Bundled payments and nursing

Interesting post by Gail Wilensky in the Robert Wood Johnson Foundation Human Capital blog. Her discussion of the impact of bundling on the role of nurses stood out:

The move to more inclusive bundles, particularly those that differentiate according to the quality of care provided, should increase the role of nursing in providing care to patients. Since nurses have not traditionally been able to bill Medicare independently, except under limited circumstances, the value they bring is easier to capture the larger the payment unit. In capitated systems, such as HMOs, where a single payment covers all services provided over the course of the year, the incentive is greatest to use the mix of health care personnel that can provide the health services needed at the lowest cost.

Not surprisingly, the role of nurses has tended to be greater at organizations such as Kaiser and Geisinger, as well as in the military relative to the care provided by more traditionally reimbursed physician groups. As the scope of services that is included in the bundled payment expand, some of the same incentives that have affected decision-making in the capitated systems will begin to dominate decision-making elsewhere. The repeated studies that have shown high quality associated with primary care services provided by nurse practitioners should only increase their attractiveness whenever payments are differentiated for quality.

More on the potential impact of bundling on nurses from Ellen Kurtzman.

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