Direct-Reimbursement Nursing Model

In our society, one of the most concrete expressions of value is payment. As people “follow the dollar” in health care, the lack of reimbursement directly to nurses and for direct nursing care makes invisible the critical role nurses play in integrating quality, safety, and efficiency of services. This means that, when faced with making difficult cost-driven decisions, nursing is not a priority investment area within health care and is often the first area to receive cuts. Further, the direct attribution of nurses’ practice to patient outcomes is undermeasured, limiting opportunities to improve and enhance nursing practice and value.

In hospitals, nursing costs are bundled into the costs of patients’ rooms. In communities, nursing is funded through philanthropic means or as local government services, which require advocacy and solicitation to maintain, putting the sustainability of these services in doubt and making expansion unlikely. Even the care provided by nurse practitioners is often unseen as many bill under physicians’ provider identifiers rather than their own to receive an appropriate rate for the services they provide.

Research proves that nurses and nurse practitioners positively affect patient outcomes through the provision of high quality, accessible, and cost-effective care. By opening payment pathways for nursing care and coordination, nurses can expand and create new places and spaces to deliver health care to patients, making health care more accessible to all.

Direct-Reimbursement Nursing Model pilots will expand nursing practice and elevate the value of nursing through direct reimbursement for nursing care delivery, management, and coordination outcomes. Pilots will help establish a model of direct reimbursement for nursing services that bring care to the places patients are. This includes clear accounting of nursing impact on outcomes, so that nurses' work and contributions are properly recognized.