Nursing intensity: In the footsteps of John Thompson

The Nursing Minimum Data Set (NMDS) provides a way to incorporate nursing data into the hospital discharge abstract to potentially compare nursing care across institutions. An extension of this framework is to use these data for directly billing and reimbursing hospital nursing care. We provide a review of the existing literature and new empirical evidence to support hospital nurse billing. Two existing large data sets are compared, one using nursing diagnosis and the other a nursing intensity based tool to collect daily nursing times. These NMDS data sources are compared to diagnostic related groups (DRG) and hospital outcomes from the UB92 discharge abstract using multivariate regression and logistic regression. Either NMDS approach provides additional explanatory power (improvements in R2) over DRG alone. The findings strengthen the argument to use primary nursing data such as nursing intensity as a basis for direct costing, billing, and reimbursement of hospital nursing care.