This is a time of both crisis and opportunity for nurses and the nursing profession. As my recent book Economics and Financial Management for Nurses and Nurse Leaders points out, health care costs place an increasing burden on the U.S. economy. In addition, nearly 50 million Americans were uninsured in 2010. The Patient Protection and Affordable Care Act of 2010 (PPACA), referred to as health reform, is an attempt to expand health insurance coverage for Americans while better controlling health costs. Whether you’re a bedside clinical provider, a community health leader or a nurse executive, health reform is already exerting an influence on your work. I’m going to discuss five ways you are affected personally and professionally by health reform initiatives.
One: Changes in Health Benefits
Nurses are consumers of health care, as are their families and dependents. Changes in health insurance eligibility and benefits specified in health reform therefore affect you and your loved ones. One example is the provision for continued coverage of children under their parents’ policies until the 26th birthday. In addition, health reform places limits on discontinuing health coverage, and allows specified free preventive screening services. More information and resources on health reform of interest to consumers is included in Economics and Financial Management for Nurses and Nurse Leaders.
Two: States Will Expand Medicaid Coverage
A 2012 Supreme Court ruling allows states to opt out of health reform’s Medicaid expansion to Americans with incomes under 133% of the federal poverty level. However, as illustrated in the interactive map, over half the states are likely to expand their Medicaid programs, effective in 2014. If you work in a public or nonprofit institution or health system, you’ll likely see an increase in patients as a result of expanded Medicaid coverage. Shortages are predicted in primary care services, so nurses and nursing care will be essential to help meet the increased demand.
Three: Value-Based Purchasing
If you work in a hospital setting, pay-for-performance provisions were implemented in 2012 by Medicare per health reform. Many of the pay-for-performance quality measures, such as discharge instructions and serum glucose management reflect the quality of inpatient nursing care. In other words, it is increasingly apparent that the quality of nursing care affects the hospital’s bottom line. You must be able to link costs, care and quality, as presented in my book.
Four: Emphasis on Care Coordination
If you’re a nurse working in community-based settings, health reform affects you as well. Initiatives including accountable care organizations (ACOs) require intensive coordination to follow the patient from home to hospital to rehabilitation facilities and then back to the home. The push to reduce preventable hospital admissions and readmissions requires community-based care and hospital discharge follow-up. Patient-centered care requires effective collaboration with patients and families. Nurses must be prepared to implement cost-effective strategies to improve care coordination, such as telephone follow-up programs.
Five: Full Scope of Practice
Although not written into the health reform law, current health policy supports all professional nurses working at their full scope of practice. The 2011 Institute of Medicine report, The Future of Nursing, discusses and supports this expansion of your professional roles and responsibilities. Another example is the recent change to Medicare regulations that now allows advanced practice RNs to function under the rules of hospital medical staff. The proliferation of nurse-managed clinics is yet another way nurses are taking a lead in health care. Economics and Financial Management for Nurses and Nurse Leaders reinforces your expanded care role by helping you also understand the dynamics of costs, revenues and nursing care in your inpatient or outpatient work setting.
Again, this is a time of both crisis and opportunity in health care. My book can help prepare you to understand the fiscal dynamics and to assume leadership roles related to current health reform efforts.