Reimagining Nurse Reimbursement

Nursing care accounts for over $266 billion in hospital labor costs annually—yet it remains invisible in hospital billing and federal price transparency policies. 

The Commission for Nurse Reimbursement calls for a fundamental shift: separating nursing care from hospital room charges and billing it directly based on actual services delivered.

For nearly a century, nursing services have been bundled into daily room rates, masking the true value and variability of direct patient care. This outdated model drives staffing cuts, worsens patient outcomes, and fails to reflect the essential role nurses play in high-quality, value-based care.

• No price = no value: Nursing care is excluded from hospital chargemasters, DRG cost weights, and CMS price transparency requirements.
   
• Hidden costs: Hospitals save millions by reducing nursing hours—without lowering room rates—resulting in care that payers reimburse but patients never receive.
   
• Quality at risk: Reduced nurse staffing is directly linked to higher mortality, longer hospital stays, and adverse events like infections and falls.

• Bill nursing care separately using existing billing codes (e.g., NUBC 023x) based on actual direct care hours.
   
• Modernize DRG reimbursement with a Nursing Case Mix Index (NCMI) to align payment with nursing intensity.
   
• Create a national nursing care database to support quality metrics, clinical outcomes, and value-based payment models.