But it was not to be. Instead, the cost of nursing was “buried along with brooms, breakfast, and the building mortgage,” hurting the visibility of nursing contributions to healthcare for the better part of a century, nursing scholars John Devereaux Thompson and Donna Diers wrote in the now out-of-print textbook Managing Hospital Resources in 1991.
Longtime nursing researcher John Welton has not given up the fight. He says hospitals could not only improve their operations, but some could even benefit their bottom lines if his ideas about linking nursing intensity to medical billing came to fruition.
Welton—named dean of the School of Nursing and Health Sciences at Florida Southern College, Lakeland, this year—has been studying what could be different if the more than $200 billion cost of hospital nursing was not lumped into the undifferentiated “blob” of room-and-board costs. The study could wrap up next year, depending on the demands on his academic role, he says.
“We've created a system where we've hidden the true cost of nursing care,” Welton says. “The argument I make is, we need to identify the cost of nursing intensity on a per-patient basis. The old assumptions that the hospital accounting system was based on, which was based in 1930s, don't hold any longer. But we're still stuck in them.”
Observers say one of the biggest weaknesses of the current billing system, which relies on patient diagnosis codes, is that ancillary factors such as drugs and laboratory testing that are easy to account for end up driving the cost of care, even though they may have less impact on what hospitals actually spend on care than the difficult-to-quantify measure of nursing intensity.
Nursing intensity is the widely debated metric describing exactly how many minutes of care a nurse provides to a given patient. Researchers say understanding variations in nursing intensity, both between classifications of patients and among the patients in a given category, is a key in setting up accounting, staffing and billing models that accurately record the true cost of the care that hospitals provide.
Catholic Health Initiatives—a 59-hospital health system based in Denver—is one of several systems contributing nursing-intensity data to the study, although Kathy Sanford, the system's senior vice president and chief nursing officer, says the academic goals are not her primary reason for implementing a new digital system to track intensity. “We're putting this in as a way to understand what patients need,” Sanford says. “As a nurse, I understand that certain patients need more care. This will tell us who those patients are.”
For example, two patients can come in to the hospital for identical reasons, but if one of them has diabetes, their nursing intensity is likely to be different than a patient without the chronic condition.
“This will help us figure out how to more effectively assign our nursing resources,” she says. “It's important to us that we provide the highest quality care possible, and we believe that to do that we have to assign the right nurse so that they're providing the right care to the right patient.”