them is a prescription for danger . . . staffing levels have been a factor in 24% of the 1,609 sentinel events – unanticipated events that result in death, injury, or permanent loss of function.”
Other research has demonstrated that when RN staffing increased 10%, rates of hospital-acquired pneumonia went down 9.5%. Intensive care units with patient-to-nurse ratios of 3:1 or more had significantly higher rates of post-surgical complications such as surgical site infections.
“The public gets the impression that everything will be fine if doctors and nurses simply wash their hands between patients,” said Gecsedi. “It’s much more complicated than that. A nurse who has been assigned too many patients must decide whether to change a catheter or respond to a patient who is coding. Every day, RNs finish their shifts knowing that they were forced to leave something undone.”
Gecsedi said the disturbing data on hospital-acquired infections reflect years during which both hospitals and policymakers have refused to deal with the staffing issue. “It’s all coming home to roost,” she said. “The trouble is, if hospitals get less money from Medicare, they will be even less likely to hire more nursing staff.”
The spirit behind the CMS decision – improving the quality of patient care – is laudable. But as with many aspects of health care, throwing money at the problem (or taking it away) is not likely to solve it.
What do you think? Do you agree with the decision to stop reimbursing hospitals for preventable patient complications? Do you think it will force hospitals to improve staffing? Send your thoughts to email@example.com.
NYSNA has proposed state legislation that would require hospitals and nursing homes to report and disclose their staffing ratios. If you’d like to see a law passed this year, contact Governmental Affairs at 800-724-NYRN (6976), ext. 283.