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Starting in October 2008, a new rule from the Centers for Medicare and Medicaid Services will limit payment for care stemming from preventable complications, such as inpatient pressure ulcers and falls. Nursing care is linked to most of the complications for which additional payment will be eliminated. Time will tell if hospitals respond by bolstering quality or making financial cuts. Both approaches will ultimately affect how nurses do their jobs.


The new rule eliminates additional payment for eight selected conditions: inpatient pressure ulcers, certain inpatient injuries (such as fractures), catheter-associated urinary tract infections, vascular catheter-associated infections, certain surgical site infections, objects left in patients during surgery, air embolism, and blood incompatibility.


In a new study funded by the Robert Wood Johnson Foundation, researchers from George Washington University in Washington, D.C., summarize the new rule and its potential effect on nurses. "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 researcher Ellen Kurtzman, RN, MPH, assistant research professor at the George Washington University department of nursing education.


However, researchers note that some hospitals may respond to the loss of federal reimbursement by making financial cuts, such as reducing training or staff, which will hinder nurses' ability to care for patients.


Researchers released the findings from their paper "A Summary of the Impact of Reforms to the Hospital Inpatient Prospective Payment System (IPPS) on Nursing Services" in conjunction with the annual meeting of the American Academy of Nursing this past fall.