Have you thanked a nurse today? Or any day, for that matter?
If not, you now have an entire week to make up for lost time. National Nurses Week 2019 runs May 6 through 12 and celebrates the innumerable contributions nurses make each day. This year’s theme is “4 Million Reasons to Celebrate,” pointing to the 4 million registered nurses licensed in the United States and the vast contributions they bring to care delivery.
Healthcare may be an ever-evolving industry, but the one thing that hasn’t changed is the integral role played by nurses. In fact, their skill set is more in-demand than ever before, especially as today’s healthcare organizations navigate the evolving value-based care landscape. For example, nurses must constantly absorb new information to keep up with rapidly-changing evidence in practice while simultaneously honing their critical thinking skills to stay current in a shifting healthcare model.
The reality is that the role of nurses is changing dramatically as healthcare organizations see increased demand for services and higher-acuity patients, many with more comorbidities than ever before. Today’s nurses are critical members of the multi-disciplinary care team. They need to be the collaborators and leaders, giving a voice not only to their patients but to other nurses and caregivers as well. This is a profession that needs to produce leaders with the savvy and acumen to feel as comfortable inside a boardroom as they do at a bedside.
Simply put, knowledge is power when it comes to producing the best possible patient outcomes. Forward-thinking healthcare organizations understand this dynamic and are designing workplaces that optimize and support a culture of learning that elevates nursing skills to align with healthcare initiatives related to chronic disease management and population health.
These strategies not only support nurses as they care for patients in today’s fast-paced healthcare environments, but they help clinical leaders address growing staffing challenges amid critical professional shortages. For example, turnover rates in 2017 shot up to nearly 17 percent as the industry faces growing challenges related to burnout and dissatisfaction. Hospitals pay dearly when nursing turnover is at its highest, and it isn’t only the quality of care that suffers. According to one survey, the average cost for the turnover of a bedside RN is between approximately $40,000 and $60,000. Each percent change in nursing turnover, the survey says, will either cost or save the average hospital more than $373,000.
Nurses who feel well-equipped and supported in their professional trajectory are much more likely to find satisfaction in their work. Consequently, healthcare organizations must provide that support from the outset—addressing education gaps during onboarding while continuing to educate new nurses on how to deliver the highest quality of care. It’s a difficult balance considering nurses are dealing with a growing number of patients and a plethora of complex diseases.
By Anne Dabrow-Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN and Dale Schumacher, MD, MPH
When nurses are armed with the latest evidence-based nursing procedures at the point of care and real-time step-by-step guides for clinical decision making at the bedside, Hospital Value-Based Purchasing (VBP) Program scores go up. That was the primary finding of a study undertaken by the Rockburn Institute in partnership with Wolters Kluwer Health, which found that hospitals where nurses used two specific evidence-based Clinical Decision Support (CDS) tools for two years had an average rank that was nearly 25 percent higher than their peers.
The findings are a rare instance where the intervention—in this case Lippincott Procedures and Lippincott Advisor from Wolters Kluwer—can be clearly associated with change in practice and quality improvement. In fact, the study’s findings clearly support the value and use of point-of-care CDS tools in a clinical setting to augment nurses’ substantial knowledge when needed. The results also demonstrate the close relationship between nurse, information, patient and performance improvement, which ultimately leads to improved quality and efficiency.
A VBP Primer
The Centers for Medicare and Medicaid Services (CMS), through its Hospital VBP Program, has incentivized hospitals to improve patient care and minimize costs by structuring its reimbursement system to reward care quality rather than service quantity. To fund the program, CMS reduces each hospital’s base operating payment by up to 2 percent, which hospitals can earn back (along with bonuses) by achieving high VBP performance scores.
In effect, VBP pits hospitals against each other and their own past performance to show achievement and improvement. Performance is currently assessed using four quality domains: 1) Clinical Care, 2) Experience and Coordination of Care, 3) Safety, and 4) Efficiency and Cost Reduction.
Each participating hospital receives an achievement and improvement score for each domain. The higher of the two is selected and weighted accordingly. All domain scores are then summed together to create the VBP Total Performance Score (TPS). This score is then converted into the hospital’s “adjustment factor,” a multiplier CMS applies to a hospital’s base payment covering each patient’s stay during a given time period.
Adjustment factors above 1.0 indicate that a hospital will receive back from CMS their full withholding plus a bonus. Hospitals with an adjustment factor below 1.0 will be assessed a penalty. For example, a hospital with a VBP adjustment factor of 0.9903 would be paid 99.03% of what Medicare usually reimburses for each service. It’s important to note that the VBP program is a mix of withholding repayment and bonus (or penalty) and required by law to be budget neutral.
The Study Methodology
To determine if and to what extent CDS could help hospitals improve performance on key metrics, the Rockburn Institute evaluated data compiled over a three-year period from all U.S.-based hospitals with a CMS Certification Number that participated in the VBP program. From this base of approximately 3,000 hospitals, 41 facilities were identified that utilized both Lippincott Procedures and Lippincott Advisor for the complete 2014 and 2015 calendar years.
The performance of hospitals using the CDS tools—which represented a mix of community-based clinics, hospitals serving large geographic regions and large university-based systems in 20 different states—was compared to the other hospitals that had received VBP scores for 2014 and 2015. Scores of the 41 CDS facilities were then evaluated for 2017 against their previous years’ results.