CMS reimbursement structures have not been updated since 1972. Healthcare has changed tremendously since then and nursing care positively impacts patients and improves outcomes. Despite the data that proves this to be true, nursing is considered an operational expense and not reimbursable for the complex care they provide. Most inpatient care is reimbursed with a simple per day/diagnosis structure which doesn’t begin to cover the costs to care for patients who are ill enough to be hospitalized. The nursing shortages are a direct result of this very outdated structure and puts patients at risk. Nurses provide the majority of a patient’s care, treatments, education regarding condition, medications, treatments yet are not considered part of the care that is reimbursed. All insurance companies base their rates off of the CMS guidelines. This issue is long overdue for an update.
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