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The Psychology of Health Care Spending


I had the privilege of listening to the best and brightest Lawyers and other healthcare experts in Louisiana talk today about Healthcare Reform and what it might mean to our industry. Alas, there are still many unknowns. While the law specifically requires certain things of providers, it offers very little guidance on how to meet those requirements. It will be a long wait, I suspect, until further guidance is available.

One of the guest speakers was Congressman Bill Cassidy from Louisiana. He spoke of the ‘psychology of health care spending’. As I understood him, he supposes that when patients are made aware of how their healthcare dollars are being spent and are encouraged to participate in their care, we will see greater efficiency in the delivery of healthcare. Of course, as a politician, he was much more skilled in delivering his message than I am at delivering it for him.

But it made me think. First of all, in home health, do you really think that if patients were aware that an average home health aide visit to assist with a bath was costing about $60.00, would patients really ‘need’ them? Are patients aware that the average cost of a skilled nursing visit is just over $100.00 and therapy visits are closer to $150.00? In hospice, payment is made for every day that a patient is on service regardless of whether or not any services are rendered on that day. Do patients know that we are being paid even on days when we aren’t scheduled to visit?

Heaven forbid we should burden a patient with financial information when we don’t even burden ourselves with it half the time.

Do we, as nurses, ever think about what our services are costing our payor sources? Frankly, I think we are worth every penny – most of the time. What about those visits we do when we just casually stop by and teach on the first medicine we see? When we spend ten minutes in a patient’s home to give an insulin injection for a BID patient, are we really providing a service worth $100.00?

One way to calculate our worth is to determine how many hospitalizations we have prevented. And yet, even today, I run across nurses who do not know what their agency hospitalization rate is. When I show them their hospitalization rate, they explain that their patients are old and have chronic diseases and are largely illiterate and poor. Hellooo? Who doesn’t have a patient mix that looks like that? None of my clients.

For now, though, as we wait for the inevitable changes to come, we should be focusing on providing value to our payor sources. That means giving our patients care that results in better outcomes and taking the time required to prepare for visits, follow an organized plan of care and keeping our patient at home. That is what home health and hospice nurses do. We care for sick people in their homes.

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