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Study: CMS Changes to Impact Nursing

A new analysis of a Centers for Medicare and Medicaid Services (CMS) rule transforming reimbursement of certain in-hospital healthcare services will have a significant impact on nurses, according to a new paper released Nov. 8.

As part of a 2-year study, researchers at The George Washington University (GW) reviewed CMS' final inpatient prospective payment system (IPPS) rule and released their findings in conjunction with the annual meeting of the American Academy of Nursing (AAN), a study collaborator.

The study, A Summary of the Impact of Reforms to the Hospital Inpatient Prospective Payment System (IPPS) on Nursing Services, summarizes the rule and its provisions with emphasis on its impact on nursing services. It is aimed at designing and promoting national policies that reflect nursing's contribution to quality.

"This ruling will have a significant impact on how patients are cared for in America's hospitals and signals the need for a serious commitment to nursing quality," said study author Ellen Kurtzman, MPH, RN, assistant research professor, Department of Nursing Education, at The George Washington University.

The primary aim of the rule is to reform the diagnosis-related group (DRG) system, which determines how much Medicare pays a given hospital in exchange for certain services.

Most significantly, beginning with Oct. 1, 2008 discharges, the rule eliminates additional Medicare payments for eight selected conditions including in-patient pressure ulcers, certain injuries (e.g., fractures), catheter-associated urinary tract infections (UTIs), vascular catheter-associated infections (BSIs), certain surgical site infections (SSIs), objects left in surgery, air embolism and blood incompatibility.

The rule is expected to drive quality improvement efforts in hospitals nationwide.

"Now, more than ever, hospital leaders need to invest in high-quality nursing care and provide resources to support nurses' ongoing contribution to patient safety and health care quality," said Ellen M. Dawson, PhD, ANP, chair of GW's Department of Nursing Education. "This rule will have a big effect on how nurses do their jobs."

The researchers say most of the complications for which higher payment has been eliminated under the rule, such as inpatient pressure ulcers and falls, are linked by evidence to nursing care. They say some hospitals may respond to this by bolstering quality improvement programs geared toward nurses, but others may respond to the loss of federal reimbursement by making financial cuts, such as a reduction in training or staff, that ultimately affect the ability of the nurse to do his or her job.

"CMS' policy change signals a major shift for which nurse executives must be prepared," said AAN President Linda Burnes Bolton, DrPH, RN, FAAN. "This paper helps hospitals better understand these important shifts and outlines anticipatory strategies for the nursing community."

The Robert Wood Johnson Foundation, which funded GW's study and this paper, will continue to fund programs that increase the quality of care that nurses provide.

"Investing in programs that emphasize the impact of nursing on quality is a priority for us now and in the future," said Susan B. Hassmiller, PhD, RN, FAAN, senior program officer at the Robert Wood Johnson Foundation. "We recognize the vital role nurses play in providing quality health care and will continue to help nurses detect and prevent obstacles to quality care in the future."

To read a copy of the IPPS final rule in its entirety or to read the complete GW study, visit

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