Issue link: https://nnumagazine.uberflip.com/i/198516
CE:Final 5/27/08 11:58 AM Page 19 Managed Care Financing of Health Care Services—Forces of Magnetism Abandon Patients Managed care capitation financing arrangements have become the dominant means for funding hospital and physician services. HMO/insurers provide a share of the monthly premium dollar for a negotiated split between medical and hospital provider organizations, transferring to physicians and hospitals the insurance risk of incurring costs for providing patient care services in excess of premium revenue from a group (and corresponding opportunity to gain surplus revenue) by limiting services to assure premium revenue exceeds costs. This radical change in hospital economics imposes operational mandates which determine the nature and methods of delivery of hospital patient care. The revenue generation priority of capitation-financed hospital service creates an inherent, adversarial relationship between patients and institutional providers operating under financial incentives to limit hospital access, ignore individual patient needs, deny necessary services, and disregard minimum standards of safe, therapeutic, and competent nursing care. The financial imperatives require massive cutbacks in nursing budgets and a concomitant reduction in direct-care RN staff and administrative support that were the fundamental perquisites to magnet hospital recognition as originally conceived and undertaken. M AY 2 0 0 8 Managed care economics motivated a significant restructuring and downsizing of hospital nursing services and decimated the ranks of hospital direct-care registered nurses. At the same time, managed care-imposed barriers to hospital access produced an inpatient population that is far sicker and more medically fragile than ever before, requiring more intense, experienced, and specialized direct registered nursing care. Managed care strategies to increase revenue generation by downsizing the direct-care registered nurse workforce and restructured patient care methods also set in motion a continuing deterioration of working and practice conditions which accelerated registered nurse flight from hospital direct patient care positions and effectively discouraged new registered nurse interest in hospital direct-care positions. Hospital direct-care registered nursing practice today is severely burdened by excessive patient assignment loads, mandatory extended work hours, unsafe patient handling practices, and routine exposure to risks of professional license, discipline, and/or malpractice liability inherent in the working and practice conditions created and maintained in derogation of prevailing community standards of hospital and professional registered nursing care. The new Magnet recognition program is bound by the economic imperatives and operational incentives of a method of healthcare W W W. C A L N U R S E S . O R G REGISTERED NURSE 19