Information on Health Facility Costs Related to Using Nurse Supplemental Staffing Services

Temporary help agencies which supply nursing personnel are called supplemental staffing services or nursing pools. The pool employs nurses and aides, assigns them to health care facilities, and provides payment for work completed. Nursing pools enable their clients to meet fluctuating workloads caused by peak patient levels and to cover for staff shortages caused by temporary absences. Some concern has been expressed within the hospital and nursing home industries about the impact on costs and quality of care arising from the use of nursing pools by facilities. Nursing pools in general were surveyed to determine: (1) if the fees that pools charge for nursing services are significantly higher than facility costs to maintain similar employees; and (2) what impact pool usage has had on facilities' annual nursing costs.

GAO found that the hourly fees charged to facilities generally were higher than facilities' costs. However, the additional hourly cost did not substantially increase total nursing costs because of the relatively low use of pool personnel. The impact on Medicaid and Medicare costs was minimal. Further, GAO found that pool fees for nursing personnel generally exceeded facility costs for similar personnel. In general, GAO found that: (1) the facilities in the main were not losing their permanent nursing staff to the pools; and (2) the use of nursing pools had leveled off or declined at the facilities surveyed and facility administrators expected this trend to continue.