Examination of the Relationship between Medicare Prospective Payment and the Nurse Shortage and Deliverable No. 3: Background Paper for Task Order 1

摘要

The study analyzes the impact of Medicare's Prospective Payment System (PPS) on the shortage of registered nurses reported in 1987. It examines demand for hospital nurses using national statistics and regression analysis with 897 hospitals. The national rate of growth of full-time equivalent registered nurses (FTE RNs) decreased after implementation of PPS. The regression analysis found that PPS was associated with a 0.6% average annual increase in FTE RNs per adjusted admission, a 1.0% average annual increase in FTE RNs per adjusted patient day, and a 3.8% average annual decrease in FTE RNs per bed. For perspective, total FTE RNs per adjusted admission, adjusted patient day, and bed were growing at annual rates of 3.3, 6.2, and 2.8%, respectively, over the 1981 to 1985 time period. If the reported trends continued beyond 1985 PPS was one of the factors leading to the reported nurse shortage by increasing the demand for RNs. However, it was neither the sole nor the predominant cause of the increased demand for RNs. Among other factors, increased casemix complexity accounted for about 25% of the observed 1981-1985 increase in RN staffing.