Improving value is one of the central aims of recent and ongoing health care reform. In our last LDI/INQRI Brief, we reviewed the evidence of the role of nurses in increasing the value of health care. In this companion brief, we dig deeper into the three reimbursement strategies that Medicare uses to align hospital financial incentives with quality of care, and we calculate the potential effects of nursing-sensitive quality indicators on hospital payments.
In our last LDI/INQRI Brief, we looked at the evidence of nursing's role in increasing the value of health care, and we pointed out where "value" and "business case" may differ for hospitals. In our latest Brief, we analyze the three Medicare programs designed to align hospital incentives with value, and how nursing-sensitive quality indicators relate to those programs.
A new LDI/INQRI Brief tackles the complexities of assessing health care value and nursing’s contributions to value in terms of outcomes and costs. It highlights evidence published by researchers in the Interdisciplinary Nursing Quality Research Initiative (INQRI), an 8-year program funded by the Robert Wood Johnson Foundation.
Increasing health care value has become a central objective of payment policies, insurance design and purchasing, and patient and provider decision-making. The word “value” appeared in the title of seven sections of the Affordable Care Act (ACA), and earlier this year CMS set a goal of having 50 percent of reimbursement based on value.
In Medical Care, Ann Kutney-Lee, Linda Aiken and colleagues analyze patient and nurse outcomes in Magnet and non-Magnet hospitals in order to establish whether there is a causal link between Magnet designation and improved outcomes. Magnet hospitals are accredited by the American Nurses Credentialing Center for excellence in nursing. The authors analyzed retrospective data for a sample of hospitals in Pennsylvania that attained Magnet recognition between 1999 and 2007 and compared it to hospitals that remained non-Magnet. The outcome measures were surgical 30-day deaths, failure-...
Twitter has been abuzz with commentary about ProPublica’s Surgeon Scorecard, which reports on how individual surgeons perform on in-hospital mortality and readmission (complication) rates for eight common elective procedures. Amidst the pointed criticisms of the Scorecard, there exists moderate agreement that it provides some value in helping consumers select a surgeon.
Not every health system can be Kaiser Permanente, but many try. Kaiser’s model of integrated health delivery is highly regarded for high-quality and efficient health care.
Although the supply of nurses is likely to meet overall demand, the nature of a nurse’s job is changing dramatically as nurses assum expanded roles in redesigned health care systems for a broad range of patients in ambulatory settings and community-based care.
In a new LDI/INQRI Research Brief, Erin Fraher, Joanne Spetz, and LDI Senior Fellow Mary Naylor analyze the challenges and opportunities that health system transformation presents to the country’s 2.9 million registered nurses. They explore the new roles and responsibilities for nurses in alternate delivery models such as Accountable Care Organizations and medical homes, and call for changes in nurse education, regulation, and policy.
In the Journal of Nursing Care Quality, Ying Xue (University of Rochester) and colleagues, including Linda Aiken, assess the effects of using agency-employed supplemental nursing staff on overall personnel costs at large academic medical centers. Through analysis of data from 19 medical centers, the investigators find that the modest use of supplemental nursing staff is a cost-efficient way to keep up with demand for personnel during peak periods. However, heavy reliance on supplemental nurses to meet staffing needs is not cost-efficient in terms of overall personnel costs.
In the Journal of Nursing Administration, Linda Aiken and Penn colleagues from the Center for Health Outcomes and Policy Research (CHOPR) examine whether the use of supplemental registered nurses (SRNs), temporary nurses often used by hospitals to alleviate staffing shortages, has an impact on overall patient satisfaction. Using survey data from nurses and patients, they found little evidence that temporary nurses affect patient satisfaction with the hospital or with nursing care in particular. After other hospital and nursing characteristics were controlled, greater use of SRNs was not...